Factors associated with fecal incontinence in a nationally representative sample of diabetic women

De La Luz Nieto M1, Wu JM, Matthews C, Whitehead WE, Markland AD. Int Urogynecol J. 2015 May 14. [Epub ahead of print]
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1Division of Urogynecology, Department of Ob/Gyn, University of North Carolina at Chapel Hill, CB#7570, 3032 Old Clinics Building, Chapel Hill, NC, 27599-7570, USA, nieto.luzm@gmail.com.


INTRODUCTION AND HYPOTHESIS: Fecal incontinence (FI) is a debilitating condition that significantly affects quality of life, and has been associated with multiple risk factors. Our goal was to assess the prevalence of FI among diabetic women and evaluate factors associated with FI in this population.

METHODS: The National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 was used to evaluate women with diabetes mellitus and FI. FI was defined as involuntary loss of mucus, liquid, or solid stool at least monthly. Severity was evaluated using the Fecal Incontinence Severity Index. Potential risk factors associated with FI were explored with weighted chi-squared statistics. Variables associated with FI in multivariable logistic regression analysis are reported with odds ratios (OR) and 95 % confidence intervals (95 % CI).

RESULTS: Among 7,039 women, 13.6 % were diabetic, and 18.1 % of diabetic women reported FI compared to 8.4 % in the overall NHANES population (p < .001). In diabetic women, FI was associated with advancing age (OR 1.3, 95 % CI 1.1 - 1.5), depression (OR 2.0 95 % CI 0.9 - 4.5), poorer health status (OR 1.9, 95 % CI 1.2 - 3.1), urinary incontinence (OR 3.5, 95 % CI 2.1 - 5.9) and bowel movement frequency of ≥21/week (OR 4.9, 95 % CI 2.3 - 10.6) in a multivariable logistic regression model adjusted for race, education level, BMI, comorbidities, prior hysterectomy, and stool consistency.

CONCLUSIONS: FI affects one in five diabetic women and is strongly associated with high bowel movement frequency, a possible important modifiable factor that should be investigated further in prospective studies.

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