Top

Published in:

01-11-2007 | Original Article

The risk of anal incontinence in obese women

Authors: Daniel Altman, Christian Falconer, Stephan Rossner, Ingela Melin

Published in: International Urogynecology Journal | Issue 11/2007

Abstract

The objectives of this study was to estimate the risk of anal incontinence in morbidly obese women and to identify risk factors associated with anal incontinence in an obese population sample. A case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index ≥35 (obesity class II) was randomly matched by age, gender and residential county to control subjects using the computerised Register of the Total Population. Data were collected by a self-reported postal survey including detailed questions on medical and obstetrical history, obesity history, socioeconomic indices, life style factors and the validated Cleveland Clinic Incontinence Score. The questionnaire was returned by 131/179 (73%) of the cases and 453/892 (51%) of the control subjects. Compared to the control group, obese women reported a significantly increased defecation frequency (p < 0.001), inability to discriminate between flatus and faeces (p < 0.001) and flatus incontinence (p < 0.001). Compared with non-obese women, the adjusted odds ratio (OR) for flatus incontinence in morbidly obese women was 1.5 [95% confidence interval (CI) 1.1–4.1]. A history of obstetric sphincter injury was independently associated with an increased risk of flatus incontinence (OR, 4.3; 95% CI, 2.0–9.2) and incontinence of loose stools (OR, 6.6; 95% CI, 1.4–31.4). Other medical and life style interactions did not remain at significant levels in an adjusted multivariable analysis. Obese women are at increased risk for mild to moderate flatus incontinence.

World Health Organization (1998) Obesity preventing and managing the global epidemic. World Health Organization, Geneva, Switzerland

Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE (1995) Body weight and mortality among women. N Engl J Med 333:677–685PubMedCrossRef

Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB (1999) Annual deaths attributable to obesity in the United States. JAMA 282:1530–1538PubMedCrossRef

White MA, O’Neil PM, Kolotkin RL, Byrne TK (2004) Gender, race, and obesity-related quality of life at extreme levels of obesity. Obes Res 12:949–955PubMed

Muennig P, Lubetkin E, Jia H, Franks P (2006) Gender and the burden of disease attributable to obesity. Am J Public Health 96:1662–1668PubMedCrossRef

Melville JL, Fan MY, Newton K, Fenner D (2005) Fecal incontinence in US women: a population-based study. Am J Obstet Gynecol 193:2071–2076PubMedCrossRef

Miner P (2004) Economic and personal impact of fecal and urinary incontinence. Gastroenterol 126:S8–S13CrossRef

Mommsen S, Foldspang A (1994) Body mass index and adult female urinary incontinence. World J Urol 12:319–322PubMedCrossRef

Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D (1996) Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol 87:715–721PubMedCrossRef

10.

Sherburn M, Guthrie JR, Dudley EC, O’Connell HE, Dennerstein L (2001) Is incontinence associated with menopause? Obstet Gynecol 98:628–633PubMedCrossRef

11.

Uustal Fornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83:383–389PubMedCrossRef

12.

Kapoor DS, Davila GW, Rosenthal RJ, Ghoniem GM (2004) Pelvic floor dysfunction in morbidly obese women: pilot study. Obes Res 12:1104–1107PubMedCrossRef

13.

Richter HE, Burgio KL, Brubaker L, Moalli PA, Markland AD, Mallet V, Menefee SA, Johnson HW, Boreham MK, Dandreo KJ, Stoddard AM (2005) Factors associated with incontinence frequency in a surgical cohort of stress incontinent women. Am J Obstet Gynecol 193:2088–2093PubMedCrossRef

14.

Boreham MK, Richter HE, Kenton KS, Nager CW, Gregory WT, Aronson MP, Vogt VY, McIntire DD, Schaffer JI (2005) Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life. Am J Obstet Gynecol 192:1637–1642PubMedCrossRef

15.

Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef

16.

Ryhammer AM, Bek KM, Laurberg S (1995) Multiple vaginal deliveries increase the risk of permanent incontinence of flatus urine in normal premenopausal women. Dis Colon Rectum 38:1206–1209PubMedCrossRef

17.

Sultan AH, Kamm MA, Bartram CI, Hudson CN (1993) Anal sphincter trauma during instrumental delivery. Int J Gynaecol Obstet 43:263–270PubMedCrossRef

18.

Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMedCrossRef

19.

Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S (2003) Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 110:247–254PubMedCrossRef

20.

Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Laksy K, Joukamaa M (2006) Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes 30:520–527CrossRef

21.

Sultan AH, Kamm MA (1997) Faecal incontinence after childbirth. Br J Obstet Gynaecol 104:979–982PubMed

22.

Altman D, Zetterstrom J, Lopez A, Pollack J, Nordenstam J, Mellgren A (2004) Effect of hysterectomy on bowel function. Dis Colon Rectum 47:502–509PubMedCrossRef

23.

Rogers J, Levy DM, Henry MM, Misiewicz JJ (1988) Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut 29:756–761PubMedCrossRef

24.

Meschia M, Buonaguidi A, Pifarotti P, Somigliana E, Spennacchio M, Amicarelli F (2002) Prevalence of anal incontinence in women with symptoms of urinary incontinence and genital prolapse. Obstet Gynecol 100:719–723PubMedCrossRef

25.

Lipton S, Estrin J, Nathan I (1994) A biomechanical study of the aponeurotic inguinal hernia repair. J Am Coll Surg 178:595–599PubMed

26.

Snooks SJ, Barnes PR, Swash M, Henry MM (1985) Damage to the innervation of the pelvic floor musculature in chronic constipation. Gastroenterol 89:977–981

27.

Lambert DM, Marceau S, Forse RA (2005) Intra-abdominal pressure in the morbidly obese. Obes Surg 15:1225–1232PubMedCrossRef

28.

Finer N, James WP, Kopelman PG, Lean ME, Williams G (2000) One-year treatment of obesity: a randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int J Obes Relat Metab Disord 24:306–313PubMedCrossRef

29.

Padwal R, Li SK, Lau DC (2003) Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord 27:1437–1446PubMedCrossRef

30.

Varma MG, Brown JS, Creasman JM, Thom DH, Van Den Eeden SK, Beattie MS, Subak LL (2006) Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum 49:841–851PubMedCrossRef

31.

Wamala SP, Wolk A, Orth-Gomer K (1997) Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women. Prev Med 26:734–744PubMedCrossRef

32.

Dietz HP, Clarke B, Vancaillie TG (2002) Vaginal childbirth and bladder neck mobility. Aust N Z J Obstet Gynaecol 42:522–525PubMedCrossRef

33.

Altman D, Ekstrom A, Gustafsson C, Lopez A, Falconer C, Zetterstrom J (2006) Risk of urinary incontinence after childbirth: a 10-year prospective cohort study. Obstet Gynecol 108:873–878PubMedCrossRef

34.

Viktrup L, Rortveit G, Lose G (2006) Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol 108:248–254PubMed

35.

Zetterstrom JP, Lopez A, Anzen B, Dolk A, Norman M, Mellgren A (1999) Anal incontinence after vaginal delivery: a prospective study in primiparous women. Br J Obstet Gynaecol 106:324–330PubMed

36.

Bek KM, Laurberg S (1992) Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol 99:724–726PubMed

37.

Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, Madelenat P, Mignon M (2000) Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum 43:590–596PubMedCrossRef

38.

Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174:190–195PubMedCrossRef

Title: The risk of anal incontinence in obese women
Authors: Daniel Altman
Christian Falconer
Stephan Rossner
Ingela Melin
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 11/2007
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-007-0341-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The risk of anal incontinence in obese women

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2007

Can community-dwelling women reliably identify infected urine?

A safety and quality of life analysis of intravaginal slingplasty in female stress incontinence: a prospective, open label, multicenter, and observational study

Association of cutis laxa and genital prolapse: a case report

Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O

Management of persistent groin pain after transobturator slings

Prevalence of urinary incontinence in Korean women:an epidemiologic survey