Fecal Incontinence in Women: Causes and Treatment

Ashima Makol; Madhusudan Grover; William E Whitehead

Disclosures

Women's Health. 2008;4(5):517-528. 

In This Article

Abstract and Introduction

Fecal incontinence is a common problem in women, which often enforces life changes owing to embarrassment and social stigma. It is frequently not reported or diagnosed. Age, obstetric trauma, pelvic surgery, chronic diarrhea, obesity and other medical conditions, such as diabetes and stroke, increase the risk of fecal incontinence. Preventive strategies include avoiding diarrheal triggers, discouraging the routine use of episiotomies, early recognition and management of obstetric injuries and possibly pelvic floor muscle exercises after childbirth. Treatment options are available and should be discussed with the patient. These, in order of progression, are education and medications for diarrhea or constipation, supportive care, biofeedback training and surgery.

Fecal incontinence (FI) is a very common complaint; it affects up to 15% of community-living women[1,2] and approximately half of the women in nursing homes.[3,4] It is widely believed to be more common in women than in men,[5] as women are exposed to a unique set of risk factors during pregnancy and childbirth. However, population-based studies that include subjects of all ages fail to find a significant difference between women and men.[6] The most likely explanation for this disparity is that FI has multiple causes and, when all ages are included, the contribution of obstetrical injuries is diluted. Reproductive hormones do not appear to have a direct impact on FI since age-related increases in the prevalence of FI are observed in both men and women.[6]

This article will focus on FI in community-dwelling women because the risk factors associated with FI and the approaches to its prevention and management are very different from those in institutional settings. We will review the definition and prevalence of FI, its impact on quality of life (QOL), the physiological mechanisms that are responsible for maintaining continence, risk factors (especially those that differentially affect women), approaches for prevention and treatment options. This is not a comprehensive systematic review or a meta-analysis; however, it is an overview that reflects the opinions of the authors. We sought to make this overview understandable to patients and healthcare providers from a variety of disciplines.

This is an opportune time to review FI in women because there has been an explosion of new research findings on FI in the past 5 years, and there is a new emphasis on prevention reflected in the sponsorship by the NIH of the State of the Science Conference on the prevention of FI and urinary incontinence (UI) in December 2007.[5]

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