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. 2004 Mar;97(3):111-6.
doi: 10.1177/014107680409700303.

Risk factors in acquired faecal incontinence

Peter J Lunniss  1 , Marc A Gladman, Franc H Hetzer, Norman S Williams, S Mark Scott
Affiliations

Risk factors in acquired faecal incontinence

Peter J Lunniss et al. J R Soc Med. 2004 Mar.

Abstract

Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing. Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple). These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.

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Figures

<i>Figure 1</i>
Figure 1
Prevalence of differing types of incontinence in female and male patients. PDL=post-defaecation leakage.
<i>Figure 2</i>
Figure 2
Age at onset of symptoms
<i>Figure 3</i>
Figure 3
Risk factors identified from patient histories. The smaller pie charts depict the proportions of male and female patients with isolated, multiple or no risk factors in their histories. The larger pie charts illustrate the relative proportions of isolated risk factors. A-P=abdominopelvic
<i>Figure 4</i>
Figure 4
Pathophysiological basis for faecal incontinence, as revealed by objective anorectal physiological testing. `Mixed' represents any combination of the other three physiological abnormalities (anatomical; sensory; neurogenic). `None identified' signifies that none of the three other pathophysiologies were demonstrated; however, 41% of these patients had reduced anal pressures on manometry. ▪ Female; □ male
See this image and copyright information in PMC

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