Prevalence of anorectal dysfunction in women attending health care services

Abstract

The aim of this study was to assess the prevalence of different bowel symptoms (constipation, faecal incontinence and faecal evacuation dysfunction) and associated urinary symptoms in women attending health care services. All women attending colposcopy clinics and general gynaecology clinics in a district general hospital in the southwest of England were invited to participate in the study. In addition, women attending the local family planning clinic were also recruited. Women attending these clinics routinely completed a history sheet and were asked to complete the Birmingham Bowel and Urinary Symptoms Questionnaire. Two hundred women participated in the study: 116 (64.4%) had at least one bowel symptom from the list in the questionnaire and 57 (31.6%) of women thought they had a bowel problem but only 26 (14.4%) consulted their family doctor regarding the problem while four (2.2%) were referred for specialist opinion. Six were unsure about their bowel symptoms. There were 46 (25.5%) of women who had constipation, 99 (55%) had faecal incontinence and 97 (53.8%) complained of faecal evacuation dysfunction. Only 48 (26.6%) of women were free of any bowel complaint. One patient with faecal incontinence discussed her problem with her midwife but no further action was taken as she was too embarrassed to discuss it with her doctor. Seventy-eight (43.3%) of patients had urinary symptoms. Fifty-five (30.5%) thought they had a urinary problem but only 29 (16.1%) consulted their doctor and 17 (9.4%) were referred for specialist opinion. Sixty-one (33.8%) of those who admitted to have urinary incontinence also had faecal incontinence. Forty-nine (27.2%) of the patients were free of all symptoms. The mode of delivery as well as previous surgery did not have any influence on urinary incontinence nor on anal incontinence. This study has demonstrated a high prevalence of bowel symptoms in women attending health care services.

Appendix 1

BBUSQ-22

How often do you open your bowels?	More than 3 times a day	[ ]
	2–3 times a day	[ ]
	Once a day	[ ]
	Every 1–3 days	[ ]
	Less than every 3 days	[ ]
	Less than once a week	[ ]
Are your motions usually…	Watery?	[ ]
	Sloppy?	[ ]
	Soft and formed?	[ ]
	Hard?	[ ]
Can you hold onto your motions for more than 5 min?	All of the time	[ ]
	Most of the time	[ ]
	Occasionally	[ ]
	Never	[ ]
Do you ever have to rush to the toilet to open your bowels?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Does stool leak before you can get to the toilet?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you leak stool for no obvious reason and without feeling that you want to go to the toilet?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you have to strain to open your bowels?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
How long do you spend in the toilet, on average, for each bowel action?	Less than 5 min	[ ]
	5 to 10 min	[ ]
	10 to 20 min	[ ]
	More than 20 min	[ ]
Do you feel that you cannot completely empty your bowel?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you use a finger or pressure to help open your bowels?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you have the urge to open your bowels but are unable to pass a motion?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you find it painful to have your bowels open?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Have you consulted a doctor in the last six months about constipation?	Yes	[ ]
	No	[ ]
Do you use laxatives?	Never	[ ]
	Once a week or less	[ ]
	More than once a week	[ ]
	Every day	[ ]
Which laxatives do you use? (Write their names here)
During the day, how many times do you urinate, on average?	1 to 6 times	[ ]
	7 to 9 times	[ ]
	10 to 12 times	[ ]
	13 times or more	[ ]
During the night, how many times do you have to get up to urinate, on average?	Never	[ ]
	1 time	[ ]
	2 times	[ ]
	3 times or more	[ ]
Do you have to rush to the toilet to urinate?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Do you difficulty completely emptying your bladder?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Does urine leak before you can get to the toilet?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Does urine leak when you are active, exert yourself, cough or sneeze?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]
Does urine leak for no obvious reason and without feeling that you want to go to the toilet?	Never	[ ]
	Occasionally	[ ]
	Most of the time	[ ]
	All of the time	[ ]