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The effect of obesity on fecal incontinence symptom distress, quality of life, and diagnostic testing measures in women

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Abstract

Introduction and hypothesis

Weight-loss has been demonstrated to result in an improvement in fecal incontinence (FI) severity; however, there is a paucity of data addressing the differential impact of FI on the quality of life (QOL) and results of diagnostic testing across BMI categories. We wished to evaluate symptom distress, QOL, and diagnostic testing parameters among normal, overweight, and obese women with fecal incontinence.

Methods

Women undergoing evaluation for FI between 2003 and 2012 were identified. Participants completed validated, symptom-specific distress, impact, and general QOL measures including the Modified Manchester Questionnaire (MMHQ), which includes the Fecal Incontinence Severity Index (FISI), and the mental and physical component summary scores, MCS and PCS, respectively, of the Short Form-12. Anorectal manometry measures were also included. Multivariate regression analyses were performed.

Results

Participants included 407 women with a mean age ± SD of 56 ± 13. Multivariate analyses revealed no differences in symptom-specific distress and impact as measured by MMHQ, MCS, and PCS across BMI groups; however, obese women had increased resting and squeeze pressures compared with normal and overweight BMI women (p < 0.0001 and p < 0.0001; p = 0.007 and p = 0.004 respectively).

Conclusions

Obese women with FI did not have more general impact and symptom-specific distress and impact on quality of life compared with normal and overweight women. Obese women with FI had higher baseline anal resting and squeeze pressures suggesting a lower threshold to leakage with pressure increases.

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References

  1. Norton C, Whitehead W, Bliss DZ, Harari D, Lang J (2009) Conservative and pharmacological management of faecal incontinence in adults. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publication Ltd, Paris, p 1343

    Google Scholar 

  2. Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126 [Suppl 1]:S3–S7

    Article  PubMed  Google Scholar 

  3. Quander CR, Morris MC, Melson J et al (2005) Prevalence of and factors associated with fecal incontinence in a large community study of older individuals. Am J Gastroenterol 100:905–909

    Article  PubMed  Google Scholar 

  4. Sailer M, Bussen D, Debus ES et al (1998) Quality of life in patients with benign anorectal disorders. Br J Surg 85:1716–1719

    Article  PubMed  CAS  Google Scholar 

  5. Johansson JK, Lafferty J et al (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36

    Google Scholar 

  6. Szurszewski JH, Holt PR, Schuster MM et al (1989) Proceedings of a workshop entitled Neuromuscular function and dysfunction of the gastrointestinal tract. Dig Dis Sci 34:1135–1146

    Article  PubMed  CAS  Google Scholar 

  7. Bharucha A et al (2003) Fecal incontinence. Gastroenterology 124:1672–1685

    Article  PubMed  Google Scholar 

  8. Sultan AH, Kamm MA, Hudson CN et al (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911

    Article  PubMed  CAS  Google Scholar 

  9. Snooks SJ, Henry MM, Swash M et al (1985) Faecal incontinence due to external sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature. Br J Obstet Gynaecol 92:824–828

    Article  PubMed  CAS  Google Scholar 

  10. Madoff RD, Parker SC, Varma MG et al (2004) Faecal incontinence in adults. Lancet 364:621–632

    Article  PubMed  Google Scholar 

  11. Giordano P, Wexner SD et al (2001) The assessment of fecal incontinence in women. J Am Coll Surg 193(4):397–406

    Article  PubMed  CAS  Google Scholar 

  12. Rao SC et al (2004) Diagnosis and management of fecal incontinence. American college of gastroenterology practice parameters committee. Am J Gastroenterol 99:1585–1604

    Article  PubMed  Google Scholar 

  13. Mokdad AH, Ford ES, Bowman BA et al (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79

    Article  PubMed  Google Scholar 

  14. Ogden CL, Carroll MD, Curtin LR et al (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Erekson EA, Sung VW, Myers DL et al (2008) Effect of body mass index on the risk of anal incontinence and defecatory dysfunction in women. Am J Obstet Gynecol 198:596e1–596e4

    Article  Google Scholar 

  17. Altman D, Falconer C, Rossner S et al (2007) The risk of anal incontinence in obese women. Int Urogynecol J Pelvic Floor Dysfunct 18:1283

    Article  PubMed  Google Scholar 

  18. Cuicchi D, Lombardi R, Cariani S, Leuratti L, Lecce F, Cola B et al (2013) Clinical and instrumental evaluation of pelvic floor disorders before and after bariatric surgery in obese women. Surg Obes Relat Dis 9:69–76

    Article  PubMed  Google Scholar 

  19. Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS (2007) Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 110:1034–1040

    Article  PubMed  Google Scholar 

  20. Sileri P, Franceshilli L, Cadeddu F, De Luca E, D’Ugo S, Tognoni V, Camperchiolo I, Benavoli D, Di Lorenzo N, Gaspari AL, Gentileschi P (2012) Prevalence of defaecatory disorders in morbidly obese patients before and after bariatric surgery. J Gastrointest Surg 16:62–66, discussion 66–67

    Article  PubMed  Google Scholar 

  21. Kwon S, Visco AG, Fitzgerald MP, Ye W, Whitehead WE (2005) Pelvic Floor Disorders Network (PFDN) Validity and reliability of the modified Manchester health questionnaire in assessing patients with fecal incontinence. Dis Colon Rectum 48(323–31):331–334

    Google Scholar 

  22. Luo X, Lynn GM, Kakouras I, Edwards CL, Pietrobon R, Richardson W, Hey L (2003) Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine 28:1739–1745

    PubMed  Google Scholar 

  23. WHO (2006) BMI classification. Global database on body mass index. WHO, Lyon. Accessed 18 October 2012

  24. Markland AD, Richter HE, Burgio KL, Myers DL, Hernandez AL, Subak LL (2011) Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J 22:1151–1157

    Article  PubMed  Google Scholar 

  25. Ware JE Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  26. Tarlov AR, Ware JE, Greenfield S et al (1989) The medical outcomes study: an application of methods for monitoring the results of medical care. J Am Med Assoc 262:925

    Article  CAS  Google Scholar 

  27. Hopman WM, Harrison MB, Coo H et al (2009) Associations between chronic disease, age, and physical and mental health status. Chronic Dis Can 29:108–116

    PubMed  CAS  Google Scholar 

  28. Wee CC, Davis RB, Hamel MB et al (2008) Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcome 6:11–18

    Article  Google Scholar 

  29. Richter HE, Kenton K, Huang L, Nygaard I, Kraus S, Whitcomb E, Chai TC, Lemack G, Sirls L, Dandreo KJ, Stoddard A (2010) The impact of obesity on urinary incontinence symptoms, severity, urodynamic characteristics and quality of life. J Urol 183:622–628

    Article  PubMed  Google Scholar 

  30. Henneman E, Somjen G, Carpenter DO (1965) Excitability and inhibitability of motoneurons of different sizes. J Neurophysiol 28:599–620

    PubMed  CAS  Google Scholar 

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Funding

Partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases to HER 2K24-DK068389.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL, 35233, USA

    David R. Ellington, Michael R. Polin & Holly E. Richter

  2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    Jeff M. Szychowski

  3. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Luqin Deng

Authors
  1. David R. Ellington
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  2. Michael R. Polin
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  3. Jeff M. Szychowski
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  4. Luqin Deng
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  5. Holly E. Richter
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Corresponding author

Correspondence to David R. Ellington.

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Ellington, D.R., Polin, M.R., Szychowski, J.M. et al. The effect of obesity on fecal incontinence symptom distress, quality of life, and diagnostic testing measures in women. Int Urogynecol J 24, 1733–1738 (2013). https://doi.org/10.1007/s00192-013-2103-1

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  • DOI: https://doi.org/10.1007/s00192-013-2103-1

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