The prevalence of faecal incontinence in older people living at home

Background: faecal incontinence affects quality of life and causes caregiver strain. Patients are often reluctant to seek help because of embarrassment and perceived lack of effective treatment. Persisting faecal soiling may lead to unwanted and premature institutionalization. Objective: to ascertain the prevalence of faecal incontinence and to identify health and socio-demographic characteristics of patients with this problem. Design: a sample of 3000 older people, living at home in the UK, randomly selected from three Family Health Service Authorities. Participants: we interviewed 2818 men and women aged greater than or equal to65 years in their own homes: a response rate of 94%. Results: 78 respondents (3%) reported faecal incontinence. There was a small but non-significant association with increasing age: 38 (2%) of those reporting incontinence were aged 65-74 years; 40 (3%) were aged greater than or equal to75 years. Faecal incontinence was significantly associated with sex, with reports from 15 men (1%) versus 63 women (4%; P<0.0005). It was also significantly associated with anxiety and with depression (P<0.00001) and very significantly associated with increasing disability (P<0.00001). Forty-six (59%) of those who had faecal incontinence had severe disability, compared with 426 (16%) of those who did not (P<0.00001). The association with urinary incontinence was also strong: 54 (69%) of those with faecal incontinence (2% of the total sample) had coexistent urinary incontinence. Over 50% had not discussed their problems with a healthcare professional. Conclusions: a reluctance to report symptoms and a significant association between faecal incontinence and symptoms of anxiety, depression and disability suggest that older people should be asked about faecal incontinence. Increasing the awareness of the scale of the problem among health- and social-care professionals, older people and their carers may lead to more appropriate management and effective provision of care.