The Relationship Between Fecal Incontinence, Constipation and Defecatory Symptoms in Women With Pelvic Floor Disorders

Aims: To determine if fecal incontinence (FI) is associated with constipation and defecatory symptoms in women with urinary incontinence, fecal incontinence, and pelvic organ prolapse. Methods: Cross-sectional study of women seeking care for urinary incontinence, fecal incontinence, and pelvic organ prolapse. FI was defined as a positive response to the question, "During the last 4 weeks how often have you leaked or soiled yourself with stool?" Constipation and defecatory symptoms, including straining, sensation of incomplete emptying, and splinting, were measured using the Birmingham Bowel Symptom Questionnaire and the Colorectal Anal Distress Inventory. Prevalence and severity of constipation and defecatory symptoms were compared between women with and without FI. We performed separate multivariable regression analyses for the association of FI and constipation and defecatory symptoms while adjusting for potential confounders. Results: We included 1,015 women: 422 (44%) with and 593 (56%) without FI. Women with FI compared to those without FI were more likely to report constipation (76% vs. 66%) as well as straining (53% vs. 38%), sensation of incomplete emptying (58% vs. 40%) and splinting (30% vs. 20%), all P < 0.001. Women with FI reported greater severity of constipation (4.3 +/- 4.3 vs. 3.1 +/- 3.6, P < 0.001), straining (2.7 +/- 1 vs. 2.5 +/- 0.9, P = 0.02) and sense of incomplete emptying (2.6 +/- 1 vs. 2.4 +/- 0.9, P = 0.02) than women without FI. Even after controlling for potential confounders, the diagnosis of FI was significantly associated with constipation and defecatory symptoms. Conclusions: In women with urinary incontinence, fecal incontinence, and pelvic organ prolapse, diagnosis of FI is associated with constipation and other defecatory symptoms; which impacts evaluation and management strategies. (C) 2016 Wiley Periodicals, Inc.