Menopause and obstetric history as risk factors for fecal incontinence in women.

BACKGROUND: Fecal incontinence is a highly prevalent condition, especially in women. However, few data on prevalence in women attending primary care are available, particularly regarding the presence of risk factors. OBJECTIVE: The aim of this study was to determine characteristics of women with fecal incontinence and to analyze obstetric history and menopause as potential risk factors. DESIGN: Observational study with a cross-sectional design. SETTINGS: Patients in primary care at 10 health care centers in Barcelona, Spain. MAIN OUTCOME MEASURES: Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on the following variables were collected by face-to-face interviews and patient questionnaires: demographic and clinical characteristics, obstetric history, menopause data, fecal incontinence, and quality of life. Univariable and multivariable analyses were performed to study the association of potential risk factors with fecal incontinence. RESULTS: The study included 332 women with a mean age of 60.8 (SD, 17.8) years. The prevalence of fecal incontinence was 12.0% (40/332). Flatus incontinence was reported in 27 patients (67.5%), liquid stool incontinence in 25 (62.5%), and solid stool incontinence in (19) 47.5%. On multivariable analysis, the only independent risk factors for fecal incontinence were an obstetric history of complicated deliveries (instrumentation or podalic presentation; OR, 3.66; 95% CI, 1.54-8.68, P = .003) and menopause (OR, 5.67; 95% CI, 1.35-23.78; P = .018). LIMITATIONS: The cross-sectional design hampered identification of the time at which the impact of menopausal status occurred, and data obtained from patient interviews was subject to recall bias. CONCLUSIONS: Complicated deliveries are risk factors for fecal incontinence in women. Fecal incontinence appears to be more prevalent in menopausal women.

[Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial]. / Tratamiento del dolor anal por patología anorrectal aguda en urgencias: ¿baños de asiento con agua fría o caliente? resultados de un ensayo clínico aleatorizado.

INTRODUCTION: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. AIM: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. MATERIAL AND METHODS: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. RESULTS: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. CONCLUSION: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).

[Prevalence of fecal incontinence and its relationship with bowel habit in patients attended in primary care]. / Prevalencia de incontinencia fecal y su relación con el hábito defecatorio en pacientes atendidos en medicina primaria.

BACKGROUND AND OBJECTIVES: Fecal incontinence is a high prevalence disease in general population. The diagnosis of alterations in bowel habit could be of interest for the management of this clinical disorder. The aim of the study was to study the relationship between fecal incontinence prevalence and alteration of bowel habit in patients of a metropolitan area of Barcelona. PATIENTS AND METHODS: A cross-sectional multicenter study was undertaken by interviewing the population attending 10 primary health centers. The presence of symptoms of fecal incontinence was analyzed and the bowel habit was assessed using the validated Spanish version of Bristol Stool Scale. RESULTS: A total of 518 subjects were studied with a mean age of 60.3 (SD: Standard deviation 17.7) years. The overall prevalence of fecal incontinence was 10.8% (2.7% incontinence to flatus, 3.7% liquid stool and 4.4% solid stool). There was a normal bowel habit in 75.6% in the group of patients without fecal incontinence and in 54.5% in patients with fecal incontinence (p=0.001). CONCLUSION: The prevalence of fecal incontinence in primary care is high. 45% of patients with fecal incontinence exhibited an abnormal bowel habit.

[Endoanal ultrasound findings in patients with faecal incontinence using a scoring system]. / Descripción de los hallazgos de la ecografía endoanal en pacientes con incontinencia fecal mediante un sistema de puntuación.

INTRODUCTION: The main aim of the study was to apply a severity classification of sphincter lesions detected by endoanal ultrasound using Starck score in patients who suffered faecal incontinence. MATERIAL AND METHOD: Data were analysed on 133 patients with faecal incontinence. Those in whom anal sphincter lesions were detected by endoanal ultrasound are described and their corresponding scores according to Starck classification calculated. This system scores severity of detected sphincter lesions from 0 to 16, involving the three axes of the anal canal. Patient demographic characteristics and anorectal manometry results were also analysed. The relationship between this score, patient gender and age, and anorectal manometric results were also analysed. RESULTS: A total of 83 (62.4%) patients had some type of anal sphincter lesion. The presence of sphincter defects was not related to gender (P=0.172), although it did correlate with younger ages (P=0.028). The severity of anal sphincter damage by Starck score did not show significant correlation to gender (P=0.327) or to the age (P=0.350) of patients. However, a significant correlation was detected between Starck score and anal resting pressure (P=0.008) or anorectal squeeze pressure (P=0.011). CONCLUSIONS: The presence of anal sphincter injuries could be well defined by Starck score in patients with faecal incontinence. Severity of damage scored by Starck correlated with anorectal manometric results.

¿Existe correlación entre la manometría anorrectal y los datos de la ecografía endoanal en sujetos sanos en función de la edad? / Does correlation exist between anorectal manometry and endoanal ultrasound findings in healthy subjects according to age?

Introducción: diferentes estudios han demostrado la correlación entre los datos de la manometría anorrectal y la ecografía endoanal en pacientes con incontinencia fecal, pero el interés ha sido escaso en describir lo mismo en sujetos sanos en relación a la edad. Objetivos: estudiar la posible correlación entre los datos de la manometría anorrectal y de la ecografía endoanal en un grupo homogéneo de mujeres sanas, también en función de la edad de las mismas. Material y métodos: estudio prospectivo observacional de una cohorte de sujetos sanos (n = 14). Grupo homogéneo de mujeres voluntarias sanas divididas en 2 subgrupos en función de la edad. Resultados: no se objetivó correlación entra la medida del esfínter anal interno y la presión basal de reposo, tanto en toda la muestra analizada como en el análisis detallado por grupos de edad. Tampoco se objetivó correlación estadísticamente significativa entre el grosor del esfínter anal externo y la presión de esfuerzo, en toda la muestra analizada y por grupos. Conclusiones: no existe correlación estadísticamente significativa entre el grosor de los esfínteres y su función en un grupo homogéneo de sujetos sanos, tampoco en función de 2 grupos de edad(AU)

Background: different studies have demonstrated the correlation between anorectal manometry and endoanal ultrasonography data in patients with fecal incontinence, but there is no almost interest describing the same in healthy subjects according to age. Aims: to study the possible correlation between anorectal manometry and endoanal ultrasonography data in a homogeneous group of healthy women, also according to age. Material and methods: prospective observational study of a healthy subjects cohort (n = 14). Homogeneous group of healthy volunteer women divided in 2 subgroups according to age. Results: there was no proved correlation between the internal anal sphincter’s measurement and the resting pressure in the whole sample as well as the analysis according to age. Neither there was any proved statistically significant correlation between the external anal sphincter’s thickness and the squeeze pressure, in the whole sample and by groups. Conclusions: it does not exist statistically significant correlation between the thickness of the sphincters and its function in a healthy subjects homogeneous group, neither in 2 groups according to age(AU)

Prevalencia de incontinencia fecal y su relación con el hábito defecatorio en pacientes atendidos en medicina primaria / Prevalence of fecal incontinence and its relationship with bowel habit in patients attended in primary care

Fundamento y objetivo: La incontinencia fecal (IF) es una enfermedad de elevada prevalencia en la población general. La detección de alteraciones en el hábito defecatorio de estos pacientes podría ser de gran utilidad para el tratamiento de esta enfermedad. El objetivo de este trabajo fue estudiar la relación entre la prevalencia de IF en un área metropolitana de Barcelona y la presencia de una alteración del hábito defecatorio de los pacientes estudiados.Pacientes y método. Estudio transversal efectuado mediante entrevista directa a la población atendida en 10 centros de atención primaria. Se estudió la presencia de síntomas de IF y para el estudio de la consistencia y forma de las heces se utilizó la escala de Bristol validada a la lengua española.Resultados. La muestra del estudio fue de 518 sujetos, con una media (DE) de edad de 60,3 (17,7) años. La prevalencia global de IF detectada fue del 10,8% (el 2,7% gases, el 3,7% heces líquidas y el 4,4% heces sólidas). La consistencia y forma de las heces fue normal en el 75,6% en el grupo de pacientes sin IF y en el 54,5% del grupo de pacientes con el diagnóstico de IF (p=0,001) (AU)

Background and objectives. Fecal incontinence is a high prevalence disease in general population. The diagnosis of alterations in bowel habit could be of interest for the management of this clinical disorder. The aim of the study was to study the relationship between fecal incontinence prevalence and alteration of bowel habit in patients of a metropolitan area of Barcelona.Patients and methods. A cross-sectional multicenter study was undertaken by interviewing the population attending 10 primary health centers. The presence of symptoms of fecal incontinence was analyzed and the bowel habit was assessed using the validated Spanish version of Bristol Stool Scale. Results: A total of 518 subjects were studied with a mean age of 60.3 (SD: Standard deviation 17.7) years. The overall prevalence of fecal incontinence was 10.8% (2.7% incontinence to flatus, 3.7% liquid stool and 4.4% solid stool). There was a normal bowel habit in 75.6% in the group of patients without fecal incontinence and in 54.5% in patients with fecal incontinence (p=0.001).Conclusion: The prevalence of fecal incontinence in primary care is high. 45% of patients with fecal incontinence exhibited an abnormal bowel habit (AU)

Tratamiento del dolor anal por patología anorrectal aguda en urgencias: ¿baños de asiento con agua fría o caliente? resultados de un ensayo clínico aleatorizado / Cold or hot sitz baths in the emergency t

Introducción: La creencia popular propugna el uso de baños de asiento con agua fría para el tratamiento del dolor anal agudo, pero las guías de práctica clínica recomiendan el uso de agua caliente por su efecto conocido sobre la presión anal de reposo. Objetivo: El objetivo fue estudiar el efecto analgésico, sobre la calidad de vida, datos de manometría y evolución clínica, de 2 temperaturas en los baños de asiento en enfermos con dolor anal. Material y métodos: Ensayo clínico aleatorizado en pacientes con dolor anal agudo por enfermedad hemorroidal o fisura anal divididos en Grupo 1: baños de asiento con agua a Ta inferior a 15°C y Grupo 2: baños con agua a Tasuperior a 30°C. La analgesia fue la misma en ambos grupos. Se analizó: el dolor durante 7 días (escala visual analógica), calidad de vida (SF-36), presión anal de reposo y evolución de la enfermedad. Resultados: De 27 pacientes elegibles, 24 fueron aleatorizados (Grupo 1: n=12 y Grupo 2: n=12). El dolor no mostró diferencias estadísticamente significativas, pero se mantuvo estable en el Grupo 1 y por el contrario fue disminuyendo progresivamente en los pacientes del Grupo 2, siendo la diferencia en los valores del dolor del primer día respecto al séptimo superior en el Grupo 2 (p=0,244). El resto de variables fueron similares. Conclusión: No hubo diferencias estadísticamente significativas en el control del dolor del 1.er al 7 día en el Grupo con baños de asiento con agua caliente (AU)

Introduction: The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. Aim: The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. Material and methods: A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15°C, and Group 2: Baths with a water temperature above 30°C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. Results: Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. Conclusion: There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water (AU)

Descripción de los hallazgos de la ecografía endoanal en pacientes con incontinencia fecal mediante un sistema de puntuación / Endoanal ultrasound findings in patients with faecal incontinence using a scoring system

Introducción El objetivo principal del estudio fue la aplicación de una clasificación de gravedad de las lesiones esfinterianas halladas en ecografías endoanales mediante el sistema de puntuación de Starck en pacientes con incontinencia fecal (IF).Material y métodos Se analizaron los datos de 133 enfermos con IF, en los que se describió la presencia ecográfica de lesiones esfinterianas, y su puntuación según el sistema de Starck. Este sistema asigna un valor entre 0 y 16 puntos a la lesión detectada según su gravedad en los 3 ejes del espacio del canal anal. Se estudió también la relación entre la gravedad de estas lesiones, el sexo, la edad de los pacientes y los hallazgos de la manometría anorrectal. Resultados Ochenta y tres pacientes (62,4%) presentaron algún tipo de lesión esfinteriana. Estas lesiones no se asociaron de manera significativa al sexo de los pacientes (p=0,172), aunque sí se presentaron en edades más tempranas (p=0,028). La gravedad de las lesiones según Starck no se correlacionó con el sexo (p=0,327) ni con la edad (p=0,350) de los pacientes. Los pacientes con lesiones ecográficas más graves presentaron una menor presión anal basal (p=0,008) y de contracción voluntaria (p=0,011) en la manometría anorrectal. Conclusiones La presencia ecográfica de lesiones en el complejo esfinteriano en pacientes con IF se pudo caracterizar con el sistema de puntuación de Starck. La gravedad de las lesiones se correlacionó con los valores de la manometría anorrectal (AU)

Introduction The main aim of the study was to apply a severity classification of sphincter lesions detected by endoanal ultrasound using Starck score in patients who suffered faecal incontinence. Material and method Data were analysed on 133 patients with faecal incontinence. Those in whom anal sphincter lesions were detected by endoanal ultrasound are described and their corresponding scores according to Starck classification calculated. This system scores severity of detected sphincter lesions from 0 to 16, involving the three axes of the anal canal. Patient demographic characteristics and anorectal manometry results were also analysed. The relationship between this score, patient gender and age, and anorectal manometric results were also analysed. Results A total of 83 (62.4%) patients had some type of anal sphincter lesion. The presence of sphincter defects was not related to gender (P=0.172), although it did correlate with younger ages (P=0.028). The severity of anal sphincter damage by Starck score did not show significant correlation to gender (P=0.327) or to the age (P=0.350) of patients. However, a significant correlation was detected between Starck score and anal resting pressure (P=0.008) or anorectal squeeze pressure (P=0.011).Conclusions The presence of anal sphincter injuries could be well defined by Starck score in patients with faecal incontinence. Severity of damage scored by Starck correlated with anorectal manometric results (AU)