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Hiramoto B, Flanagan R, Muftah M, Shah ED, Chan WW. Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis. Clin Gastroenterol Hepatol 2024; 22:1908-1916.e1. [PMID: 38657883 PMCID: PMC11344694 DOI: 10.1016/j.cgh.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]). METHODS This was a population-based analysis of the National Health and Nutrition Examination Survey, including participants who responded to the bowel health survey in 2005 to 2010. FI was defined by the accidental bowel leakage of solid stool, liquid, or mucus at least once in the past month. Stepwise multivariable logistic regression models were constructed to assess risk factors for FI. RESULTS A total of 7606 participants were included, with an overall FI prevalence of 9.2%. When stratified by quartiles of body measurements, FI was increasingly prevalent from the 1st to the 4th quartile for both WHtR (range, 5.3%-12.5%) and BMI (range, 7.1%-10.5%). WHtR was associated with FI and was a stronger predictor than BMI in all quartiles of body measurement. On multivariable analysis, WHtR remained a significant predictor of FI comparing the 4th with the 1st quartile of body measurements (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.11-2.80; P = .017), whereas BMI was not. A WHtR cutoff of >0.592 optimized the Youden index in prediction of FI in the overall sample. CONCLUSION WHtR was independently associated with increased odds of FI in this nationally representative sample of United States adults, whereas BMI was not consistently correlated. This suggests bowel continence may depend more on how body mass is distributed.
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Affiliation(s)
- Brent Hiramoto
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ryan Flanagan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mayssan Muftah
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Eric D Shah
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Li LC, Liang LM, Ji HY, Zhang C, Wang M, Liu HS. Exploring the association between type 2 diabetes and fecal incontinence in american adults: insights from a large cross-sectional study. Int J Colorectal Dis 2024; 39:121. [PMID: 39085653 PMCID: PMC11291540 DOI: 10.1007/s00384-024-04697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The relationship between fecal incontinence (FI) and type 2 diabetes (T2D) has been well recognized, but a comprehensive understanding of this relationship is lacking, taking into account demographic factors and lifestyle variables. METHODS Using a cross-sectional approach, 13,510 adults aged 20 years and older were identified from the 2005-2010 National Health and Nutrition Examination Survey. Multivariate logistic regression models were used to calculate the adjusted odds ratios (ORs), and further subgroup analyses and propensity score analysis were performed to ensure stable results. RESULTS Among 13,510 adults, 11.2% had T2D, and 8.8% had FI. We found a strong T2D-FI link (OR: 1.30; 95% CI: 1.09-1.54, P < 0.001), even after adjusting for covariates. Age > 45 was a critical factor, with a stronger T2D-FI association. Sedentary behavior (OR: 1.41; 95% CI: 1.15-1.73) in T2D patients were associated with FI. CONCLUSIONS Our study highlights the significant T2D-FI link in US adults, especially in older T2D patients. Lifestyle changes may reduce FI risk. More research is needed for causality and mechanisms.
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Affiliation(s)
- Lun-Chao Li
- Department of Emergency Medicine, the Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, P.R. China
| | - Li-Ming Liang
- Plastic and Reconstructive Surgery Unit, Department of Burns and Plastic Surgery, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, P.R. China
| | - Hong-Ye Ji
- Department of Emergency Medicine, the Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, P.R. China
| | - Can Zhang
- Department of Emergency Medicine, the Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, P.R. China
| | - Man Wang
- Department of Emergency Medicine, the Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, P.R. China.
| | - Hong-Sheng Liu
- Department of Emergency Medicine, the Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, P.R. China.
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Burholt V, Pillai A, Cheung G, Awatere SA, Daltrey J. Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data. Gerontology 2024:1-10. [PMID: 38861937 DOI: 10.1159/000539753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Globally, there are few studies but wide variation in the epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for FI for people living with dementia. METHODS A retrospective cohort study comprising the International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109,964). For prevalence analysis, we selected a dementia cohort for a 1-year period from August 1, 2020, to July 31, 2021 (n = 7,775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period August 1, 2016, and July 31, 2021. Dementia was identified by combining diagnosis of "Alzheimer's disease" and "Dementia other than Alzheimer's disease." Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent. RESULTS One year period (1 August 2020-31 July 2021) prevalence of FI was 26.7% (2,082/7,775) of people with dementia. 5-Year incident FI rate was 19.0 per 100 person-years for people with dementia and 12.3 per 100 person-years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for people with dementia. CONCLUSION FI affects a significant proportion of people with dementia in New Zealand. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention needs for people with dementia to redress or manage FI.
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Affiliation(s)
- Vanessa Burholt
- School of Nursing/School of Population Health, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
- Centre for Innovative Ageing, Swansea University, Swansea, UK
| | - Avinesh Pillai
- Department of Statistics, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Sharon Aroha Awatere
- School of Nursing, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
| | - Julie Daltrey
- School of Nursing, Waipapa Taumata Rau, The University of Auckland, Auckland, New Zealand
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Neshatian L, Grant G, Fernandez-Becker N, Yuan Y, Garcia P, Becker L, Gurland B, Triadafilopoulos G. The association between vitamin-D deficiency and fecal incontinence. Neurogastroenterol Motil 2024; 36:e14753. [PMID: 38316640 DOI: 10.1111/nmo.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Vitamin-D is essential for musculoskeletal health. We aimed to determine whether patients with fecal incontinence (FI): (1) are more likely to have vitamin-D deficiency and, (2) have higher rates of comorbid medical conditions. METHODS We examined 18- to 90-year-old subjects who had 25-hydroxy vitamin-D levels, and no vitamin-D supplementation within 3 months of testing, in a large, single-institutional electronic health records dataset, between 2017 and 2022. Cox proportional hazards survival analysis was used to assess association of vitamin-D deficiency on FI. KEY RESULTS Of 100,111 unique individuals tested for serum 25-hydroxy vitamin-D, 1205 (1.2%) had an established diagnosis of FI. Most patients with FI were female (75.9% vs. 68.7%, p = 0.0255), Caucasian (66.3% vs. 52%, p = 0.0001), and older (64.2 vs. 53.8, p < 0.0001). Smoking (6.56% vs. 2.64%, p = 0.0001) and GI comorbidities, including constipation (44.9% vs. 9.17%, p = 0.0001), irritable bowel syndrome (20.91% vs. 3.72%, p = 0.0001), and diarrhea (28.55% vs. 5.2%, p = 0.0001) were more common among FI patients. Charlson Comorbidity Index score was significantly higher in patients with FI (5.5 vs. 2.7, p < 0.0001). Significantly higher proportions of patients with FI had vitamin-D deficiency (7.14% vs. 4.45%, p < 0.0001). Moreover, after propensity-score matching, rate of new FI diagnosis was higher in patients with vitamin-D deficiency; HR 1.9 (95% CI [1.14-3.15]), p = 0.0131. CONCLUSION & INFERENCES Patients with FI had higher rates of vitamin-D deficiency along with increased overall morbidity. Future research is needed to determine whether increased rate of FI in patients with vitamin-D deficiency is related to frailty associated with increased medical morbidities.
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Affiliation(s)
- Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Gabrielle Grant
- Clinical Observation and Medical Transcription Program, Stanford University School of Medicine, Stanford, California, USA
| | - Nielsen Fernandez-Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Ye Yuan
- Atropos Health, New York, New York, USA
| | - Patricia Garcia
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Laren Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Department of Surgery, Stanford University, Stanford, California, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2024; 22:712-731.e8. [PMID: 37734583 PMCID: PMC10948379 DOI: 10.1016/j.cgh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. METHODS We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. RESULTS Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%-12.0%) compared with younger persons (4.9%; 95% CI, 2.9%-6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39-2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%-10.6%) than men (7.4%; 95% CI, 6.0%-8.8%]) (OR, 1.17; 95% CI, 1.06-1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. CONCLUSIONS Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Heiko Hahn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Celina Gödel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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ten Hoor MB, Trzpis M, Broens PM. The Severity of Fecal Problems Is Negatively Associated With Quality of Life in a Dutch Population Without Bowel Function Comorbidities. Dis Colon Rectum 2024; 67:448-456. [PMID: 37962140 PMCID: PMC10846588 DOI: 10.1097/dcr.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Constipation and fecal incontinence negatively influence quality of life. The association between the severity of fecal problems and quality of life has not been investigated in the general population without bowel function comorbidities. OBJECTIVE To investigate the association between the severity of constipation and fecal incontinence and quality of life in patients without comorbidities influencing bowel function. DESIGN A population-based, cross-sectional study. SETTINGS The study involved 3668 Dutch study participants. PATIENTS A survey company conducted a population-wide study of the general Dutch population. Altogether, 5000 Dutch citizens completed the Groningen Defecation and Fecal Continence and Short Form-36 questionnaires. The data on 3668 respondents without comorbidities that could influence bowel function were included for analysis (study group). MAIN OUTCOME MEASURES The severity of constipation (Agachan score) and fecal incontinence (Wexner score) in relation to the quality-of-life scores. RESULTS In the study group (n = 3668), 487 had constipation (13.3%), 116 had fecal incontinence (3.2%), and 64 had 2 coexisting fecal problems (1.7%). In the multivariable analysis, all quality-of-life domains were negatively associated with the severity of constipation and fecal incontinence. The associations between the severity of constipation and quality of life were stronger (highest: ß = -2.413; 95% CI, -2.681 to -2.145; p < 0.001) than those of fecal incontinence (highest: ß = -1.280; 95% CI, -1.681 to -.880; p < 0.001). We also found that a longer duration of bowel complaints coincided with higher severity scores, especially for constipation. Respondents mostly rated their defecation health as positive, regardless of the severity of their fecal problems. LIMITATIONS Cross-sectional design. CONCLUSIONS The severity of constipation and fecal incontinence is significantly associated with reduced quality of life, with the severity of constipation having stronger associations than fecal incontinence. Given respondents' unawareness of their fecal problems and the progressive character, timely intervention is advocated. See Video Abstract . LA GRAVEDAD DE LOS PROBLEMAS FECALES SE ASOCIA NEGATIVAMENTE CON LA CALIDAD DE VIDA EN UNA POBLACIN HOLANDESA SIN COMORBILIDADES DE LA FUNCIN INTESTINAL ANTECEDENTES:El estreñimiento y la incontinencia fecal influyen negativamente en la calidad de vida. La asociación entre la gravedad de los problemas fecales y la calidad de vida no se ha investigado en la población general sin comorbilidades de la función intestinal.OBJETIVO:Investigar la asociación entre la gravedad del estreñimiento y la incontinencia fecal y la calidad de vida en la población holandesa general sin comorbilidades que influyan en la función intestinal.DISEÑO:Estudio transversal de base poblacional.ENTORNO CLINICO:El estudio involucró a 3668 participantes holandeses.PACIENTES:Una empresa de encuestas realizó un estudio poblacional de la población holandesa en general. En total, 5.000 ciudadanos holandeses completaron los cuestionarios Groningen Defecation and Fecal Continence y Short-Form 36. Se incluyeron para el análisis los datos de 3668 encuestados sin comorbilidades que pudieran influir en la función intestinal (grupo de estudio).PRINCIPALES MEDIDAS DE RESULTADO:La gravedad del estreñimiento (puntuación de Agachan) y la incontinencia fecal (puntuación de Wexner) en relación con las puntuaciones de calidad de vida.RESULTADOS:En el grupo de estudio (n = 3668), 487 tenían estreñimiento (13,3%), 116 tenían incontinencia fecal (3,2%) y 64 tenían 2 problemas fecales coexistentes (1,7%). En el análisis multivariable, todos los dominios de calidad de vida se asociaron negativamente con la gravedad del estreñimiento y la incontinencia fecal. Las asociaciones entre la gravedad del estreñimiento y la calidad de vida fueron más fuertes (más alta: ß = -2,413; IC del 95 %, -2,681 a -2,145; p < 0,001) que las de la incontinencia fecal (más alta: ß = -1,280; 95 IC %: -1,681 a -0,880; p < 0,001). También encontramos que una mayor duración de las molestias intestinales coincidió con puntuaciones de gravedad más altas, especialmente para el estreñimiento. La mayoría de los encuestados calificaron su salud en la defecación como positiva, independientemente de la gravedad de sus problemas fecales.LIMITACIONES:Diseño transversal.CONCLUSIONES:La gravedad del estreñimiento y la incontinencia fecal se asocia significativamente con una calidad de vida reducida; la gravedad del estreñimiento tiene asociaciones más fuertes que la incontinencia fecal. Dado el desconocimiento de los encuestados sobre sus problemas fecales y el carácter progresivo, se recomienda una intervención oportuna. (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Maaike B.C. ten Hoor
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Chaichanavichkij P, Vollebregt PF, Keshishian K, Knowles CH, Scott SM. The Clinical Impact of Obesity in Patients With Disorders of Defecation: A Cross-Sectional Study of 1,155 Patients. Am J Gastroenterol 2023; 118:2247-2257. [PMID: 37417793 DOI: 10.14309/ajg.0000000000002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Obesity is a global epidemic. Its clinical impact on symptoms of fecal incontinence (FI) and/or constipation and underlying anorectal pathophysiology remains uncertain. METHODS This is a cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017 and 2021. Clinical history, symptoms, and anorectal physiologic test results were analyzed according to BMI categories. RESULTS A total of 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; and 31.7% obese). Obese patients had higher odds of FI to liquid stools (69.9 vs 47.8%, odds ratio [OR] 1.96 [confidence interval: 1.43-2.70]), use of containment products (54.6% vs 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs 60.7%, OR 1.54 [1.11-2.14]), urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]). A higher proportion of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight patients (33.8%, 44.8%) and patients with normal BMI (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R 2 0.25, P = 0.0003), although the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction. Obese patients more often had a large clinically significant rectocele (34.4% vs 20.6%, OR 2.62 [1.51-4.55]) compared with patients with normal BMI. DISCUSSION Obesity affects specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure and significant rectocele). Prospective studies are required to determine whether obesity is a modifiable risk factor of FI and constipation.
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Affiliation(s)
- Pam Chaichanavichkij
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Paul F Vollebregt
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Karekin Keshishian
- Department of Colorectal Surgery, The Royal London Hospital, Whitechapel Road, London, United Kingdom
| | - Charles H Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - S Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
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Remes-Troche JM, Coss-Adame E, García-Zermeño KR, Gómez-Escudero O, Amieva-Balmori M, Gómez-Castaños PC, Charúa-Guindic L, Icaza-Chávez ME, López-Colombo A, Morel-Cerda EC, Pérez Y López N, Rodríguez-Leal MC, Salgado-Nesme N, Sánchez-Avila MT, Valdovinos-García LR, Vergara-Fernández O, Villar-Chávez AS. The Mexican consensus on fecal incontinence. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:404-428. [PMID: 38097437 DOI: 10.1016/j.rgmxen.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 01/01/2024]
Abstract
Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence» and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.
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Affiliation(s)
- J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Mexico.
| | - E Coss-Adame
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Mexico City, Mexico
| | - K R García-Zermeño
- Gastroenterología y Motilidad Digestiva, CIGMA, Boca del Río, Veracruz, Mexico
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopía Digestiva y Motilidad Gastrointestinal, Hospital Ángeles de Puebla, Puebla, Mexico
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Mexico
| | - P C Gómez-Castaños
- Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - L Charúa-Guindic
- Práctica privada, Coloproctología del Hospital Ángeles Lomas, Mexico City, Mexico
| | - M E Icaza-Chávez
- Hospital Christus Muguerza Faro del Mayab, Mérida, Yucatán, Mexico
| | - A López-Colombo
- UMAE Hospital de Especialidades, Centro Médico Nacional Manuel Ávila Camacho, IMSS Puebla, Puebla, Mexico
| | - E C Morel-Cerda
- Laboratorio de Motilidad Gastrointestinal, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - M C Rodríguez-Leal
- Hospital Ángeles Valle Oriente, IMSS UMAE 25, Monterrey, Nuevo León, Mexico
| | - N Salgado-Nesme
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Mexico City,Mexico
| | - M T Sánchez-Avila
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - L R Valdovinos-García
- Laboratorio de Motilidad Gastrointestinal Fundación Clínica Médica Sur, Mexico City, Mexico
| | - O Vergara-Fernández
- Departamento de Cirugía Colorrectal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, Mexico
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10
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Burholt V, Peri K, Awatere S, Balmer D, Cheung G, Daltrey J, Fearn J, Gibson R, Kerse N, Lawrence AM, Moeke-Maxwell T, Munro E, Orton Y, Pillai A, Riki A, Williams LA. Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study. PLoS One 2023; 18:e0288613. [PMID: 37463158 PMCID: PMC10353819 DOI: 10.1371/journal.pone.0288613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions. METHODS AND ANALYSIS A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.
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Affiliation(s)
- Vanessa Burholt
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Kathryn Peri
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sharon Awatere
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julie Daltrey
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jaime Fearn
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Rosemary Gibson
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tess Moeke-Maxwell
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erica Munro
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yasmin Orton
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Arapera Riki
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa Ann Williams
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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11
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Parker-Autry C, Leng I, Matthews CA, Thorne N, Kritchevsky S. Characterizing the physical function decline and disabilities present among older adults with fecal incontinence: a secondary analysis of the health, aging, and body composition study. Int Urogynecol J 2022; 33:2815-2824. [PMID: 34379165 DOI: 10.1007/s00192-021-04933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Unhealthy aging is associated with fecal incontinence (FI) and poor physical performance. The link between FI and physical performance in older adults is unknown. We aim to examine the longitudinal relationship between FI symptoms and physical performance among older US adults. METHODS We analyzed a cohort of well-functioning, adults aged 70-79 years enrolled in the prospective cohort of the Health, Aging, and Body Composition study. Fecal incontinence symptoms were assessed at baseline using a validated question. Physical performance was determined by the expanded version of the Short Physical Performance Battery (HABC PBB), which includes an assessment of usual and fast walking speed and balance measures. Objective measures of physical performance were determined at baseline and year 4. Univariate and multivariate analyses compared physical performance based on presence of FI symptoms adjusting for important demographic and clinical covariates. RESULTS Of the 2914 participants in the Health ABC cohort, 222 (8%) had FI symptoms and 2692 (92%) did not. Mean age and BMI were 73 years and 27 kg/m2, respectively. Older adults with FI symptoms demonstrated a clinically significant decline in total HABC PBB scores from baseline to year 4 of -0.33 (95% CI: -0.41, -0.25), a statistically significant difference compared to adults without FI symptoms (-0.26 [95% CI: -0.32, -0.20]), p = 0.04. Sub-scale components demonstrated greater deficits in narrow walk speed, p = 0.03, and non-significant trend in greater deficits in repeated chair rise pace and gait speed, p ≥ 0.05. CONCLUSIONS Fecal incontinence symptoms are associated with clinically important declines in physical performance in older adults.
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Affiliation(s)
- Candace Parker-Autry
- Department of Urology and OB/GYN, Wake Forest School of Medicine, 1 Medical Center Blvd, NC, 27157, Winston Salem, USA.
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Catherine A Matthews
- Department of Urology and OB/GYN, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nyree Thorne
- Department of Internal Medicine, Division of Gastroenterology and Motility Disorders, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen Kritchevsky
- Department of Internal Medicine, Division of Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
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12
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Neshatian L, Lam JP, Gurland BH, Liang T, Becker L, Sheth VR. MRI biomarker of muscle composition is associated with severity of pelvic organ prolapse. Tech Coloproctol 2022; 26:725-733. [PMID: 35727428 DOI: 10.1007/s10151-022-02651-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The pathophysiology of pelvic organ prolapse is largely unknown. We hypothesized that reduced muscle mass on magnetic resonance defecography (MRD) is associated with increased pelvic floor laxity. The aim of this study was to compare the psoas and puborectalis muscle mass composition and cross-sectional area among patients with or without pelvic laxity. METHODS An observational retrospective study was conducted on women > age 18 years old who had undergone MRD for pelvic floor complaints from January 2020 to December 2020 at Stanford Pelvic Health Center. Pelvic floor laxity, pelvic organ descent, and rectal prolapse were characterized by standard measurements on MRD and compared to the psoas (L4 level) and puborectalis muscle index (cross-sectional area adjusted by height) and relative fat fraction, quantified by utilizing a 2-point Dixon technique. Regression analysis was used to quantify the association between muscle characteristics and pelvic organ measurements. RESULTS The psoas fat fraction was significantly elevated in patients with abnormally increased resting and strain H and M lines (p < 0.05) and increased with rising grades of Oxford rectal prolapse (p = 0.0001), uterovaginal descent (p = 0.001) and bladder descent (p = 0.0005). In multivariate regression analysis, adjusted for age and body mass index, the psoas fat fraction (not muscle index) was an independent risk factor for abnormal strain H and M line; odds ratio (95% confidence interval) of 17.8 (2-155.4) and 18.5 (1.3-258.3) respectively, and rising Oxford grade of rectal prolapse 153.9 (4.4-5383) and bladder descent 12.4 (1.5-106). Puborectalis fat fraction was increased by rising grades of Oxford rectal prolapse (p = 0.0002). CONCLUSIONS Severity of pelvic organ prolapse appears to be associated with increasing psoas muscle fat fraction, a biomarker for reduced skeletal muscle mass. Future prospective research is needed to determine if sarcopenia may predict postsurgical outcomes after pelvic organ prolapse repair.
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Affiliation(s)
- L Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, CA, Stanford, USA.
| | - J P Lam
- American Radiology Associates, Dallas, TX, USA
| | - B H Gurland
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - T Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - L Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, CA, Stanford, USA
| | - V R Sheth
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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13
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Abstract
Fecal incontinence can be a challenging and stigmatizing disease with a high prevalence in the elderly population. Despite effective treatment options, most patients do not receive care. Clues in the history and physical examination can assist the provider in establishing the diagnosis. Direct inquiry about the presence of incontinence is key. Bowel disturbances are common triggers for symptoms and represent some of the easiest treatment targets. We review the epidemiology and impact of the disease, delineate a diagnostic and treatment approach for primary care physicians to identify patients with suspected fecal incontinence and describe appropriate treatment options.
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Affiliation(s)
- Trisha Pasricha
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA.
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14
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Abstract
PURPOSE OF REVIEW To review the epidemiology, pathogenesis, clinical features, and management of primary constipation and fecal incontinence in the elderly. RECENT FINDINGS Among elderly people, 6.5%, 1.7%, and 1.1% have functional constipation, constipation-predominant IBS, and opioid-induced constipation. In elderly people, the number of colonic enteric neurons and smooth muscle functions is preserved; decreased cholinergic function with unopposed nitrergic relaxation may explain colonic motor dysfunction. Less physical activity or dietary fiber intake and postmenopausal hormonal therapy are risk factors for fecal incontinence in elderly people. Two thirds of patients with fecal incontinence respond to biofeedback therapy. Used in combination, loperamide and biofeedback therapy are more effective than placebo, education, and biofeedback therapy. Vaginal or anal insert devices are another option. In the elderly, constipation and fecal incontinence are common and often distressing symptoms that can often be managed by addressing bowel disturbances. Selected diagnostic tests, prescription medications, and, infrequently, surgical options should be considered when necessary.
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Affiliation(s)
- Brototo Deb
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA
| | - David O Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA.
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15
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Sharma A, Rao SSC. Epidemiologic Trends and Diagnostic Evaluation of Fecal Incontinence. Gastroenterol Hepatol (N Y) 2020; 16:302-309. [PMID: 34035733 PMCID: PMC8132710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fecal incontinence (FI) is a prevalent condition that occurs in up to 15% of the Western population and significantly impairs quality of life. The current understanding of the epidemiology of FI is shifting because of an increasing recognition of FI in men, better appreciation for the impact of changing obstetric practices on FI in women, and comprehension of the effect of modifiable risk factors on the development of FI over time. The pathophysiology of FI is complex and multifactorial, which necessitates the use of multiple diagnostic tests, including tests of anorectal sensorimotor function, peripheral nerve function, and anatomic structure. Translumbosacral anorectal magnetic stimulation is an emerging noninvasive diagnostic test for assessing lumbosacral neuropathy. This article is not intended as a comprehensive recitation of the literature, but rather focuses on recent developments in the understanding of the epidemiology of FI, as well as on the diagnostic evaluation of this condition. This article aims to increase awareness of FI and to outline an initial diagnostic approach to affected patients.
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Affiliation(s)
- Amol Sharma
- Dr Sharma is an associate professor of medicine and Dr Rao is a professor of medicine and the J. Harold Harrison, MD, Distinguished University Chair in Gastroenterology in the Division of Gastroenterology and Hepatology in the Medical College of Georgia at Augusta University in Augusta, Georgia
| | - Satish S C Rao
- Dr Sharma is an associate professor of medicine and Dr Rao is a professor of medicine and the J. Harold Harrison, MD, Distinguished University Chair in Gastroenterology in the Division of Gastroenterology and Hepatology in the Medical College of Georgia at Augusta University in Augusta, Georgia
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16
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Hassani D, Arya L, Andy U. Continence: Bowel and Bladder and Physical Function Decline in Women. CURRENT GERIATRICS REPORTS 2020; 9:64-71. [PMID: 32440467 DOI: 10.1007/s13670-020-00313-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of review The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence. Recent findings Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic. Summary Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.
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Affiliation(s)
- Daisy Hassani
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Lily Arya
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Uduak Andy
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
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