Diseases of the Colon & Rectum

, Volume 49, Issue 6, pp 841–851 | Cite as

Fecal Incontinence in Females Older Than Aged 40 Years: Who is at Risk?

  • Madhulika G. VarmaEmail author
  • Jeanette S. Brown
  • Jennifer M. Creasman
  • David H. Thom
  • Stephen K. Van Den Eeden
  • Mary S. Beattie
  • Leslee L. Subak
  • Reproductive Risks for Incontinence Study at Kaiser (RRISK) Research Group


This study was designed to estimate the prevalence of, and identify risk factors associated with, fecal incontinence in racially diverse females older than aged 40 years.


The Reproductive Risks for Incontinence Study at Kaiser is a population-based study of 2,109 randomly selected middle-aged and older females (average age, 56 years). Fecal incontinence, determined by self-report, was categorized by frequency. Females reported the level of bother of fecal incontinence and their general quality of life. Potential risk factors were assessed by self-report, interview, physical examination, and record review. Multivariate logistic regression analysis was used to determine the independent association between selected risk factors and the primary outcome of any reported fecal incontinence in the past year.


Fecal incontinence in the past year was reported by 24 percent of females (3.4 percent monthly, 1.9 percent weekly, and 0.2 percent daily). Greater frequency of fecal incontinence was associated with decreased quality of life (Medical Outcome Short Form-36 Mental Component Scale score, P = 0.01), and increased bother (P < 0.001) with 45 percent of females with fecal incontinence in the past year and 100 percent of females with daily fecal incontinence reporting moderate or great bother. In multivariate analysis, the prevalence of fecal incontinence in the past year increased significantly [odds ratio per 5 kg/m2 (95 percent confidence interval)] with obesity [1.2 (1.1–1.3)], chronic obstructive pulmonary disease [1.9 (1.3–2.9)], irritable bowel syndrome [2.4 (1.7–3.4)], urinary incontinence [2.1 (1.7–2.6)], and colectomy [1.9 (1.1–3.1)]. Latina females were less likely to report fecal incontinence than white females [0.6 (0.4–0.9)].


Fecal incontinence, a common problem for females, is associated with substantial adverse affects on quality of life. Several of the identified risk factors are preventable or modifiable, and may direct future research in fecal incontinence therapy.

Key words

Fecal incontinence Epidemiology Risk factors Prevalence 


  1. 1.
    Nelson, R, Norton, N, Cautley, E, Furner, S 1995Community-based prevalence of anal incontinenceJAMA274559561PubMedCrossRefGoogle Scholar
  2. 2.
    Nakanishi, N, Tatara, K, Shinsho, F,  et al. 1999Mortality in relation to urinary and faecal incontinence in elderly people living at homeAge Ageing28301306PubMedCrossRefGoogle Scholar
  3. 3.
    Drossman, DA, Li, Z, Andruzzi, E,  et al. 1993U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impactDig Dis Sci3815691580PubMedCrossRefGoogle Scholar
  4. 4.
    Boreham, MK, Richter, HE, Kenton, KS,  et al. 2005Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of lifeAm J Obstet Gynecol19216371642PubMedCrossRefGoogle Scholar
  5. 5.
    Faltin, DL, Sangalli, MR, Curtin, F, Morabia, A, Weil, A 2001Prevalence of anal incontinence and other anorectal symptoms in womenInt Urogynecol J Pelvic Floor Dysfunct12117120PubMedCrossRefGoogle Scholar
  6. 6.
    Gordon, D, Groutz, A, Goldman, G,  et al. 1999Anal incontinence: prevalence among female patients attending a urogynecologic clinicNeurourol Urodyn18199204PubMedCrossRefGoogle Scholar
  7. 7.
    Johanson, JF, Lafferty, J 1996Epidemiology of fecal incontinence: the silent afflictionAm J Gastroenterol913336PubMedGoogle Scholar
  8. 8.
    Tobin, GW, Brocklehurst, JC 1986Faecal incontinence in residential homes for the elderly: prevalence, aetiology and managementAge Ageing154146PubMedGoogle Scholar
  9. 9.
    Nelson, R, Furner, S, Jesudason, V 1998Fecal incontinence in Wisconsin nursing homes: prevalence and associationsDis Colon Rectum4112261229PubMedCrossRefGoogle Scholar
  10. 10.
    Goode, PS, Burgio, KL, Halli, AD,  et al. 2005Prevalence and correlates of fecal incontinence in community-dwelling older adultsJ Am Geriatr Soc53629635PubMedCrossRefGoogle Scholar
  11. 11.
    Quander, CR, Morris, MC, Melson, J, Bienias, JL, Evans, DA 2005Prevalence of and factors associated with fecal incontinence in a large community study of older individualsAm J Gastroenterol100905909PubMedCrossRefGoogle Scholar
  12. 12.
    Madoff, RD, Parker, SC, Varma, MG, Lowry, AC 2004Faecal incontinence in adultsLancet364621632PubMedCrossRefGoogle Scholar
  13. 13.
    Byrne, CM, Pager, CK, Rex, J, Roberts, R, Solomon, MJ 2002Assessment of quality of life in the treatment of patients with neuropathic fecal incontinenceDis Colon Rectum4514311436PubMedCrossRefGoogle Scholar
  14. 14.
    Rothbarth, J, Bemelman, WA, Meijerink, WJ,  et al. 2001What is the impact of fecal incontinence on quality of life?Dis Colon Rectum446771PubMedCrossRefGoogle Scholar
  15. 15.
    Krieger, N 1992Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodologyAm J Public Health82703710PubMedCrossRefGoogle Scholar
  16. 16.
    Thom, DH, Eeden, SK, Ragins, AI,  et al. 2006Differences in prevalence of urinary incontinence by race/ethnicityJ Urol175259264PubMedCrossRefGoogle Scholar
  17. 17.
    Ware, JE,Jr, Sherbourne, CD 1992The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selectionMed Care30473483PubMedGoogle Scholar
  18. 18.
    McCullagh, P, Nelder, JA 1989Generalized linear modelsChapman & HallNew YorkGoogle Scholar
  19. 19.
    Nygaard, IE, Rao, SS, Dawson, JD 1997Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort studyObstet Gynecol89896901PubMedCrossRefGoogle Scholar
  20. 20.
    Uustal Fornell, E, Wingren, G, Kjolhede, P 2004Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological studyActa Obstet Gynecol Scand83383389PubMedCrossRefGoogle Scholar
  21. 21.
    Lysy, J, Israeli, E, Goldin, E 1999The prevalence of chronic diarrhea among diabetic patientsAm J Gastroenterol9421652170PubMedCrossRefGoogle Scholar
  22. 22.
    Nelson, RL 2004Epidemiology of fecal incontinence (1Suppl1)Gastroenterology126S3S7PubMedCrossRefGoogle Scholar
  23. 23.
    Bytzer, P, Talley, NJ, Leemon, M, Young, LJ, Jones, MP, Horowitz, M 2001Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adultsArch Intern Med16119891996PubMedCrossRefGoogle Scholar
  24. 24.
    Guilera, M, Balboa, A, Mearin, F 2005Bowel habit subtypes and temporal patterns in irritable bowel syndrome: systematic reviewAm J Gastroenterol10011741184PubMedCrossRefGoogle Scholar
  25. 25.
    Sauter, GH, Moussavian, AC, Meyer, G, Steitz, HO, Parhofer, KG, Jungst, D 2002Bowel habits and bile acid malabsorption in the months after cholecystectomyAm J Gastroenterol9717321735PubMedCrossRefGoogle Scholar
  26. 26.
    Ho, YH, Low, D, Goh, HS 1996Bowel function survey after segmental colorectal resectionsDis Colon Rectum39307310PubMedCrossRefGoogle Scholar
  27. 27.
    MacLennan, AH, Taylor, AW, Wilson, DH, Wilson, D 2000Theprevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of deliveryBr J Obstet Gynaecol10714601470Google Scholar
  28. 28.
    Lacima, G, Pera, M 2003Combined fecal and urinary incontinence: an updateCurr Opin Obstet Gynecol15405410PubMedGoogle Scholar
  29. 29.
    Grady, D, Brown, JS, Vittinghoff, E, Applegate, W, Varner, E, Snyder, T 2001Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement StudyObstet Gynecol97116120PubMedCrossRefGoogle Scholar
  30. 30.
    Hendrix, SL, Cochrane, BB, Nygaard, IE,  et al. 2005Effects of estrogen with and without progestin on urinary incontinenceJAMA293935948PubMedCrossRefGoogle Scholar
  31. 31.
    Jackson, S, James, M, Abrams, P 2002The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinenceBr J Obstet Gynaecol109339344Google Scholar
  32. 32.
    Robinson, D, Rainer, RO, Washburn, SA, Clarkson, TB 1996Effects of estrogen and progestin replacement on the urogenital tract of the ovariectomized cynomolgus monkeyNeurourol Urodyn15215221PubMedCrossRefGoogle Scholar
  33. 33.
    Russo, A, Botten, R, Kong, MF,  et al. 2004Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitusDiabet Med21176182PubMedCrossRefGoogle Scholar
  34. 34.
    Soffer, EE, Hull, T 2000Fecal incontinence: a practical approach to evaluation and treatmentAm J Gastroenterol9518731880PubMedCrossRefGoogle Scholar
  35. 35.
    Rockwood, TH, Church, JM, Fleshman, JW,  et al. 2000Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinenceDis Colon Rectum43917PubMedCrossRefGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2006

Authors and Affiliations

  • Madhulika G. Varma
    • 1
    • 7
    Email author
  • Jeanette S. Brown
    • 2
    • 3
  • Jennifer M. Creasman
    • 3
  • David H. Thom
    • 4
  • Stephen K. Van Den Eeden
    • 5
  • Mary S. Beattie
    • 6
  • Leslee L. Subak
    • 2
    • 3
  • Reproductive Risks for Incontinence Study at Kaiser (RRISK) Research Group
  1. 1.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Family and Community MedicineUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Kaiser Permanente Division of ResearchOaklandUSA
  6. 6.Department of Medicine, Division of General Internal MedicineUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA

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