Fecal incontinence: community prevalence and associated factors - A systematic review

BACKGROUND: Fecal incontinence is a chronic and debilitating condition with significant health burden. Despite its clinical relevance, the prevalence of fecal incontinence remains inconsistently described. OBJECTIVE: This study aimed to systematically review the literature regarding the prevalence of and factors associated with fecal incontinence among community-dwelling adults. DATA SOURCES: A search of the PubMed, Embase, and Cochrane databases was performed. STUDY SELECTION: Studies that reported the prevalence of fecal incontinence and/or associated factors in a community-based (ie, unselected) adult population were included. Two independent assessors reviewed eligible articles. MAIN OUTCOME MEASURES: Relevant data were extracted from each study and presented in descriptive form. The main outcome measures included the prevalence of fecal incontinence (adjusted and/or unadjusted), stratified for age and sex if reported; factors associated (and not associated) with fecal incontinence; and study quality, assessed using predefined criteria. RESULTS: Of 3523 citations identified, 38 studies were included for review. The reported median prevalence of fecal incontinence was 7.7% (range, 2.0%–20.7%). Fecal incontinence equally affected both men (median, 8.1%; range, 2.3%–16.1%) and women (median, 8.9%; range, 2.0%–20.7%) and increased with age (15–34 years, 5.7%; >90 years, 15.9%). The study populations and diagnostic criteria used were heterogeneous, precluding any meaningful pooling of prevalence estimates. Study quality assessment revealed 6 high-quality studies, of which only 3 were performed in a representative sample. The median prevalence of fecal incontinence was higher in these studies at 11.2% (range, 8.3%–13.2%). The factors most commonly reported to be associated with fecal incontinence included increasing age, diarrhea, and urinary incontinence. LIMITATIONS: Heterogeneity of studies precluded meaningful pooling or meta-analysis of data. CONCLUSIONS: Fecal incontinence is a prevalent condition of equal sex distribution, affecting [almost equal to]1 in 8 community adults, and has identifiable associated factors. The paucity of high-quality prevalence studies emphasizes the need for future population-based studies that use standardized diagnostic criteria for fecal incontinence.Kheng-Seong Ng, Yogeesan Sivakumaran, Natasha Nassar, Marc A. Gladma