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Obstetric Sphincter Injury Interacts With Diarrhea and Urgency to Increase the Risk of Fecal Incontinence in Women With Irritable Bowel Syndrome

Robinson, Barbara L. MD*; Matthews, Catherine A. MD*; Palsson, Olafur S. PsyD; Geller, Elizabeth MD*; Turner, Marsha MS; Parnell, Brent MD*; Crane, Andrea MD*; Jannelli, Mary MD*; Wells, Ellen MD*; Connolly, AnnaMarie MD*; Lin, Feng-Chang PhD; Whitehead, William E. PhD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2013 - Volume 19 - Issue 1 - p 40–45
doi: 10.1097/SPV.0b013e31827bfd64
Original Article

Objectives This study aimed to confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with irritable bowel syndrome, and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI.

Methods The study is a supplement to a diary study of bowel symptoms in 164 female patients with irritable bowel syndrome. Subjects completed daily bowel symptom diaries for 90 consecutive days and rated each bowel movement for stool consistency and presence of urgency, pain, and FI. All female participants from the parent study were invited to complete a telephone-administered 33-item bowel symptom and obstetric history questionnaire, which included the fecal incontinence severity index.

Results Of the 164 women in the parent study, 115 (70.1%) completed the interview. Seventy-four (45.1%) reported FI on their diary including 34 (29.6%) who reported at least 1 episode per month, 112 (97.4%) reported episodes of urgency, and 106 (92.2%) reported episodes of diarrhea. The mean fecal incontinence severity index score was 13.9 (9.7). On multivariable analysis, FI was significantly associated with parity (P = 0.007), operative abdominal delivery (P = 0.049), obstetrical sphincter lacerations (P = 0.007), fecal urgency (P = 0.005), diarrhea (P = 0.008), and hysterectomy (P = 0.004), but was not associated with episiotomy, pelvic organ prolapse, or urinary incontinence. The synergistic interactions of obstetric anal sphincter laceration with urgency (P = 0.002) and diarrhea (P = 0.004) were significant risk factors for FI.

Conclusions Fecal urgency and diarrhea are independent risk factors for FI, and they interact with obstetric anal sphincter laceration to amplify the risk of FI.

From the *Division of Urogynecology, †Center for Functional Gastrointestinal and Motility Disorders, and ‡Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC.

Reprints: William E. Whitehead, PhD, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, 130 Mason Farm Rd, Chapel Hill, NC 27599-7080. E-mail:

Supported by generous grants from McNeil Consumer Health and the National Institute of Diabetes, Digestive and Kidney Diseases (R01 DK31369) and the National Center for Research Resources (UL1RR025747).

The authors have declared they have no conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins