Fecal incontinence in the elderly: FAQ

American Journal of Gastroenterology

Volumn 107, Issue 11, 2012, Pages 1635-1646

  Shah, Brijen J ^a   Chokhavatia, Sita ^a   Rose, Suzanne ^b  

^a MOUNT SINAI SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DIPHENOXYLATE; LOPERAMIDE;

AGED; AGING; ANORECTAL PRESSURE; ANUS SPHINCTER; BEHAVIOR CHANGE; BRAIN TUMOR; CAUDA EQUINA SYNDROME; CEREBROVASCULAR ACCIDENT; CHILDBIRTH; CHRONICITY; CONSTIPATION; DEMENTIA; DEPRESSION; DIABETES MELLITUS; DIARRHEA; DIET; DIGITAL RECTAL EXAMINATION; DISEASE ASSOCIATION; DISEASE COURSE; DISEASE SEVERITY; FECES IMPACTION; FECES INCONTINENCE; FEEDBACK SYSTEM; FOLLOW UP; FUNCTIONAL STATUS; GERIATRIC PATIENT; HEALTH CARE COST; HEALTH EDUCATION; HUMAN; HYPERCALCEMIA; HYPOKALEMIA; HYPOTHYROIDISM; KIDNEY DISEASE; LABOR STAGE 2; LIFESTYLE MODIFICATION; MEDICAL HISTORY; MEDICARE; MULTIPLE SCLEROSIS; PATIENT COMPLIANCE; POLYPHARMACY; PRACTICE GUIDELINE; PREVALENCE; PRIORITY JOURNAL; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK FACTOR; SHY DRAGER SYNDROME; TREATMENT PLANNING; URINE INCONTINENCE; VAGINAL DELIVERY;

AGED; AGED, 80 AND OVER; COST OF ILLNESS; FECAL INCONTINENCE; FEMALE; FRAIL ELDERLY; HUMANS; MALE; NURSING HOMES; PREVALENCE;

EID: 84869491447     PISSN: 00029270     EISSN: 15720241     Source Type: Journal    
DOI: 10.1038/ajg.2012.284     Document Type: Review

References (118)

1. Sailer M, Bussen D, Debus ES et al. Quality of life in patients with benign anorectal disorders. Br J Surg 1998; 85: 1716-9. (Pubitemid 28548354)
2. Rao SS. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 2004; 99: 1585-604. (Pubitemid 39180111)
3. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA 1995; 274: 559-61.
4. Edwards NI, Jones D. The prevalence of faecal incontinence in older people living at home. Age Ageing 2001; 30: 503-7. (Pubitemid 34071491)
5. Markland AD, Goode PS, Burgio KL et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc 2010; 58: 1341-6.
6. Rey E, Choung RS, Schleck CD et al. Onset and risk factors for fecal incontinence in a US community. Am J Gastroenterol 2010; 105: 412-9.
7. AlAmeel T, Andrew MK, MacKnight C. The association of fecal incontinence with institutionalization and mortality in older adults. Am J Gastroenterol 2010; 105: 1830-4.
8. Whitehead WE, Borrud L, Goode PS et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137: 512-7, 517 e511-512.
9. Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum 1998; 41: 1226-9. (Pubitemid 28477969)
10. Ouslander JG, Beck JC. Defining the health problems of the elderly. Annu Rev Public Health 1982; 3: 55-83.
11. Ouslander JG, Palmer MH, Rovner BW et al. Urinary incontinence in nursing homes: incidence, remission and associated factors. J Am Geriatr Soc 1993; 41: 1083-9. (Pubitemid 23299864)
12. Brocklehurst J, Dickinson E, Windsor J. Laxatives and faecal incontinence in long-term care. Elder Care 1998; 10: 22-5.
13. Hagglund D. A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs 2010; 19: 303-12.
14. Hughes BT, Chepyala P, Hendon S et al. Fecal incontinence in an inpatient population: a not uncommon finding. Dig Dis Sci 2009; 54: 2215-9.
15. Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction . Am J Gastroenterol 1996; 91: 33-6. (Pubitemid 26026033)
16. Dunivan GC, Heymen S, Palsson OS et al. Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 2010; 202: 493 e491-6.
17. Wald A. Anorectum: Normal Function and Clinical Disorders. B.C. Decker: Hamilton, ON, 2002.
18. Papachrysostomou M, Pye SD, Wild SR et al. Significance of the thickness of the anal sphincters with age and its relevance in faecal incontinence. Scand J Gastroenterol 1994; 29: 710-4. (Pubitemid 24261633)
19. Lewicky-Gaupp C, Hamilton Q, Ashton-Miller J et al. Anal sphincter structure and function relationships in aging and fecal incontinence. Am J Obstet Gynecol 2009; 200: 559; e551-555.
20. Fox JC, Fletcher JG, Zinsmeister AR et al. Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 2006; 49: 1726-35. (Pubitemid 44800490)
21. Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989; 32: 737-42. (Pubitemid 19215922)
22. Bilali S, Pfeifer J. Anorectal manometry: are fatigue rate and fatigue rate index of any clinical importance? Tech Coloproctol 2005; 9: 225-8. (Pubitemid 41772337)
23. Gundling F, Seidl H, Scalercio N et al. Influence of gender and age on anorectal function: normal values from anorectal manometry in a large Caucasian population. Digestion 2010; 81: 207-13.
24. Ryhammer AM, Laurberg S, Bek KM. Age and anorectal sensibility in normal women. Scand J Gastroenterol 1997; 32: 278-84. (Pubitemid 27105305)
25. Shamliyan TA, Bliss DZ, Du J et al. Prevalence and risk factors of fecal incontinence in community-dwelling men. Rev Gastroenterol Disord 2009; 9: E97-E110.
26. Locke GR 3rd, Pemberton JH, Phillips SF. AGA technical review on constipation. American Gastroenterological Association. Gastroenterology 2000; 119: 1766-78.
27. Kelly H, Duunn WM. Urinary incontinence in women, without manifest injury to the bladder. Surg Gynecol Obstet 1914; 119: 444-50.
28. Wang A, Guess M, Connell K et al. Fecal incontinence: a review of prevalence and obstetric risk factors. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17: 253-60.
29. Samarasekera DN, Bekhit MT, Wright Y et al. Long-term anal continence and quality of life following postpartum anal sphincter injury. Colorectal Dis 2008; 10: 793-9.
30. Fornell EU, Matthiesen L, Sjodahl R et al. Obstetric anal sphincter injury ten years aft er: subjective and objective long term effects. BJOG 2005; 112: 312-6. (Pubitemid 40314006)
31. Nelson RL, Furner SE, Westercamp M et al. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010, CD006756.
32. Fritel X, Ringa V, Varnoux N et al. Mode of delivery and fecal incontinence at midlife: a study of 2, 640 women in the Gazel cohort. Obstet Gynecol 2007; 110: 31-8. (Pubitemid 47015697)
33. Bharucha AE, Zinsmeister AR, Schleck CD et al. Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterology 2010; 139: 1559-66.
34. Moore KL, Agur AMR, Moore M et al. Essential Clinical Anatomy, 3 rd edn. Lippincott, Williams and Wilkens: Baltimore, 2007.
35. Goyal RK, Hirano I. The enteric nervous system. N Engl J Med 1996; 334: 1106-15. (Pubitemid 26120190)
36. Brittain KR, Peet SM, Castleden CM. Stroke and incontinence. Stroke 1998; 29: 524-8. (Pubitemid 28086702)
37. Podsiadlo D, Richardson S. The timed " Up & Go ": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-8.
38. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119-26. (Pubitemid 16159911)
39. Stenzelius K, Mattiasson A, Hallberg IR et al. Symptoms of urinary and faecal incontinence among men and women 75+ in relations to health complaints and quality of life. Neurourol Urodyn 2004; 23: 211-22. (Pubitemid 39549980)
40. Schnelle JF, Kapur K, Alessi C et al. Does an exercise and incontinence intervention save healthcare costs in a nursing home population? J Am Geriatr Soc 2003; 51: 161-8. (Pubitemid 36205843)
41. http://apps.mccd.cdc.gov/DDTSTRS/default.aspx. Accessed 18 May 2011.
42. Schiller LR, Santa Ana CA, Schmulen AC et al. Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction . N Engl J Med 1982; 307: 1666-71. (Pubitemid 13206047)
43. Quander CR, Morris MC, Melson J et al. Prevalence of and factors associated with fecal incontinence in a large community study of older individuals . Am J Gastroenterol 2005; 100: 905-9. (Pubitemid 40592386)
44. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 1984; 310: 1282-7. (Pubitemid 14138760)
45. Whitehead WE, Bharucha AE. Diagnosis and treatment of pelvic floor disorders: what's new and what to do. Gastroenterology 2010; 138: 1231-5, 1235 e1231-1234.
46. Caruana BJ, Wald A, Hinds JP et al. Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology 1991; 100: 465-70.
47. deSouza NM, Williams AD, Wilson HJ et al. Fecal incontinence in scleroderma: assessment of the anal sphincter with thin-section endoanal MR imaging. Radiology 1998; 208: 529-35. (Pubitemid 28373767)
48. Wald A. Fecal incontinence: three steps to successful management. Geriatrics 1997; 52: 44-6, 49-52.
49. Ananthakrishnan AN, Binion DG. Treatment of ulcerative colitis in the elderly. Dig Dis 2009; 27: 327-34.
50. Katz S, Feldstein R. Inflammatory bowel disease of the elderly: a wake-up call. Gastroenterol Hepatol (NY) 2008; 4: 337-47. (Pubitemid 351768987)
51. Bliss DZ, Johnson S, Savik K et al. Fecal incontinence in hospitalized patients who are acutely ill. Nurs Res 2000; 49: 101-8.
52. Riordan SM, McIver CJ, Wakefield D et al. Small intestinal bacterial overgrowth in the symptomatic elderly. Am J Gastroenterol 1997; 92: 47-51. (Pubitemid 27027027)
53. Almeida JA, Kim R, Stoita A et al. Lactose malabsorption in the elderly: role of small intestinal bacterial overgrowth. Scand J Gastroenterol 2008; 43: 146-54. (Pubitemid 351161533)
54. Pardi DS, Kelly CP. Microscopic colitis. Gastroenterology 2011; 140: 1155-65.
55. Brandt LJ, Prather CM, Quigley EM et al. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005; 100 (Suppl 1): S5-S21.
56. Schnelle JF, Simmons SF, Beuscher L et al. Prevalence of constipation symptoms in fecally incontinent nursing home residents. J Am Geriatr Soc 2009; 57: 647-52.
57. Gladman MA, Lunniss PJ, Scott SM et al. Rectal hyposensitivity. Am J Gastroenterol 2006; 101: 1140-51. (Pubitemid 43725332)
58. Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence. Gut 1986; 27: 283-7. (Pubitemid 16101899)
59. Read NW, Abouzekry L, Read MG et al. Anorectal function in elderly patients with fecal impaction. Gastroenterology 1985; 89: 959-66. (Pubitemid 16231555)
60. Tariq SH. Geriatric fecal incontinence. Clin Geriatr Med 2004; 20: 571-87, ix. (Pubitemid 39078145)
61. Karling P, Abrahamsson H, Dolk A et al. Function and dysfunction of the colon and anorectum in adults: working team report of the Swedish Motility Group (SMoG). Scand J Gastroenterol 2009; 44: 646-60.
62. Wald A. Management and prevention of fecal impaction. Curr Gastroenterol Rep 2008; 10: 499-501.
63. Lynch AC, Wong C, Anthony A et al. Bowel dysfunction following spinal cord injury: a description of bowel function in a spinal cord-injured population and comparison with age and gender matched controls. Spinal Cord 2000; 38: 717-23. (Pubitemid 32060050)
64. Hill J, Corson RJ, Brandon H et al. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum 1994; 37: 473-7. (Pubitemid 24149683)
65. Dobben AC, Terra MP, Deutekom M et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis 2007; 22: 783-90. (Pubitemid 46863755)
66. Tariq SH, Morley JE, Prather CM. Fecal incontinence in the elderly patient. Am J Med 2003; 115: 217-27. (Pubitemid 37338147)
67. Wald A. Clinical practice. Fecal incontinence in adults. N Engl J Med 2007; 356: 1648-55. (Pubitemid 46631674)
68. Lazarescu A, Turnbull GK, Vanner S. Investigating and treating fecal incontinence: when and how. Can J Gastroenterol 2009; 23: 301-8.
69. Hahnloser D, Pemberton JH, Wolff BG et al. Results at up to 20 years aft er ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 2007; 94: 333-40. (Pubitemid 46423852)
70. Morgado PJ Jr, Wexner SD, James K et al. Ileal pouch-anal anastomosis: is preoperative anal manometry predictive of postoperative functional outcome? Dis Colon Rectum 1994; 37: 224-8. (Pubitemid 24093761)
71. Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Eur J Surg 1994; 160: 167-74. (Pubitemid 24123114)
72. Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997; 92: 469-75.
73. Raza N, Bielefeldt K. Discriminative value of anorectal manometry in clinical practice. Dig Dis Sci 2009; 54: 2503-11.
74. Kumar A, Rao SS. Diagnostic testing in fecal incontinence. Curr Gastroenterol Rep 2003; 5: 406-13. (Pubitemid 38899283)
75. Felt-Bersma RJ. Endoanal ultrasound in benign anorectal disorders: clinical relevance and possibilities. Expert Rev Gastroenterol Hepatol 2008; 2: 587-606.
76. Diamant NE, Kamm MA, Wald A et al. AGA technical review on anorectal testing techniques. Gastroenterology 1999; 116: 735-60.
77. De Lillo AR, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol 2000; 95: 901-5. (Pubitemid 30196722)
78. Patel K, Bliss DZ, Savik K. Health literacy and emotional responses related to fecal incontinence. J Wound Ostomy Continence Nurs 2010; 37: 73-9.
79. Croswell E, Bliss DZ, Savik K. Diet and eating pattern modifications used by community-living adults to manage their fecal incontinence. J Wound Ostomy Continence Nurs 2010; 37: 677-82.
80. Bliss DZ, Jung HJ, Savik K et al. Supplementation with dietary fiber improves fecal incontinence. Nurs Res 2001; 50: 203-13. (Pubitemid 33603810)
81. Whitehead WE, Wald A, Norton NJ. Treatment options for fecal incontinence. Dis Colon Rectum 2001; 44: 131-42; discussion 142-134.
82. Leung FW, Beard MH, Grbic V et al. Dyssynergia-key pathophysiologic mechanism for fecal incontinence in nursing home residents. Am J Gastroenterol 2007; 102 (S2): S257.
83. Bates-Jensen BM, Alessi CA, Al-Samarrai NR et al. The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents. J Am Geriatr Soc 2003; 51: 348-55. (Pubitemid 36348896)
84. Read M, Read NW, Barber DC et al. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 1982; 27: 807-14. (Pubitemid 12053371)
85. Sun WM, Read NW, Verlinden M. Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Scand J Gastroenterol 1997; 32: 34-8. (Pubitemid 27026464)
86. Fox M, Stutz B, Menne D et al. The effects of loperamide on continence problems and anorectal function in obese subjects taking orlistat. Dig Dis Sci 2005; 50: 1576-83. (Pubitemid 41203647)
87. Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 1980; 79: 1272-5. (Pubitemid 11250471)
88. Lauti M, Scott D, Thompson-Fawcett MW. Fibre supplementation in addition to loperamide for faecal incontinence in adults: a randomized trial. Colorectal Dis 2008; 10: 553-62. (Pubitemid 351803061)
89. Cheetham M, Brazzelli M, Norton C et al. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2003, CD002116.
90. Santoro GA, Eitan BZ, Pryde A et al. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 2000; 43: 1676-81; discussion 1681-1672.
91. Remes-Troche JM, Ozturk R, Philips C et al. Cholestyramine-a useful adjunct for the treatment of patients with fecal incontinence. Int J Colorectal Dis 2008; 23: 189-94. (Pubitemid 350302516)
92. Donnelly V, O' Connell PR, O' Herlihy C. The influence of oestrogen replacement on faecal incontinence in postmenopausal women. Br J Obstet Gynaecol 1997; 104: 311-5. (Pubitemid 27112662)
93. Deutekom M, Dobben A. Plugs for containing faecal incontinence. Cochrane Database Syst Rev 2005, CD005086.
94. Giamundo P, Altomare DF, Rinaldi M et al. The ProTect device in the treatment of severe fecal incontinence: preliminary results of a multicenter trial. Tech Coloproctol 2007; 11: 310-4.
95. Chew MH, Quah HM, Ooi BS et al. A prospective study assessing anal plug for containment of faecal soilage and incontinence. Colorectal Dis 2008; 10: 677-80.
96. Zubaidi AM. Artificial bowel sphincters for severe fecal incontinence. Are they a solution? Saudi Med J 2010; 31: 965-73.
97. Romano G, La Torre F, Cutini G et al. Total anorectal reconstruction with an artificial bowel sphincter: Report of five cases with a minimum followup of 6 months. Colorectal Dis 2002; 4: 339-44.
98. Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation . Dis Colon Rectum 2009; 52: 1681-7.
99. Bravo Gutierrez A, Madoff RD, Lowry AC et al. Long-term results of anterior sphincteroplasty. Dis Colon Rectum 2004; 47: 727-31; discussion 731-722.
100. Nikiteas N, Korsgen S, Kumar D et al. Audit of sphincter repair. Factors associated with poor outcome. Dis Colon Rectum 1996; 39: 1164-70. (Pubitemid 26330530)
101. Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum 2002; 45: 345-8. (Pubitemid 34273614)
102. Orrom WJ, Miller R, Cornes H et al. Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic fecal incontinence . Dis Colon Rectum 1991; 34: 305-10.
103. Tjandra JJ, Chan MK, Yeh CH et al. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 2008; 51: 494-502.
104. Indinnimeo M, Ratto C, Moschella CM et al. Sacral neuromodulation for the treatment of fecal incontinence: analysis of cost-effectiveness. Dis Colon Rectum 2010; 53: 1661-9.
105. Boyle DJ, Murphy J, Gooneratne ML et al. Efficacy of sacral nerve stimulation for the treatment of fecal incontinence. Dis Colon Rectum 2011; 54: 1271-8.
106. Mellgren A, Wexner SD, Coller JA et al. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2011; 54: 1065-75.
107. George AT, Kalmar K, Goncalves J et al. Sacral nerve stimulation in the elderly. Colorectal Dis 2012; 14: 200-4.
108. Kim DW, Yoon HM, Park JS et al. Radiofrequency energy delivery to the anal canal: is it a promising new approach to the treatment of fecal incontinence? Am J Surg 2009; 197: 14-8.
109. Ruiz D, Pinto RA, Hull TL et al. Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up? Dis Colon Rectum 2010; 53: 1041-6.
110. Takahashi-Monroy T, Morales M, Garcia-Osogobio S et al. SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up. Dis Colon Rectum 2008; 51: 355-9.
111. Graf W, Mellgren A, Matzel KE et al. Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, shamcontrolled trial. Lancet 2011; 377: 997-1003.
112. Dodi G, Jongen J, de la Portilla F et al. An open-label, noncomparative, multicenter study to evaluate efficacy and safety of NASHA/Dx gel as a bulking agent for the treatment of fecal incontinence. Gastroenterol Res Pract 2010; 2010: 467136.
113. Bartlett L, Ho YH. PTQ anal implants for the treatment of faecal incontinence . Br J Surg 2009; 96: 1468-75.
114. Norton C, Chelvanayagam S, Wilson-Barnett J et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 2003; 125: 1320-9. (Pubitemid 37409752)
115. Byrne CM, Solomon MJ, Young JM et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 2007; 50: 417-27. (Pubitemid 46701624)
116. Fernandez-Fraga X, Azpiroz F, Aparici A et al. Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 2003; 46: 1218-25. (Pubitemid 37129560)
117. Heymen S, Scarlett Y, Jones K et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 2009; 52: 1730-7.
118. Norton C. Behavioral management of fecal incontinence in adults. Gastroenterology 2004; 126: S64-70. (Pubitemid 38036844)