Diseases of the Colon & Rectum

, Volume 42, Issue 7, pp 857–865 | Cite as

Long-term cost of fecal incontinence secondary to obstetric injuries

  • Anders Mellgren
  • Linda L. Jensen
  • Jan P. Zetterström
  • W. Douglas Wong
  • Joseph H. Hofmeister
  • Ann C. Lowry
Original Contributions


INTRODUCTION: Anal incontinence is eight times more frequent in females than in males because of injuries sustained at childbirth. The aim of the present study was to determine the long-term costs associated with anal incontinence related to obstetric injuries. METHODS: Sixty-three patients with anal incontinence caused by obstetric sphincter injuries answered questionnaires regarding previous treatments, symptoms, and use of protective products. Of the patients, 31 were treated surgically, 11 with biofeedback, 6 with a combination of surgery and biofeedback, and 15 conservatively. Treatments and their respective costs were obtained from patient records, patient questionnaires, billing database, and Health Care Financing Administration's 1996 inpatient database. Costs were expressed in 1996 dollars. RESULTS: The mean incontinence score changed from 26 at evaluation to 16 at follow-up (P<0.001). The average cost per patient was $17,166. Evaluation and follow-up charges totaled $65,412, and physiologic assessment accounted for 64 percent of these costs. Treatment charges totaled $559,341, and physician charges accounted for 18 percent of these charges. CONCLUSIONS: Fecal incontinence after childbirth results in substantial economic costs, and treatment is not always successful. New treatment modalities, such as artificial bowel sphincter or dynamic graciloplasty, should be assessed to determine their cost-effectiveness.

Key words

Anal incontinence Fecal incontinence Cost analysis Costs Charges Delivery Obstetric complication Endoanal ultrasound Manometry Pudendal latency 


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Copyright information

© The American Society of Colon and Rectal Surgeons 1999

Authors and Affiliations

  • Anders Mellgren
    • 1
  • Linda L. Jensen
    • 1
  • Jan P. Zetterström
    • 2
  • W. Douglas Wong
    • 1
  • Joseph H. Hofmeister
    • 3
  • Ann C. Lowry
    • 1
  1. 1.From the Department of Surgery, Division of Colon and Rectal SurgeryUniversity of Minnesota Medical SchoolSt. Paul
  2. 2.Department of Obstetrics and GynecologyKarolinska Institute at Danderyd HospitalStockholmSweden
  3. 3.American Medical Systems Inc.Minnetonka

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