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Women's silent health problem: Study finds fecal incontinence is prevalent in US women
Women's silent health problem: Study finds fecal incontinence
is prevalent in US women
January 18, 2006
Numbers high among older women, women who have had several
babies and women who have major depression
It's a topic that is discussed so infrequently - for reasons that
are easy to understand - that it may seem it isn't much of a
problem.
But new research shows that fecal incontinence is
prevalent among U.S. women, especially those in older age groups,
those who have had numerous babies, women whose deliveries were
assisted by forceps or vacuum devices, and those who have had a
hysterectomy.
Many women in the study who had fecal incontinence also had
another medical condition, such as major depression or diabetes,
and often experienced urinary incontinence in addition to FI.
The
findings are reported in the American Journal of Obstetrics and
Gynecology.
"Increased attention should be paid to this debilitating
condition, especially considering the aging of our population and
the available treatments for FI," says senior author Dee E. Fenner,
M.D.
, associate professor of obstetrics and gynecology, and
director of gynecology, at the University of Michigan Medical
School. "It is very important to the health of women that
clinicians are aware of the prevalence of FI and can treat their
patients accordingly."
The study, led by the University of Washington, was a postal
survey of 6,000 women ages 30-90 who were enrolled in a large HMO
in Washington state (the condition also affects men, but only women
were involved in the study). Of the 64 percent who responded, the
prevalence of FI was found to be 7.
2 percent, with the occurrence
increasing notably with age. FI was defined as loss of liquid or
solid stool at least monthly.
The study was the first, to the authors' knowledge, to examine
major depression as a potential risk factor for FI. They say FI
could be a contributing factor to major depression in some cases,
and major depression could be a contributing factor to FI in other
cases.
FI can occur after damage to the anal sphincter muscles or
scarring to the rectum, causing it to be unable to hold stool.
Ulcerative colitis, Crohn's disease and some other conditions can
cause this scarring to occur. Another contributing factor can be
the stretching of the nerves that supply the sphincters, called the
pudendal nerves, which can occur with childbirth, old age, trauma,
or with medical diseases that affect the nerves, such as diabetes.
Without intact nerves to stimulate the sphincters, the sphincters
may undergo atrophy.
Because of the nature of the condition, people who have FI often
do not discuss it with their doctors, experts say. That is why the
study's authors encourage clinicians to take a more active role in
finding out if their patients are experiencing FI, especially among
patients age 50 or older. They note that while FI is present in
many elderly women, it should not be considered merely a normal
part of aging. They also encourage women to discuss the issue with
their doctors.
It also is important for women and their doctors to be aware of
the conditions that often go along with FI. Researchers found that
women in the study with FI were more likely to have:
- A higher number of deliveries
- Urinary incontinence
- A previous hysterectomy
- Another medical condition as well, such as major depression or
diabetes
- A history of operative vaginal delivery, such as those using
forceps or a vacuum-assisted device.
The impact of incontinence on the quality of life of the
respondents was "significant," says Fenner, who is one of the
founders of the Michigan Bowel Control Program at the University of
Michigan Health System. "We found that half of the subjects with FI
reported that their bowel symptoms had a large impact on their
quality of life," she notes.
Treatments that can help people manage FI can range from changes
in diet and exercise, to medications that improve the formation of
stools, to surgery that repairs the sphincter muscles. In some
cases, an artificial bowel sphincter can be implanted under the
skin to mimic the natural function of the anal sphincter.
Biofeedback - which involves daily exercises to improve the
strength of muscles used to hold back a bowel movement - also is an
option for some patients.
The lead author of the study was Jennifer L.
Melville, M.D.,
M.P.
H., of the Department of Obstetrics and Gynecology and the
Department of Psychiatry & Behavioral Sciences at the
University of Washington. In addition to Melville and Fenner, other
authors were Ming-Yu Fan, Ph.D.
, of the Department of Psychiatry
& Behavioral Sciences at the University of Washington and
Katherine Newton, Ph.D., of the Center for Health Studies at the
Group Health Cooperative of Puget Sound of Seattle.
University of Michigan Health System
[ Comment, Edit or Article Submission ]
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