The Differential Impact of Flatal Incontinence in Women With Anal Versus Fecal Incontinence.
OBJECTIVE
The differential impact on quality of life (QOL) that leakage of both stool and flatus confers on women compared with stool only is unclear. Our aim was to characterize differences in symptom distress, impact on QOL, and anorectal testing among women with leakage of stool and flatus, stool only, and flatus only.


METHODS
A retrospective review was conducted of women undergoing evaluation of at least monthly bowel incontinence symptoms. Subjects were divided into the following 3 groups: liquid/solid stool and flatus (anal incontinence [AI]), liquid/solid stool only (fecal incontinence [FI]), and flatal only (FL). Baseline assessment included the Modified Manchester Health Questionnaire (MMHQ) including the Fecal Incontinence Severity Index (FISI), Short Form-12 (SF-12), as well as anorectal manometry and endoanal ultrasound evaluations.


RESULTS
Of 436 subjects, 381 had AI, 45 FI, and 10 FL. Significant between-group differences were noted in MMHQ (P = 0.0002) and FISI total scores (P < 0.0001) where women with AI reflected greater negative impact than women with FI. The Short Form-12 (mental and physical component summary scores) scores were similar in all 3 groups (P = 0.22, 0.08). Resting/squeeze pressures were significantly lower in AI and FI groups compared with FL (P = 0.0004), whereas rectal capacity was similar in all 3 groups. Although exploratory, MMHQ scores were similar between FI and FL groups, although FISI scores were higher in the FI group (P < 0.0001).


CONCLUSIONS
Women with AI have higher symptom specific distress and greater negative impact on QOL compared with women with FI. Treatment of all bowel incontinence symptoms is important to improve symptom-specific and general QOL.
From the *Division of Urogynecology and Pelvic Reconstructive Surgery, †Department of Obstetrics and Gynecology, and ‡Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
Isuzu
I
Meyer
Ying
Y
Tang
Jeff M
JM
Szychowski
Holly E
HE
Richter
D000328:Adult; D000368:Aged; D000407:Alabama; D001003:Anal Canal / Q000000981:diagnostic imaging; D005242:Fecal Incontinence / Q000523:psychology*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014463:Ultrasonography