Digestive Diseases News
Winter 2008

NIH Conference Explores Problem of Fecal and Urinary Incontinence

More than a quarter of Americans will experience fecal or urinary incontinence at some point in their lives, but less than half will voluntarily report their symptoms to a health care provider, according to an independent panel appointed by the National Institutes of Health (NIH) to study the conditions.

Secrecy, distress, and embarrassment related to incontinence erode the quality of life for millions of people and hamper scientific understanding and development of prevention and treatment strategies, according to the 15-member conference panel, which included experts in geriatrics, nursing, gastroenterology, obstetrics and gynecology, internal medicine, urology, general surgery, oncology, neurosurgery, and other areas of health care.

Following 3 days of meetings, the panel produced a state-of-the-science conference statement reflecting current scientific knowledge of fecal and urinary incontinence and identifying areas for further research. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the NIH Office of Medical Applications of Research, along with other NIH components, sponsored the conference.

Prevalence of Incontinence

Fecal or urinary incontinence—the inability to control bowel movements or urination—disproportionately affects women, although both men and women at all stages of life could experience the problem. Because routine episiotomy is associated with a higher rate of fecal incontinence, the panel recommended against the routine performance of this procedure during childbirth.

The prevalence of fecal incontinence in women increases with age, from 6 percent among those younger than 40 to 15 percent among older women, according to the panel. Between 6 and 10 percent of men experience fecal incontinence, with slight increases in prevalence as men age. The overall prevalence of fecal incontinence among nursing home residents is an estimated 45 percent.

Removing the stigma associated with incontinence would help more people with the condition get the help they need, according to the panel. Panel members recommended that health care providers address four issues when raising the subject of incontinence with their patients: frequency, volume, the degree to which symptoms are bothersome, and the desire for treatment.

The panel acknowledged that behavioral and lifestyle changes—such as getting adequate exercise, losing and maintaining weight, and not smoking—can reduce the risk of both fecal and urinary incontinence. Pelvic floor muscle training and biofeedback are effective in preventing and reversing some pregnancy-related fecal and urinary incontinence for the first year following delivery, according to the panel.

However, research about the sustained long-term benefits of pelvic floor muscle training or biofeedback in preventing fecal or urinary incontinence is insufficient. Panel members called for other interventions that increase muscle strength and mobility and standardized protocols for pelvic floor muscle training.

Additional Recommendations

Some of the panel’s other recommendations addressed the need for

• uniform definitions for fecal and urinary incontinence
• more studies to estimate the direct and indirect economic and societal costs of incontinence and the potential benefits of successful prevention and treatment
• studies to test specific hypotheses derived from the conceptual model of the causes of abnormal bowel or bladder function that could lead to incontinence
• natural history studies to identify factors affecting the incidence, progression, and remission of incontinence
• research on medical and surgical treatments that might secondarily cause incontinence, such as anorectal surgery, prostatectomy, pelvic radiation, and commonly prescribed drugs
• research to examine the impact of public health initiatives, increased public and provider awareness, reimbursement changes, and health delivery redesign

The panel’s complete state-of-the-science document, which is not a policy statement of the NIH or the Federal Government, is available at www.consensus.nih.gov. Background information about the NIH Consensus Development Program Process, which includes state-of-the science conferences, is available at www.consensus.nih.gov/forthemedia.htm.

The National Digestive Diseases Information Clearinghouse has a fact sheet about fecal incontinence at www.digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence.

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NIH Publication No. 08–4552
March 2008