title: Faecal incontinence in rural and regional northern Queensland community-dwelling adults.
abstract: BACKGROUND
  In Australia, faecal incontinence, the involuntary loss of liquid or solid stool with or without a person's awareness, has been reported in 8% of the South Australian and 11% of the urban New South Wales community-dwelling populations. Studies conducted in 2004 and 2005 reported faecal incontinence in more than 20% of colorectal and urogynaecological clinic patients at Townsville Hospital (a referral centre serving rural North Queensland). This prompted concern regarding the level of faecal incontinence in the community. The aim of this study was to investigate the prevalence of faecal incontinence in the North and Far North Queensland urban and rural communities.
  
  
  METHODS
  The sample size was based on the New South Wales postal surveys (11% prevalence). Higher rates were expected in North/Far North Queensland, so prevalence there was estimated at 12.1% (confidence interval ± 2%, ie the true level to be between 10.1% and 14.1%). The sample for each of the Townsville, Cairns (in Far North Queensland) and rural/remote settings was calculated at 1022. The database for the present study was compiled using a systematic randomised process selecting two private names from each column on each page of the Cairns and Townsville White Pages® (Cairns: 1112 urban, 481 rural, 226 remote; Townsville: 1049 urban, 432 rural, 320 remote). The questionnaire covered personal demographics, health/risk factors, bowel habits, nutrition (fibre and fluid intake) and physical activity. Faecal incontinence was defined as accidental leakage of solid or liquid stool in the past 12 months that was not caused by a virus, medication or contaminated food. To improve the response rate a participation incentive of a chance to win a $250 voucher or one of ten $50 vouchers was offered in the initial mail-out. The initial survey was mailed out in July 2007; two follow-up surveys were mailed out to non-responders in September 2007 and January 2008. One hundred randomly selected non-responders were telephoned in February 2008.
  
  
  RESULTS
  A total of 1523 responses provided a 48.1% response rate. Faecal incontinence prevalence was 12.7% (174/1366) with no gender or locality differences. Prevalence increased significantly with age in men (p=0.034), but not in women. Only 10 respondents with faecal incontinence consulted their doctor in the previous year for this reason. Incontinent respondents had significantly more medical conditions including urinary incontinence, coeliac disease, irritable bowel syndrome, injury to the anus, bowel cancer, spinal cord disease, neurological disease and psychiatric problems (all, p< 0.05). Stool-related accidental bowel leakage including faecal incontinence (defined), soiling with flatus or urgency, was 18.2%. An additional 3% were possibly incontinent, having disclosed leakage of mucus, bothersome or passive staining. Of the remaining respondents, 16.2% reported incontinent episodes due to an acute illness, 22.9% could not always differentiate between flatus and stool, and only 35.2% reported neither concerns with nor accidental bowel leakage.
  
  
  CONCLUSIONS
  There is a high level of untreated faecal incontinence in North/Far North Queensland communities. Demand for treatment will increase because of the ageing population and the expectations of younger, more assertive cohorts.
authors.affiliation: James Cook University, Townsville, Queensland, Australia. lynne.bartlett@my.jcu.edu.au.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Bartlett
authors.forename: Madeleine J
authors.initials: MJ
authors.lastname: Nowak
authors.forename: Yikhong
authors.initials: Y
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult