Fecal Incontinence Linked to High Prevalence of Urinary Incontinence in Women with Pelvic Floor Disorders

Birth trauma, obesity and smoking are risk factors for both fecal incontinence (FI) and stress urinary incontinence (UI) in women. Given the overlapping pathophysiology of bowel and bladder control, physicians at Massachusetts General Hospital recently explored the connection between symptoms of FI and UI in women attending the pelvic floor disorders clinic.

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Marcus V. Ortega, MD, a fellow, and Milena M. Weinstein, MD, a specialist in the Female Pelvic Medicine and Reconstructive Surgery Program at Mass General, and colleagues report in Colorectal Disease that FI was associated with higher prevalence of the three most common forms of UI. Furthermore, increased severity of FI was associated with a higher likelihood of urge UI.

Study Methods

The researchers reviewed records on 2,932 adult women who were evaluated for FI, UI or pelvic organ prolapse between May 2007 and August 2019. Patients were eligible if they:

• Completed the Urogenital Distress Inventory short form, which asks about stress urinary symptoms, irritative urinary symptoms and obstructive/discomfort symptoms
• Answered questions about the presence or absence of stress UI and urge UI symptoms
• Answered a question about bladder splinting (the act of lifting the bladder by vaginal manipulation in order to initiate or complete voiding)
• Completed the Fecal Incontinence Severity Instrument (FISI), used to classify women as having FI if they answered "yes" to the question, "Have you experienced accidental loss of stool or gas without control?"

Presence of Fecal Incontinence

1,404 women (48%) reported FI. Compared to women without FI, they were more likely to report:

• Urge UI symptoms—15% vs. 12% (P=0.01)
• Mixed UI symptoms (both stress and urge)—42% vs. 27% (P<0.001)
• Nocturnal enuresis—15% vs. 9% (P<0.001)
• Incontinence pad use—35% vs. 26% (P<0.001)
• Leakage of urine during intercourse—15% vs. 9% (P<0.001)

After adjustment for age, smoking, diabetes, irritable bowel syndrome and history of hysterectomy, women with FI had higher odds of all common types of UI symptoms compared to women without FI:

• Stress UI—OR, 1.28 (P=0.03)
• Urge UI—OR, 1.52 (P<0.001)
• Mixed UI—OR, 1.94 (P<0.001)

Severity of Fecal Incontinence

Compared with the rest of the cohort, women who had FISI scores in the highest quartile reported more:

• Urge UI symptoms—19% vs. 14% (P<0.04)
• Bladder splinting—21% vs. 11% (P<0.05)
• Nocturnal enuresis—20% vs. 14% (P=0.02)

Opportunities to Improve Care

Given the overlap of FI and UI, women found to have FI should be screened for UI and vice versa. This is particularly important since patients may be embarrassed to mention incontinence. Treating one condition without recognizing any cross-sensitization it's having on the other may interfere with achieving satisfactory results.

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