Symptom outcomes important to women with anal incontinence: a conceptual framework.
OBJECTIVE
To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective.


METHODS
A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semistructured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment "success"; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews.


RESULTS
Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: "primary bowel leakage symptoms" and "ancillary bowel symptoms." Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort.


CONCLUSIONS
Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence. LEVEL OF EVIEDENCE: II.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New, Mexico, Albuquerque, New Mexico; the Program for Research in Survey Methodology, RTI International, Research Triangle Park, North Carolina; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Health System Department, Philadelphia, Pennsylvania; the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's, Health Institute, Cleveland Clinic, Cleveland, Ohio; the Women's Center for Bladder and Pelvic Health, Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, California; the Birmingham and Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Vivian W
VW
Sung
Rebecca G
RG
Rogers
Carla M
CM
Bann
Lily
L
Arya
Matthew D
MD
Barber
Jerry
J
Lowder
Emily S
ES
Lukacz
Alayne
A
Markland
Nazema
N
Siddiqui
Amanda
A
Wilmot
Susan F
SF
Meikle
D000368:Aged; D001364:Awareness; D003248:Constipation / Q000150:complications; D003967:Diarrhea / Q000150:complications; D005242:Fecal Incontinence / Q000150:complications / Q000517:prevention & control* / Q000523:psychology*; D005243:Feces; D005260:Female; D005414:Flatulence / Q000150:complications; D017144:Focus Groups; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008875:Middle Aged; D010347:Patient Care Planning; D009626:Terminology as Topic