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Is there an association between fecal incontinence and lower urinary dysfunction?

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Diseases of the Colon & Rectum

Abstract

BACKGROUND: Urinary and fecal incontinence in females are both common and distressing conditions. Because common pathophysiologic mechanisms have been described, an association between the two would be expected. The aim of this study was to determine whether patients with lower urinary tract dysfunction have concomitant fecal incontinence when compared with age and gender matched community controls and, second, to determine whether they have predisposing factors that have led to lower urinary tract symptoms and concomitant fecal incontinence. METHODS: A case-control study was performed by means of detailed questionnaire and review of investigation results. One thousand consecutive females presenting for urodynamic investigation of lower urinary tract dysfunction, were compared with 148 age and gender matched community controls. RESULTS: Frequent fecal incontinence was significantly more prevalent among all cases than among community controls (5vs. 0.72 percent,P=0.023). Occasional fecal incontinence was also more prevalent (24.6vs. 8.4 percent,P<0.001). Fecal incontinence was not significantly more prevalent among females with genuine stress incontinence (5.1 percent) when compared with females with detrusor instability (3.8 percent) or any other urodynamic diagnosis. Symptoms of fecal urgency and fecal urge incontinence were significantly more prevalent among those with a urodynamic diagnosis of detrusor instability or sensory urgency than among females with other urodynamic diagnoses or community controls. Multivariate analysis comparing cases with fecal incontinence with other cases and also with community controls did not indicate that individual obstetric factors contributed significantly to the occurrence of fecal incontinence in these patients. CONCLUSIONS: There is an association between genuine stress incontinence, lower urinary tract dysfunction, and symptoms of fecal incontinence, but the exact mechanism of injury related to childbirth trauma is questioned.

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References

  1. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J Urol 1991;146:1255–9.

    PubMed  Google Scholar 

  2. MacArthur C, Bick DE, Keighley MR. Faecal incontinence after childbirth. Br J Obstet Gynaecol 1997;104:46–50.

    PubMed  Google Scholar 

  3. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA 1995;274:559–61.

    Article  PubMed  Google Scholar 

  4. Jackson SL, Weber AM, Hull TL, Mitchinson AR, Walters MD. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 1997;89:423–7.

    Article  PubMed  Google Scholar 

  5. Lewis P, Abrahams P, Shepherd A. The incidence of bowel symptoms in urodynamic patients [meeting abstract]. Neurourol Urodyn 1990;9:357–8.

    Google Scholar 

  6. Anderson RS. Neurogenic element to urinary genuine stress incontinence. Br J Obstet Gynaecol 1984;91:41–5.

    PubMed  Google Scholar 

  7. Kok AL, Voorhorst FJ, Burger CW, Van Houten P, Kenemans P, Janssens J. Urinary and faecal incontinence in community residing elderly women. Age Aging 1992;21:211–5.

    Google Scholar 

  8. Tetzschner T, Sorensen M, Lose G, Christiansen J. Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 1996;103:1034–40.

    PubMed  Google Scholar 

  9. Thorpe AC, Roberts JP, Williams NS, Blandy JP, Badenoch DF. Pelvic floor physiology in women with faecal incontinence and urinary symptoms. Br J Surg 1995;82:173–6.

    PubMed  Google Scholar 

  10. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546–50.

    Article  PubMed  Google Scholar 

  11. Snooks SJ, Barnes PR, Swash M. Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 1984;47:1269–73.

    PubMed  Google Scholar 

  12. Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.

    PubMed  Google Scholar 

  13. Snooks SJ, Swash M. Perineal nerve and transcutaneous spinal stimulation: new methods for investigation of the urethral striated sphincter musculature. Br J Urol 1984;56:406–9.

    PubMed  Google Scholar 

  14. Snooks SJ, Swash M, Henry MM. Abnormalities in central and peripheral nerve conduction in patients with anorectal incontinence. J R Soc Med 1985;78:294–300.

    PubMed  Google Scholar 

  15. Ryhammer AM, Beck KM, Laurberg A. Multiple vaginal deliveries increase the risk of permanent incontinence of flatus and urine in normal premenopausal women. Dis Colon Rectum 1995;38:1206–9.

    Article  PubMed  Google Scholar 

  16. Thind P, Bagi P, Mieszczak C, Lose G. Influence of pudendal nerve blockade on stress relaxation in the female urethra. Neurourol Urodyn 1996;15:31–6.

    Article  PubMed  Google Scholar 

  17. Allen RE, Hosker GL, Smith AR, Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br J Obstet Gynaecol 1990;97:770–9.

    PubMed  Google Scholar 

  18. Smith AR, Hosker GL, Warrell DW. The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 1989;96:29–32.

    PubMed  Google Scholar 

  19. Smith AR, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol 1989;96:24–8.

    PubMed  Google Scholar 

  20. Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.

    PubMed  Google Scholar 

  21. Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 1994;101:22–8.

    PubMed  Google Scholar 

  22. Jarvis GJ, Hall S, Stamp S, Millar DR, Johnson A. An assessment of urodynamic examination in incontinent women. Br J Obstet Gynaecol 1980;87:893–6.

    PubMed  Google Scholar 

  23. Tetzschner T, Sorensen M, Lose G, Christiansen J. Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 1996;103:1034–40.

    PubMed  Google Scholar 

  24. Snooks SJ, Henry MM, Swash M. Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology. Br J Obstet Gynaecol 1985;92:824–8.

    PubMed  Google Scholar 

  25. Moller Bek K, Laurberg S. Intervention during labour: risk factors associated with complete tear of the anal sphincter. Acta Obstet Gynecol Scand 1992;71:520–4.

    PubMed  Google Scholar 

  26. Bek KM, Laurberg S. Risks of incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol 1992;99:724–6.

    PubMed  Google Scholar 

  27. Drossman DA. What can be done to control incontinence associated with the irritable bowel syndrome? Am J Gastroenterol 1989;84:355–7.

    PubMed  Google Scholar 

  28. Monga AK, Marrero JM, Stanton SL, Lemieux MC, Maxwell JD. Is there an irritable bladder in the irritable bowel syndrome? Br J Obstet Gynaecol 1997;104:1409–12.

    PubMed  Google Scholar 

  29. Cukier JM, Cortina-Borjia M, Brading AF. A case control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder. Br J Urol 1997;79:865–78.

    PubMed  Google Scholar 

  30. Spence-Jones C, Kamm MA, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynecol 1994;101:147–52.

    Google Scholar 

  31. Engel AF, Kamm MA. The acute effect of straining on pelvic floor neurological function. Int J Colorectal Dis 1994;9:8–12.

    Article  PubMed  Google Scholar 

  32. Lubowski DZ, Swash M, Nicholls RJ, Henry MM. Increase in pudendal nerve terminal motor latency with defaecation straining. Br J Surg 1988;75:1095–7.

    PubMed  Google Scholar 

  33. Snooks SJ, Barnes PR, Swash M, Henry MM. Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterology 1985;89:977–81.

    PubMed  Google Scholar 

  34. Keane DP. A study of the pathophysiology of genuine stress incontinence in the pre-menopausal nulliparous female [M.D. thesis]. Dublin, Ireland: University College Dublin; 1993.

    Google Scholar 

  35. Ulmsten U, Ekman G, Giertz G, Malmström A. Different biochemical composition of connective tissue in continent and stress incontinent women. Acta Obstet Gynecol Scand 1987;66:455–7.

    PubMed  Google Scholar 

  36. Bergman A, Elia G, Cheung D, Perelman N, Nimni ME. Biochemical composition of collagen in continent and stress urinary incontinent women. Gynecol Obstet Invest 1994;37:48–51.

    PubMed  Google Scholar 

  37. Norton PA. Pathogenesis of stress urinary incontinence: the role of connective tissue. In: Ostergard DR, Bent AE, eds. Urogynaecology and urodynamics: theory and practice. Baltimore: Williams and Wilkins, 1996:284–5.

    Google Scholar 

  38. Sayer T, Dixon J, Hosker G, Warrell D. A study of paraurethral connective tissue in women with stress incontinence of urine. Neurourol Urodyn 1990;9:319–452.

    Google Scholar 

  39. Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma; gastrointestinal disorders and systemic disease, part 1. Gastroenterol Clin North Am 1998;27:563–94.

    Article  PubMed  Google Scholar 

  40. Leighton JA, Valdovinos MA, Pemberton JH, Rath DM, Camilleri M. Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis. Dis Colon Rectum 1993;36:182–5.

    Article  PubMed  Google Scholar 

  41. D'Angelo G, Stern HS, Myers E. Rectal prolapse in scleroderma: case report and review of colonic complications of scleroderma. Can J Surg 1985;28:62–3.

    PubMed  Google Scholar 

  42. Al Rawi ZS, Al Aszawi AJ, Al Chalabi T. Joint mobility among university students in Iraq. Br J Rheumatol 1985;24:326–31.

    PubMed  Google Scholar 

  43. Child AH. Joint hypermobility syndrome: inherited disorder of collagen synthesis. J Rheumatol 1986;13:239–43.

    PubMed  Google Scholar 

  44. Marshman D, Percy J, Fielding I, Delbridge L. Rectal prolapse: relationship with joint mobility. Aust N Z J Surg 1987;57:827–9.

    PubMed  Google Scholar 

  45. Swash M. The pelvic floor and incontinence [letter]. Lancet 1994;344:1301.

    Article  Google Scholar 

  46. Guyatt G, Mitchell A, Irvine EJ,et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology 1989;96:804–10.

    PubMed  Google Scholar 

  47. Irvine EJ, Feagan BG, Wong CJ. Does self administration of a quality of life index for inflammatory bowel disease change the results? J Clin Epidemiol 1996;49:1177–85.

    Article  PubMed  Google Scholar 

  48. Swash M, Snooks SJ, Henry MM. Unifying concept of pelvic floor disorders and incontinence. J R Soc Med 1985;78:906–11.

    PubMed  Google Scholar 

  49. Khullar V, Damiano R, Tooz-Hobson P, Cardozo L. Prevalence of faecal incontinence among women with urinary incontinence. Br J Obstet Gynaecol 1998;105:1211–3.

    PubMed  Google Scholar 

  50. Jones PN, Lubowski DZ, Swash M, Henry MM. Relation between perineal descent and pudendal nerve damage in idiopathic fecal incontinence. Int J Colorectal Dis 1987;12:93–5.

    Article  Google Scholar 

  51. Jorge JM, Wexner SD, Ehrenpreis ED, Nogueras JJ, Jagelman DG. Does perineal descent correlate with pudendal neuropathy? Dis Colon Rectum 1993;36:475–83.

    Article  PubMed  Google Scholar 

  52. Henry M, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg 1982;69:470–2.

    PubMed  Google Scholar 

  53. Dwyer PL, Lee ET, Hay DM. Obesity and urinary incontinence in women. Br J Obstet Gynaecol 1988;95:91–6.

    PubMed  Google Scholar 

  54. Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics and study type. J Am Geriatr Soc 1998;46:473–80.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. From the Urogynaecology Unit, Royal Prince Alfred Hospital, Australia

    Jane Manning M.B.B.S. (M.R.A.C.O.G.), Andrew Korda M.A., M.B.B.S. (F.R.A.C.O.G., F.R.C.O.G., C.U.) & Chris Benness M.B.B.S. M.D. (F.R.A.C.O.G.)

  2. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Australia

    Michael J. Solomon M.B., B.Ch.(Hons.), M.Sc.(Cl. Epid.) (F.R.A.C.S.)

  3. Department of Surgery, University of Sydney, Sydney, Australia

    Anthony A. Eyers M.B.B.S.(Hons.) (F.R.A.C.S.) &  Michael J. Solomon M.B., B.Ch.(Hons.), M.Sc.(Cl. Epid.) (F.R.A.C.S.)

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  1. Jane Manning M.B.B.S.
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  2. Anthony A. Eyers M.B.B.S.(Hons.)
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Supported by a research grant from the ANZAC Health and Medical Research Foundation.

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Manning, J., Eyers, A.A., Korda, A. et al. Is there an association between fecal incontinence and lower urinary dysfunction?. Dis Colon Rectum 44, 790–798 (2001). https://doi.org/10.1007/BF02234696

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