title: Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence and associations between anal intercourse and fecal incontinence.
  
  
  METHODS
  Analyses were based on data from 6,150 adults (≥20 years) from the 2009-2010 cycle of the National Health and Nutrition Examination Surveys. Fecal incontinence was defined as the loss of liquid, solid, or mucus stool occurring at least monthly on a validated questionnaire. A gender-specific sexual behavior questionnaire assessed any anal intercourse via an audio computer-assisted personal interview. Co-variables included: age, race, education, poverty income ratio, body mass index, chronic illnesses, depression, loose stool consistency (Bristol Stool Scale types 6 or 7), and reproductive variables in women. Prevalence estimates and prevalence odds ratios (PORs) were analyzed in adjusted multivariable models using appropriate sampling weights.
  
  
  RESULTS
  Overall, 4,170 adults aged 20-69 years (2,070 women and 2,100 men) completed sexual behavior questionnaires and responded to fecal incontinence questions. Anal intercourse was higher among women (37.3%) than men (4.5%), P<0.001. Fecal incontinence rates were higher among women (9.9 vs. 7.4%, P=0.05) and men (11.6 vs. 5.3%, P=0.03) reporting anal intercourse compared with those not reporting anal intercourse. After multivariable adjustment for other factors associated with fecal incontinence, anal intercourse remained a predictor of fecal incontinence among women (POR: 1.5; 95% confidence interval (CI): 1.0-2.0) and men (POR: 2.8; 95% CI: 1.6-5.0).
  
  
  CONCLUSIONS
  The findings support the assessment of anal intercourse as a factor contributing to fecal incontinence in adults, especially among men.
authors.affiliation: Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA.|Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA.|Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Aging, School 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, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA.
authors.forename: Gena C
authors.initials: GC
authors.lastname: Dunivan
authors.affiliation: Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA.|Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia, USA.
authors.forename: Camille P
authors.initials: CP
authors.lastname: Vaughan
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult