LAS VEGAS - The prevalence of fecal incontinence rose modestly but steadily over a 5-year period ending in 2010, according to a survey of U.S. households.
The proportion of affected adults increased from less than 7.3% during 2005/2006 to more than 7.74% in 2009/2010.
Women had higher rates of fecal incontinence throughout the 5 years, and the study confirmed a recognized association with older age, as almost 10% of study participants were ≥70, as reported here at the American College of Gastroenterology meeting.
"The primary message from this study is that fecal incontinence is a significant problem in the U.S.," Ivo Ditah, MD, of the Mayo Clinic in Rochester, Minn., told MedPage Today.
"The only surprise was that the prevalence was kind of stable over the 5 years of the study. The reason for that is not clear, but I think that is because a lot of people with fecal incontinence are referred to nursing homes, and [the database] is limited to the general population. Therefore, we are not capturing those patients. As a result, the rates we observed are an underestimation of the true extent of the problem."
Fecal incontinence has been studied most extensively among institutionalized individuals, such as those living in nursing homes. Limited information exists regarding the epidemiology and risk factors for the condition in the general population, Ditah noted in his presentation.
Additionally, patients affected by fecal incontinence often do not report the problem to physicians or other healthcare providers because of embarrassment, further complicating efforts to determine the scope and causes of fecal incontinence in the general population.
Beginning in 2005, the National Health and Nutrition Examination Survey (NHANES) included a validated scale to assess fecal incontinence. By 2010, sufficient data had accumulated to permit an analysis of the prevalence of and risk factors for fecal incontinence.
The survey included noninstitutionalized men and women ≥20. Investigators defined fecal incontinence as "accidental leakage of solid, liquid, or mucus at least once in the preceding month." They weighted the survey participants to approximate the U.S. population for extrapolation of the results.
The analysis comprised 8,303 men and 8,829 women. The overall prevalence of fecal incontinence for the 5-year period was 7.33%. The rate increased from 7.3% in 2005/2006 to 7.48% in 2007/2008 to 7.74% in 2009/2010.
Women had a higher prevalence during each interval included in the analysis: 7.69% for 2005/2006, 8.39% for 2007/2008, and 8.41% for 2009/2010. Corresponding rates for men were 6.87%, 6.46%, and 6.97%.
Prevalence of fecal incontinence increased with age, ranging from 1.8% of respondents 20 to 29, 3.2% for age group 30 to 39, 5.71% for people 40 to 54, 7.88% among those 55 to 69, and 9.59% of individuals ≥70.
A multivariate analysis revealed multiple factors that had significant associations with fecal incontinence: age, body mass index, general health status, sex, ethnicity (more common in whites and blacks compared with Hispanics), marital status (less common among married individuals), education, and a history of urinary incontinence.
Given demographic trends in the U.S., the scope and burden of fecal incontinence will almost certainly increase in the future, said Ditah.
"People are living longer, and we know that age is the one factor that is consistently associated with fecal incontinence," he said. "If we understand that, then we should realize that this is going to become a major public health problem in the near future."
"Thankfully, in the past decade, many methods have been developed to help these patients. Physicians just need to recognize it. It's a very significant social problem, very embarrassing, and people don't want to talk about it."