Digestive Diseases News Summer 2010
10-year Study Identifies Risk Factors and Onset Rate of Fecal Incontinence in Older Adults
Fecal incontinence (FI)—accidental loss of liquid or solid stool—affects about one in 12 adults in the United States, and the prevalence increases with age, according to National Institutes of Health-supported research. Fecal incontinence is a primary reason for institutionalization of older adults. However, researchers had been uncertain about the rate at which FI develops in the population; for example, how many 50-year-olds without FI are likely to develop the condition by the time they reach 60?
Now, there is an answer: about 7 percent of men and women age 50 or older will develop FI over the course of 10 years, according to an article published in the February 2010 issue of The American Journal of Gastroenterology by researchers at the Mayo Clinic, Mayo Medical School, College of Medicine in Rochester, MN.
"This onset rate in a community population sample is striking and emphasizes the magnitude of the problem in the community. Prevention of FI deserves greater attention by health authorities and health care providers," wrote lead researcher Enrique Rey, M.D., and co-authors.
The researchers surveyed a randomly selected group of 1,513 residents age 50 or older in Olmstead County, MN, in 1993. The median age of participants was 65; about half—50.5 percent—were men. Participants were considered to have FI if they answered "yes" to the question, "Have you ever had problems with leakage of stool—accidents or soiling because of the inability to control the passage of stool until you reached a toilet?" The survey also included questions that allowed the researchers to assess the association of FI with possible risk factors related to bowel habits, such as frequency, urgency, incomplete evacuation, and straining; anatomic perianal disease or injury such as infection, fistula, anorectal surgery, or trauma; and factors associated with neurologic injury such as diabetes, spinal cord injury, or stroke.
In the initial survey, FI prevalence among women—17.7 percent—was substantially higher than among men—12.6 percent. Overall prevalence was 15.3 percent and increased with age for men and women.
In 2003, the original survey group was contacted again and 683—312 males—filled out a questionnaire that included the same FI-related questions. This time, 6.3 percent of respondents who answered "no" to the FI question on the first survey answered "yes." This shift, which occurred over a span of 9 years between surveys, corresponds to a 7.0 percent onset rate over 10 years.
Overall, more women than men reported FI, the researchers noted. However, the rate of onset was the same for men and women. "These results suggest that women are at greater risk before 50 years of age but not later," wrote Dr. Rey and co-authors.
Changes in bowel habits that were associated with FI onset included urgency, increased frequency of defecation, diarrhea, and loose, watery stools. Of these factors, development of urgency was most closely linked to new onset of FI. Among men and women who developed urgency, more than a third—37 percent—also developed FI. Understanding risk factors allows clinicians to monitor patients at high risk for development of FI. “Prevention may be possible if bowel habits are appropriately managed in high-risk individuals,” the researchers concluded.
The National Digestive Diseases Information Clearinghouse, an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases, has fact sheets and easy-to-read booklets about digestive disorders, including FI. For more information and to obtain copies, visit www.digestive.niddk.nih.gov.
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NIH Publication No. 10–4552
August 2010
