Objective
We sought to determine the prevalence and predictors of fecal incontinence (FI) and to evaluate the impact of FI on quality of life (QoL)
in women seeking treatment for urge-predominant urinary incontinence (UUI).
Methods
This is an ancillary analysis of baseline information collected from 307 women enrolled in the Urinary Incontinence Treatment Network’s Behavior Enhances Drug Reduction of Incontinence (BEDRI) study. BEDRI randomized women with UUI seeking treatment to drug or drug plus behavioral therapy. FI type was defined by participants’ responses to “Do you have leaking or loss of control of liquid/solid stool?” Participants reporting FI “more than once a month” were then categorized as FI . Independent variables included: sociodemographic characteristics (age, race, education, and Nam Powers occupation score), health status and history (body mass index [BMI], diabetes, congestive heart failure, obstetrical history, prior surgical history, and menopausal status), physical examination findings (pelvic organ prolapse quantification [POP-Q], pelvic muscle strength and duration [Brink’s score], anal sphincter contraction, UI severity (daily UI episodes on 3-day bladder diary), and UI symptom bother (urogenital distress inventory [UDI], incontinence impact questionnaire [IIQ]). The overactive bladder questionnaire (OAB-Q) and SF-12 scores measured condition-specific and general QOL, respectively. In univariate analysis, independent variables were compared between 2 groups: women with isolated UUI (n=251) and women with UUI and FI (n = 56). Multivariable logistic regression models were created using variables significant at 0.1 level to distinguish factors that may impact having both FI and UUI from isolated UUI. Results of the logistic regression are presented as odds ratio (OR) and 95% confidence interval (CI).
Results
Eighteen percent of participants (mean 57±14 years of age) reported monthly FI: 12% had liquid stool FI and 6% had liquid and solid stool FI. All mean QOL measures were significantly worse in women with UUI and FI than those with UUI only: IIQ (192±104 vs 145±97, P=.002); SF-12 (88±16 vs 94±15, P=.003); OAB-Q QOL (55±27 vs 63±23, P=.03). The following sociodemographic and clinical variables were significantly different between the 2 groups and included in the multivariable regression model: age, occupational score, BMI, ethnicity, diabetes, prior UI treatment, POPQ Bp, vaginal delivery (yes/no), MESA stress and urge scores, and UDI score. Women with UUI and monthly FI were more likely to have had a vaginal delivery (OR=2.67 95%CI: 1.08-6.64), more likely to have a more prolapsed POP-Q point Bp (OR=1.38 95% CI: 1.06-1.81), more likely to have higher BMI (OR= 1.05 95% CI:1.01-1.09), and more likely to have higher MESA urge score (OR=1.15 95% CI:1.04-1.26) than those with UUI only.
Conclusions
Nearly 20% of women enrolled in a clinical trial comparing drug and behavioral therapy for UUI reported monthly FI. Women with UUI and FI reported greater general and condition specific health-related QoL impact than those with isolated UUI. Significant predictors of FI in women with UUI included prior vaginal delivery and posterior compartment prolapse.
Keywords
urge urinary incontinence, fecal incontinence, risk factors, women, quality of life
Supported by cooperative agreements from the National Institute of Diabetes and Digestive and Kidney Diseases, U01 DK58225, U01 DK58229, U01 DK58234, U01 DK58231, U01 DK60379, U01 DK60380, U01 DK60393, U01 DK60395, U01 DK60397, U01 DK60401 and DK068389. Support was also provided by the National Institute of Child Health and Human Development and Office of Research in Women’s Health, NIH.