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Fecal Incontinence Symptoms and Impact in Older Versus Younger Women Seeking Care

Meyer, Isuzu, M.D1; Blanchard, Christina T., M.S.2; Markland, Alayne D., D.O., M.Sc.3; Gibson, Elena G., B.S.4; Richter, Holly E., Ph.D., M.D.1

Diseases of the Colon & Rectum: June 2019 - Volume 62 - Issue 6 - p 733–738
doi: 10.1097/DCR.0000000000001353
Original Contributions: Pelvic Floor
Denotes Associated Video Abstract
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BACKGROUND: The differential impact of aging on fecal incontinence symptom severity and condition-specific quality of life remains unclear.

OBJECTIVE: The purpose of this study was to characterize differences in symptom distress, quality of life, and anorectal physiology assessments in older versus younger women with fecal incontinence.

DESIGN: This was a cross-sectional study.

SETTINGS: This study was conducted at a tertiary genitorectal disorder clinic.

PATIENTS: Women presenting for fecal incontinence evaluation between 2003 and 2016 were classified as older or younger based on age ≥65 or <65 years.

MAIN OUTCOME MEASURES: The main outcomes were symptom-specific quality of life and distress measured by validated questionnaires (the Modified Manchester Health Questionnaire containing the Fecal Incontinence Severity Index); anorectal physiology and anatomy were assessed by manometry and endoanal ultrasound.

RESULTS: Of 879 subjects, 286 and 593 were classified as older and younger (mean ages, 71.4 ± 5.3 y and 51.3 ± 10.5 y). Solid stool leakage was more frequent in older women (83.2% vs 76.7%; p = 0.03), whereas liquid stool leakage (83.2% vs 82.8%; p = 0.88) and fecal urgency (76.9% vs 78.8%; p = 0.54) did not differ between groups. Mean symptom severity scores were similar between groups (28.0 ± 11.9 and 27.6 ± 13.5; p = 0.69); however, there was greater negative impact on quality of life among younger women (46.3 ± 22.0 vs 51.8 ± 21.8; p < 0.01). Multivariable linear regression controlling for pertinent covariates revealed younger age as an independent predictor for worse condition-specific quality-of-life scores (p < 0.01). Squeeze pressures were similar between groups, whereas younger women had greater resting pressures and higher rates of sphincter defects (external, 7.7% vs 20.2%; internal, 12.2% vs 26.8%; both p < 0.01).

LIMITATIONS: This study was limited by its lack of patient obstetric history and the duration of their incontinence symptoms.

CONCLUSIONS: Characteristics differ between older and younger women seeking care for fecal incontinence. The differential impact and age-related phenotypes may provide useful information for patient counseling and developing management algorithms for women with fecal incontinence. See Video Abstract at

1 Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

2 Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

3 Birmingham/Atlanta Geriatrics, Research, Education, and Clinical Center at the Birmingham VA Medical Center, Departments of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama

4 School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Funding/Support: This work was partially supported by the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development Women’s Reproductive Health Research Career Development Program (RFA HD-15-011).

Financial Disclosure: None reported.

Oral poster presentation at PFD Week 2017 of the American Urogynecologic Society, Providence, RI, October 3 to 7, 2017.

Correspondence: Isuzu Meyer, M.D., Division of Urogynecology and Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Ave South, Suite 10382, Birmingham, AL 35233. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons