Fecal Incontinence in Women: Causes and Treatment

Ashima Makol; Madhusudan Grover; William E Whitehead

Women's Health. 2008;4(5):517-528.

Economic Impact of Fecal Incontinence

Very little data are available on the direct and indirect healthcare costs associated with FI, since the few studies that have looked at healthcare costs for incontinence have not distinguished between UI and FI. The largest known direct healthcare cost is the cost of nursing home admission; since FI and UI rank as the second leading causes of nursing home admission, this is a considerable but poorly defined cost to society.^[28] For women living in the community who have FI, the principal direct healthcare costs are for supplies e.g., (diapers, absorbent pads and panties) and antidiarrheal drugs. Approximately US$400 million/year are spent on adult diapers,^[29,30] and these costs are usually not reimbursed by insurance companies. The costs for medical, behavioral or surgical treatment have not been systematically studied.^[5] A study by a surgical group estimated the average cost for evaluation and treatment of FI to be $17,166 per patient.^[31]

Indirect costs include lost wages by individuals with FI as well as family members who may miss work to help care for them. With the progressive aging of the population, and with incontinence being a major caregiver burden and predictor of institutional placement, the role and responsibility of spousal caregivers further increases. This is becoming more important because the government is restraining expenditures for institutional healthcare.

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Cite this: Fecal Incontinence in Women: Causes and Treatment - Medscape - Sep 01, 2008.

Abstract and Introduction
Case Definition
Prevalence
Impact of Fecal Incontinence on Quality of Life
Economic Impact of Fecal Incontinence
Pathophysiology & Diagnostic Tests
Risk Factors
Prevention
Treatment
Conclusion & Future Perspective
References
Sidebar: Executive Summary
Sidebar: Website

Sidebar: Executive Summary

Fecal Incontinence (FI) is a common medical condition affecting up to 15% of women.

It significantly impairs the lifestyle of women and has a tremendous negative impact on social interactions and self-image, resulting in poor quality of life, work absenteeism and self-imposed isolation and depression.

The physiological mechanisms that maintain continence are adequate strength in the pelvic floor muscles to hold back a bowel movement, adequate compliance of the rectum to be able to store stool between bowel movements, ability to sense rectal filling and normal stool consistency. Deficits in any of these may contribute to FI and, in any given patient, the etiology may be multifactorial.

Risk factors that are unique to women include obstetric trauma (instrumental vaginal delivery, prolonged second stage of labor, large neonatal birthweight and occipito-posterior presentation) and hysterectomy. Other risk factors common to both men and women include chronic diarrhea or urgency, obesity and older age. Systemic diseases that increase the risk of FI are irritable bowel syndrome and diabetes, and many neurological disorders increase the risk of FI. Urinary incontinence is a frequently associated condition.

Primary prevention strategies include reducing the incidence of diarrheal diseases through public health measures, discouraging routine use of episiotomies and internal anal sphincter myectomies, encouraging the use of pelvic floor exercises immediately after childbirth and decreasing obesity. Secondary prevention hinges on increasing the willingness of patients to consult their doctors about FI and the willingness of physicians to screen for FI. Conservative treatment measures that are effective are already available.

The role of elective cesarean section to prevent FI is controversial.

Treatments range from education and conservative medical management to biofeedback and surgery. Conservative treatment emphasizes normalization of stool consistency with antidiarrheal drugs or laxatives and encouragement of pelvic floor exercises. Biofeedback aims to strengthen pelvic floor muscles and improve perception of rectal sensations. The most common surgical options are sphincteroplasty, injection of bulking agents to improve resting pressure in the anal canal and colostomy. Sacral nerve stimulation is an experimental approach that appears promising.

It is important to sensitize general practitioners to this under-recognized condition with a high prevalence. Since effective therapies are available, clinicians who care for postpartum and elderly women should routinely screen for FI and offer evaluation and treatment to women with FI.

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