Digestive Diseases News Spring 2010
Fecal Incontinence Affects One in 12 Adults
A National Institutes of Health (NIH)-funded study has found that about 8 percent of U.S. adults—representing 18 million Americans—have fecal incontinence (FI), a condition whose epidemiology and prevalence has been poorly documented. The study provides a clearer picture of the frequency, demographics, and risk factors of FI in the general population.
“Efforts to develop prevention and treatment strategies for FI have been hampered by lack of reliable information on its prevalence and characteristics,” wrote William E. Whitehead, Ph.D., professor of medicine at the University of North Carolina at Chapel Hill, and co-authors in their report on the study, which appeared in the August 2009 issue of Gastroenterology. “The most common type of FI consists of the loss of liquid stools, followed by loss of mucus.”
FI, the involuntary loss of liquid or solid stool, can have a devastating effect on a person's quality of life. Anxiety and embarrassment associated with FI can lead to isolation and withdrawal from social and family activities. For older men and women with FI, the inability of family members or other caregivers to manage the condition is a primary reason for institutionalization. Because of the stigma and shame associated with FI, patients and physicians are reluctant to discuss the condition.
The researchers gathered data from a questionnaire submitted to more than 4,000 men and women, ages 20 and older, who participated in the Centers for Disease Control and Prevention's 2005–2006 annual National Health and Nutrition Examination Survey (NHANES). At participants' homes, NHANES researchers used mobile examination centers to conduct extensive health interviews and physical examinations and perform laboratory tests. The 2005–2006 NHANES bowel health questionnaire included questions about accidental bowel leakage and stool consistency.
Overall, FI prevalence was similar among women and men, increasing from 2.6 percent among adults 20 to 29 years old to 15.3 percent among adults 70 and older. The researchers found a variety of factors associated with an increased risk of FI, including advancing age, urinary incontinence, the inability to engage in physical activity, chronic illness, and diarrhea. Participants who reported their bowel movements were frequent—more than 21 per week—and “loose or watery” were significantly more likely to report FI than those with less frequent bowel movements and more normal stool consistency.
“An aim of this study was to identify modifiable risk factors that can be incorporated into prevention or treatment strategies,” wrote Whitehead and co-authors. “There are studies showing that the treatment of diarrhea-associated FI with loperamide or fiber supplements is effective at least short-term.” But, according to the authors, better long-term treatments are urgently needed.
The research was supported by NIH grants administered by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Office of Research on Women's Health, and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
In 2007, the NIH held a state-of-the-science conference about the prevention of urinary and fecal incontinence. The resulting consensus statement is available at www.consensus.nih.gov/previous.htm.
The NIDDK is currently planning a bowel control awareness campaign to focus health care providers' attention on this prevalent condition.
The NIDDK has fact sheets and easy-to-read booklets about digestive disorders, including FI. For more information or to obtain copies, visit www.digestive.niddk.nih.gov.
NIH Publication No. 10–4552