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Fecal Incontinence: Silent Health Problem for Older
Women
Study says it's prevalent in US, high among older
women, those who had several babies or have major depression
By Katie Gazella
Jan. 17, 2006 - It's a topic that is discussed so
infrequently for reasons that are easy to understand that it may
seem it isn't much of a problem. But new research shows that fecal
incontinence is prevalent among U.S. women, especially those in older
age groups, those who have had numerous babies, women whose deliveries
were assisted by forceps or vacuum devices, and those who have had a
hysterectomy.
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Many women in the study who had fecal incontinence
also had another medical condition, such as major depression or
diabetes, and often experienced urinary incontinence in addition to FI.
The findings are reported in the American Journal of Obstetrics and
Gynecology.
"Increased attention should be paid to this
debilitating condition, especially considering the aging of our
population and the available treatments for FI," says senior author Dee
E. Fenner, M.D., associate professor of obstetrics and gynecology, and
director of gynecology, at the University of Michigan Medical School.
"It is very important to the health of women that clinicians are aware
of the prevalence of FI and can treat their patients accordingly."
The study, led by the University of Washington, was
a postal survey of 6,000 women ages 30-90 who were enrolled in a large
HMO in Washington state (the condition also affects men, but only women
were involved in the study). Of the 64 percent who responded, the
prevalence of FI was found to be 7.2 percent, with the occurrence
increasing notably with age. FI was defined as loss of liquid or solid
stool at least monthly.
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About Fecal Incontinence |
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By National Digestive
Diseases Information Clearinghouse
Fecal incontinence is the inability to
control your bowels. When you feel the urge to have a bowel
movement, you may not be able to hold it until you can get to a
toilet. Or stool may leak from the rectum unexpectedly.
More than 5.5 million Americans have fecal
incontinence. It affects people of all ageschildren as well as
adults. Fecal incontinence is more common in women than in men
and more common in older adults than in younger ones. It is not,
however, a normal part of aging.
Loss of bowel control can be devastating.
People who have fecal incontinence may feel ashamed,
embarrassed, or humiliated. Some don't want to leave the house
out of fear they might have an accident in public. Most try to
hide the problem as long as possible, so they withdraw from
friends and family. The social isolation is unfortunate but may
be reduced because treatment can improve bowel control and make
incontinence easier to manage.
For more detailed information click here.
For information by Mayo Clinic click here. |
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The study was the first, to the authors' knowledge,
to examine major depression as a potential risk factor for FI. They say
FI could be a contributing factor to major depression in some cases, and
major depression could be a contributing factor to FI in other cases.
FI can occur after damage to the anal sphincter
muscles or scarring to the rectum, causing it to be unable to hold
stool. Ulcerative colitis, Crohn's disease and some other conditions can
cause this scarring to occur. Another contributing factor can be the
stretching of the nerves that supply the sphincters, called the pudendal
nerves, which can occur with childbirth, old age, trauma, or with
medical diseases that affect the nerves, such as diabetes. Without
intact nerves to stimulate the sphincters, the sphincters may undergo
atrophy.
Because of the nature of the condition, people who
have FI often do not discuss it with their doctors, experts say. That is
why the study's authors encourage clinicians to take a more active role
in finding out if their patients are experiencing FI, especially among
patients age 50 or older. They note that while FI is present in many
elderly women, it should not be considered merely a normal part of
aging. They also encourage women to discuss the issue with their
doctors.
It also is important for women and their doctors to
be aware of the conditions that often go along with FI. Researchers
found that women in the study with FI were more likely to have:
● A higher number of deliveries
● Urinary incontinence
● A previous hysterectomy
● Another medical condition as well, such as major depression or
diabetes
● A history of operative vaginal delivery, such as those using forceps
or a vacuum-assisted device.
The impact of incontinence on the quality of life
of the respondents was "significant," says Fenner, who is one of the
founders of the Michigan Bowel Control Program at the University of
Michigan Health System. "We found that half of the subjects with FI
reported that their bowel symptoms had a large impact on their quality
of life," she notes.
Treatments that can help people manage FI can range
from changes in diet and exercise, to medications that improve the
formation of stools, to surgery that repairs the sphincter muscles. In
some cases, an artificial bowel sphincter can be implanted under the
skin to mimic the natural function of the anal sphincter. Biofeedback
which involves daily exercises to improve the strength of muscles used
to hold back a bowel movement also is an option for some patients.
The lead author of the study was Jennifer L.
Melville, M.D., M.P.H., of the Department of Obstetrics and Gynecology
and the Department of Psychiatry & Behavioral Sciences at the University
of Washington. In addition to Melville and Fenner, other authors were
Ming-Yu Fan, Ph.D., of the Department of Psychiatry & Behavioral
Sciences at the University of Washington and Katherine Newton, Ph.D., of
the Center for Health Studies at the Group Health Cooperative of Puget
Sound of Seattle.
About the research
The research was supported by grants from the
National Institute of Child Health and Human Development and the
National Institute of Mental Health, and a project-specific grant from
Pharmacia Corporation.
Citation: American Journal of Obstetrics and
Gynecology, Dec. 2005, vol. 193, 2071-6.
For more information about fecal incontinence:
www.med.umich.edu/1libr/aha/umfecal.htm
For more information about the Michigan Bowel
Control Program:
www.med.umich.edu/bowelcontrol/about/fecal_incont.htm
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