Gastroenterology

Gastroenterology

Volume 137, Issue 2, August 2009, Pages 512-517.e2
Gastroenterology

Clinical—Alimentary Tract
Fecal Incontinence in US Adults: Epidemiology and Risk Factors

https://doi.org/10.1053/j.gastro.2009.04.054Get rights and content

Background & Aims

The study aims were to estimate the prevalence of different types and frequencies of fecal incontinence (FI), describe demographic factors, and identify risk factors.

Methods

The National Health and Nutrition Examination Survey (NHANES) assesses health status in the civilian noninstitutionalized US population. The validated Fecal Incontinence Severity Index was added to NHANES in 2005–2006. Participants were 2229 women and 2079 men aged 20 years or older. FI was defined as accidental leakage of solid, liquid, or mucus at least once in the preceding month. Sampling weights were used to obtain prevalence estimates for the national population. Multivariate logistic regression identified independent risk factors.

Results

The estimated prevalence of FI in noninstitutionalized US adults is 8.3% (95% confidence interval, 7.1–9.5) and consists of liquid stool in 6.2%, solid stool in 1.6%, and mucus in 3.1%. It occurs at least weekly in 2.7%. Prevalence is similar in women (8.9%) and men (7.7%) and increases with age from 2.6% in 20 to 29 year olds up to 15.3% in participants aged 70 years and older. FI is not significantly associated with race/ethnicity, education, income, or marital status after adjusting for age. Independent risk factors in women are advancing age, loose or watery stools, more than 21 stools per week, multiple chronic illnesses, and urinary incontinence. Independent risk factors in men are age, loose or watery stools, poor self-rated health, and urinary incontinence.

Conclusions

FI is a prevalent age-related disorder. Chronic diarrhea is a strong modifiable risk factor that may form the basis for prevention and treatment.

Section snippets

Subjects and Methods

The NHANES program consists of annual cross-sectional, national health surveys conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. Demographic, socioeconomic, and health interview data are collected in the home followed by physical examinations, interviews, and laboratory assessments in mobile examination centers. Questions on topics considered to be sensitive for the participant, such as FI, are administered by an interviewer in a private room in

Results

The household interview was completed by 4773 (71.0%) of the 6719 adults aged 20 years and older who were selected to participate in the NHANES 2005–2006. Of these, 465 (9.7%) did not complete the mobile examination center health examination components, which included the bowel health questionnaire; however, no subjects declined to complete only the questions on FI. The 2079 men and 2229 women who completed the bowel health questionnaire provided the data for this study. The demographics of the

Discussion

Efforts to develop prevention and treatment strategies for FI have been hampered by lack of reliable information on its prevalence and characteristics.15 This study of a nationally representative sample of US adults shows that FI at least once in the past month is very common, affecting 8.3% of noninstitutionalized adults. FI occurs at least weekly in 2.7% (95% CI, 2.1–3.2) of the population and is a daily occurrence in 0.9%. The most common type of FI consists of the loss of liquid stools,

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01 HD41249, U10 HD41248, U10 HD41250, U10 HD41261, U10 HD41263, U10 HD41267, U10 HD41268, and U10 HD41269), the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institutes of Health Office of Research on Women's Health. The International Foundation for Functional Gastrointestinal Disorders assisted in arranging financial support for the study.

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