title: Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop.
abstract: In August 2013, the National Institutes of Health sponsored a conference to address major gaps in our understanding of the epidemiology, pathophysiology, and management of fecal incontinence (FI) and to identify topics for future clinical research. This article is the first of a two-part summary of those proceedings. FI is a common symptom, with a prevalence that ranges from 7 to 15% in community-dwelling men and women, but it is often underreported, as providers seldom screen for FI and patients do not volunteer the symptom, even though the symptoms can have a devastating impact on the quality of life. Rough estimates suggest that FI is associated with a substantial economic burden, particularly in patients who require surgical therapy. Bowel disturbances, particularly diarrhea, the symptom of rectal urgency, and burden of chronic illness are the strongest independent risk factors for FI in the community. Smoking, obesity, and inappropriate cholecystectomy are emerging, potentially modifiable risk factors. Other risk factors for FI include advanced age, female gender, disease burden (comorbidity count, diabetes), anal sphincter trauma (obstetrical injury, prior surgery), and decreased physical activity. Neurological disorders, inflammatory bowel disease, and pelvic floor anatomical disturbances (rectal prolapse) are also associated with FI. The pathophysiological mechanisms responsible for FI include diarrhea, anal and pelvic floor weakness, reduced rectal compliance, and reduced or increased rectal sensation; many patients have multifaceted anorectal dysfunctions. The type (urge, passive or combined), etiology (anorectal disturbance, bowel symptoms, or both), and severity of FI provide the basis for classifying FI; these domains can be integrated to comprehensively characterize the symptom. Several validated scales for classifying symptom severity and its impact on the quality of life are available. Symptom severity scales should incorporate the frequency, volume, consistency, and nature (urge or passive) of stool leakage. Despite the basic understanding of FI, there are still major knowledge gaps in disease epidemiology and pathogenesis, necessitating future clinical research in FI.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Gena
authors.initials: G
authors.lastname: Dunivan
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Goode
authors.affiliation: Department of Reproductive Medicine, UC San Diego Health Systems, La Jolla, California, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Alayne D
authors.initials: AD
authors.lastname: Markland
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Matthews
authors.affiliation: Simon Foundation, Langley, British Columbia, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Mott
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.affiliation: 1] Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA [2] Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.affiliation: Department of Gastroenterology, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.affiliation: National Institutes of Diabetes, Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Hamilton
mesh_terms: D001003:Anal Canal / Q000503:physiopathology; D004493:Education; D005242:Fecal Incontinence / Q000145:classification* / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D054586:National Institute of Diabetes and Digestive and Kidney Diseases (U.S.); D017773:Pelvic Floor / Q000503:physiopathology; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States