Epidemiology, pathophysiology, and classification of fecal incontinence: State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop

Adil E. Bharucha, Gena Dunivan, Patricia S. Goode, Emily S. Lukacz, Alayne D. Markland, Catherine A. Matthews, Louise Mott, Rebecca G. Rogers, Alan R. Zinsmeister, William E. Whitehead, Satish S.C. Rao, Frank A. Hamilton

Research output: Contribution to journalReview article

97 Citations (Scopus)

Abstract

In August 2013, the National Institutes of Health sponsored a conference to address major gaps in our understanding of the epidemiology, pathophysiology, and management of fecal incontinence (FI) and to identify topics for future clinical research. This article is the first of a two-part summary of those proceedings. FI is a common symptom, with a prevalence that ranges from 7 to 15% in community-dwelling men and women, but it is often underreported, as providers seldom screen for FI and patients do not volunteer the symptom, even though the symptoms can have a devastating impact on the quality of life. Rough estimates suggest that FI is associated with a substantial economic burden, particularly in patients who require surgical therapy. Bowel disturbances, particularly diarrhea, the symptom of rectal urgency, and burden of chronic illness are the strongest independent risk factors for FI in the community. Smoking, obesity, and inappropriate cholecystectomy are emerging, potentially modifiable risk factors. Other risk factors for FI include advanced age, female gender, disease burden (comorbidity count, diabetes), anal sphincter trauma (obstetrical injury, prior surgery), and decreased physical activity. Neurological disorders, inflammatory bowel disease, and pelvic floor anatomical disturbances (rectal prolapse) are also associated with FI. The pathophysiological mechanisms responsible for FI include diarrhea, anal and pelvic floor weakness, reduced rectal compliance, and reduced or increased rectal sensation; many patients have multifaceted anorectal dysfunctions. The type (urge, passive or combined), etiology (anorectal disturbance, bowel symptoms, or both), and severity of FI provide the basis for classifying FI; these domains can be integrated to comprehensively characterize the symptom. Several validated scales for classifying symptom severity and its impact on the quality of life are available. Symptom severity scales should incorporate the frequency, volume, consistency, and nature (urge or passive) of stool leakage. Despite the basic understanding of FI, there are still major knowledge gaps in disease epidemiology and pathogenesis, necessitating future clinical research in FI.

Original languageEnglish (US)
Pages (from-to)127-136
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume110
Issue number1
DOIs
StatePublished - Jan 10 2015

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National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
Fecal Incontinence
Epidemiology
Education
Pelvic Floor
Diarrhea
Quality of Life
Rectal Prolapse
Independent Living
Cost of Illness
Wounds and Injuries
National Institutes of Health (U.S.)
Anal Canal
Cholecystectomy
Nervous System Diseases
Inflammatory Bowel Diseases
Research

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Epidemiology, pathophysiology, and classification of fecal incontinence : State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. / Bharucha, Adil E.; Dunivan, Gena; Goode, Patricia S.; Lukacz, Emily S.; Markland, Alayne D.; Matthews, Catherine A.; Mott, Louise; Rogers, Rebecca G.; Zinsmeister, Alan R.; Whitehead, William E.; Rao, Satish S.C.; Hamilton, Frank A.

In: American Journal of Gastroenterology, Vol. 110, No. 1, 10.01.2015, p. 127-136.

Research output: Contribution to journalReview article

Bharucha, AE, Dunivan, G, Goode, PS, Lukacz, ES, Markland, AD, Matthews, CA, Mott, L, Rogers, RG, Zinsmeister, AR, Whitehead, WE, Rao, SSC & Hamilton, FA 2015, 'Epidemiology, pathophysiology, and classification of fecal incontinence: State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop', American Journal of Gastroenterology, vol. 110, no. 1, pp. 127-136. https://doi.org/10.1038/ajg.2014.396
Bharucha, Adil E. ; Dunivan, Gena ; Goode, Patricia S. ; Lukacz, Emily S. ; Markland, Alayne D. ; Matthews, Catherine A. ; Mott, Louise ; Rogers, Rebecca G. ; Zinsmeister, Alan R. ; Whitehead, William E. ; Rao, Satish S.C. ; Hamilton, Frank A. / Epidemiology, pathophysiology, and classification of fecal incontinence : State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. In: American Journal of Gastroenterology. 2015 ; Vol. 110, No. 1. pp. 127-136.
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abstract = "In August 2013, the National Institutes of Health sponsored a conference to address major gaps in our understanding of the epidemiology, pathophysiology, and management of fecal incontinence (FI) and to identify topics for future clinical research. This article is the first of a two-part summary of those proceedings. FI is a common symptom, with a prevalence that ranges from 7 to 15{\%} in community-dwelling men and women, but it is often underreported, as providers seldom screen for FI and patients do not volunteer the symptom, even though the symptoms can have a devastating impact on the quality of life. Rough estimates suggest that FI is associated with a substantial economic burden, particularly in patients who require surgical therapy. Bowel disturbances, particularly diarrhea, the symptom of rectal urgency, and burden of chronic illness are the strongest independent risk factors for FI in the community. Smoking, obesity, and inappropriate cholecystectomy are emerging, potentially modifiable risk factors. Other risk factors for FI include advanced age, female gender, disease burden (comorbidity count, diabetes), anal sphincter trauma (obstetrical injury, prior surgery), and decreased physical activity. Neurological disorders, inflammatory bowel disease, and pelvic floor anatomical disturbances (rectal prolapse) are also associated with FI. The pathophysiological mechanisms responsible for FI include diarrhea, anal and pelvic floor weakness, reduced rectal compliance, and reduced or increased rectal sensation; many patients have multifaceted anorectal dysfunctions. The type (urge, passive or combined), etiology (anorectal disturbance, bowel symptoms, or both), and severity of FI provide the basis for classifying FI; these domains can be integrated to comprehensively characterize the symptom. Several validated scales for classifying symptom severity and its impact on the quality of life are available. Symptom severity scales should incorporate the frequency, volume, consistency, and nature (urge or passive) of stool leakage. Despite the basic understanding of FI, there are still major knowledge gaps in disease epidemiology and pathogenesis, necessitating future clinical research in FI.",
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