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National Institutes of Health State-of-the-Science Conference Statement: Prevention of Fecal and Urinary Incontinence in Adults
- C. Seth Landefeld, MD;
- Barbara J. Bowers, PhD, RN;
- Andrew D. Feld, MD, JD;
- Katherine E. Hartmann, MD, PhD;
- Eileen Hoffman, MD;
- Melvin J. Ingber, PhD;
- Joseph T. King, Jr., MD, MSCE;
- W. Scott McDougal, MD;
- Heidi Nelson, MD;
- Endel John Orav, PhD;
- Michael Pignone, MD, MPH;
- Lisa H. Richardson;
- Robert M. Rohrbaugh, MD;
- Hilary C. Siebens, MD; and
- Bruce J. Trock, PhD*
- From the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; University of Wisconsin–Madison, Madison, Wisconsin; University of Washington, Seattle, Washington; Vanderbilt Institute for Medicine and Public Health, Nashville, Tennessee; New York University School of Medicine, New York, New York; RTI International, Washington, D.C.; Veterans Affairs Connecticut Healthcare System and Yale University School of Medicine, New Haven, Connecticut; Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Mayo Medical School, Rochester, Minnesota; University of North Carolina Hospital, Chapel Hill, North Carolina; Crohn's and Colitis Foundation of America, Houston, Texas; University of Virginia, Charlottesville, Virginia; and The Johns Hopkins University School of Medicine, Baltimore, Maryland.
National Institutes of Health consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality (AHRQ), 2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, 3) questions and statements from conference attendees during open discussion periods that are part of the public session, and 4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of the National Institutes of Health or the U.S. government.
Fecal incontinence and urinary incontinence are conditions with ramifications that extend well beyond their physical manifestations. Many individuals find themselves withdrawing from their social lives and attempting to hide the problem from their families, friends, and even their doctors. The shame, embarrassment, and stigma associated with these conditions pose significant barriers to seeking professional treatment, resulting in many persons who suffer from these conditions without help. As baby boomers approach their sixties, the incidence and public health burden of incontinence are likely to increase.
Fecal incontinence is a syndrome that involves the unintentional loss of solid or liquid stool. It is serious and embarrassing. Fecal incontinence may affect individuals living at home, as well as many living in nursing homes. Although fecal incontinence affects individuals of all ages, it is more common in women and older persons. Bowel function is controlled by 4 factors: rectal sensation, rectal storage capacity, anal sphincter pressure, and established bowel habits. If any of these is compromised, fecal incontinence can occur. Despite its serious effects on patients, families, and society, fecal incontinence is …
