Depression among older people living in the community with urinary, fecal, and double incontinence in Bali, Indonesia: a secondary data analysis

Urinary incontinence is common in the elderly. The epidemiology of fecal and double (urinary and fecal) incontinence is less known. The Canadian Study of Health and Aging (CSHA) is a national study of elderly living in the community at baseline (n = 8,949) and interviewed in 1991-1992, 1996, and 2001. Using data from the CSHA, we report the prevalence of urinary, fecal, and double incontinence in each wave and the cumulative incidence between waves and investigate the predictors of urinary and fecal incontinence. Urinary incontinence increased rapidly in old age, being almost twice as high in women as in men. Fecal and double incontinence were less common, but also increased rapidly with age. In women, parity showed a positive relationship with (prevalent) urinary incontinence. In men, diabetes was a risk factor for urinary and fecal incontinence. We conclude that urinary, fecal, and double incontinence increase rapidly with age and that inquiry about incontinence should be part of routine medical and nursing assessment of all elderly.

The aim of this study was to evaluate the prevalence of urinary, fecal and double incontinence in the elderly, through a population-based cross-sectional survey. The study included all patients aged 60 and over of nine general practices in the Nijmegen Monitoring Project. Patients living in a home for the elderly were excluded, as well as patients with dementia, patients who were too ill to participate and patients with a catheter. There were 5278 selected patients who received a postal questionnaire. Of these, 88% returned it. Nineteen percent of the respondents had involuntary loss of urine twice a month or more, 6% loss of feces and 3% both. The prevalence of urinary, fecal and double incontinence increased with age in both men and women, and especially in men in the oldest age group. Urinary incontinence was more prevalent in women than in men. The prevalence of fecal incontinence showed no sex differences, but the type of fecal incontinence did differ between men and women. In men loss of mucus was twice as common as in women. Double incontinence was also equally prevalent in men and women, except in the age group 65-74 years. In conclusion, urinary, fecal and double incontinence are common conditions in the community-dwelling population. The prevalence rates increase with age. Urinary incontinence is more prevalent in women. There were no sex differences in the prevalence of fecal incontinence but the type of fecal incontinence was different in men and women.

The aim of this study was to identify and evaluate the prevalence of urinary incontinence and risk factors that influenced it among inpatients treated in the departments of internal medicine. A total of 151 inpatients were questioned using a standardized geriatric questionnaire (InterRAI-Acute Care). Inpatients aged 65 years and more and who gave written informed consent were enrolled into the study. The mean age of the inpatients was 78+/-0.6 years. There were 58.9% of women and 41.06% of men. Urinary incontinence was significantly influenced by the age of the inpatients. Inpatients with urinary incontinence were 3 years older on the average as compared to those without urinary continence (P<0.025). Women were more frequently affected than men (74.2% vs. 48.4%). A significant association between urinary and fecal incontinence and memory problems, movement disorders, delirium, dependence in daily activities, falls was established. The odds of having double incontinence were increased by dementia (OR=20.9; 95%, CI 2.3-186) and residual effects of a stroke (OR=3.5; 95%, CI 1.2-9.6). The prevalence of urinary incontinence decreased from 63.6% before hospitalization to 39.7% after hospitalization. According to standard medical documentation, urinary incontinence was diagnosed in 3.3% of cases, while using the interRAI-AC questionnaire, it was documented in 63.6% of cases. The prevalence of urinary incontinence increases in the elderly; therefore, it has to be investigated and treated. Memory problems, delirium, dependence in daily activities, movement disorders, and falls are directly related to the risk of urinary, fecal, and double incontinence among elderly inpatients. Double incontinence was significantly influenced by dementia (20.9 times) and residual effects of a stroke (3.5 times). Underdiagnosis of urinary and fecal incontinence in inpatients burdens the possibility of providing aid for elderly patients with this disorder.

To assess the prevalence of combined fecal and urinary incontinence. A cross-sectional, community-based study. Olmsted County, Minnesota. Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population. Participants completed a previously validated self-administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year. The age-adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8-13.5) in men and 15.2% (95% CI, 12.5-17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5-28.8) in men and 48.4% (95% CI, 44.7-52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1-7.6) in men and 9.4% (95% CI, 7.1-11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend = .001). For women, the prevalence increased from 13.1% among 50-year-old women to 20.7% among women 80 years or older (P for trend = .5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P = .001 and P = .003, respectively). Cross-sectionally, the age-adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9-4.8 in men and OR = 1.8; 95% CI, 1.2-2.7 in women, P = .04). These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.

To determine the prevalence of fecal incontinence in patients with urinary incontinence, who were referred for urodynamic evaluation, and to compare clinical and manometric findings between double incontinence and isolated fecal incontinence. Nine hundred women with urinary and/or fecal incontinence were prospectively investigated. Patients with double incontinence (group 1) were compared with 38 women with isolated fecal incontinence (group 2). Clinical data regarding obstetric and urogynecologic history, bowel habit, and type of fecal incontinence were collected. Urodynamics and anal manometry were performed. Seventy-eight patients (8.7%) presented double incontinence. A history of vaginal delivery and chronic straining was more frequent in patients with double incontinence (P=0.043). No differences were found in the severity of fecal incontinence. Physical examination showed a greater prevalence of rectocele (54% vs. 12%) in group 1. On urodynamics, 80% of women with double incontinence had stress urinary incontinence. Rectal sensation testing revealed a significantly higher rate of hyposensitivity in group 2 (22% vs. 43%). This study supports a close association between combined stress urinary and fecal incontinence, history of vaginal delivery, and chronic straining.

Morbidly obese women have markedly high rates of urinary and fecal incontinence. Weight loss reduces prevalence and severity of urinary incontinence; however, the effect of weight loss on fecal incontinence is unknown. The aim of this study was to document the prevalence of urinary and fecal incontinence in subjects who underwent bariatric surgery and associated weight loss. We mailed a detailed survey to all 404 adults who underwent bariatric surgery at the University of Wisconsin prior to May 2006. Type and severity of urinary and fecal incontinence was obtained using previously validated questionnaires. Perceived effect of surgery on bowel and bladder function was also assessed. Forty-eight percent (193) of the surveys were returned. Urinary incontinence was reported in 72% of the women, 39% of whom perceived improvement after surgery. Only 21% of the men reported urinary incontinence. In contrast, fecal incontinence was common in both men and women; 48% of the women and 42% of the men reported liquid stool incontinence and 21% of the women and 30% of the men reported solid stool incontinence. Fifty-five percent of the women and 31% of the men with fecal incontinence perceived worsening after surgery. Women with diarrhea were four times more likely to report fecal incontinence (P<0.0001). Furthermore, women who perceived worsening of diarrhea after surgery were significantly more likely to have fecal incontinence (P=0.003). Both fecal and urinary incontinence were common after bariatric surgery. Risk factors for fecal incontinence in women after bariatric surgery include diarrhea and worsening of diarrhea; we suggest that such surgery may uncover prior weaknesses in the continence mechanism.

Urinary and fecal incontinence as well as skin pressure injury are common healthcare problems in nursing homes; however, the prevalence and related risk factors were not well understood in the Japanese special elderly nursing home settings. We surveyed the prevalence of urinary, fecal and double incontinence, and skin pressure injury among the elderly living in special elderly nursing homes in Japan. A nationwide cross-sectional epidemiological survey was conducted with a total of 4881 residents. The prevalence of urinary, fecal and double incontinence was 82.9%, 68.9% and 64.9%, respectively. Skin pressure injury was found in 283 residents (283/4881, 5.8%). Age, Care-Needs level, loss of voiding desire, and fecal incontinence were significant risk factors for urinary incontinence. Residential period, Care-Needs level, loss of voiding and defecation desires, and urinary incontinence were significant risk factors for fecal incontinence. Only male sex was a significant risk factor for skin pressure injury. Our study revealed continence status and the prevalence of pressure skin injury among older adult residents who receive end-of-life care in special elderly nursing homes in Japan. Further studies should be conducted to examine whether recovery of urinary and fecal sensations improves continence status.

SummaryThe Department of Health in the UK recommends as good practice in continence services that opportunistic screening for urinary and anal incontinence is carried out by all healthcare professionals. The aim of this study was to record the prevalence of urinary and anal incontinence in a general gynaecology clinic. In addition, to ascertain the proportion of women with incontinence who wish further help and assess the current opportunistic screening for incontinence. Overall, the prevalence of urinary incontinence is 26.8% and the prevalence of mixed (urinary and anal) incontinence is 8.4% of women attending a general gynaecology clinic. The prevalence of both types of incontinence increases with the age of the women. Although a significant proportion wished to receive help, 61.6% of women with urinary incontinence were not specifically asked about urinary incontinence and 66.6% of women with anal or mixed incontinence were not specifically asked about anal incontinence. Our current screening for incontinence is unsatisfactory.

Sir: Clozapine is known to be an effective agent in the treatment of refractory psychotic disorders. Although clozapine causes minimal extrapyramidal symptoms, adverse effects such as agranulocytosis, weight gain, hypersalivation, seizures, and urinary incontinence form obstacles to patients' compliance. Clozapine-induced urinary incontinence is a frequently reported side effect1; however, the literature is sparse about the combination of urinary and fecal incontinence. Here, we present a male adult patient who had transient double incontinence during clozapine treatment. Case report. Mr. A, a 35-year-old man with a 16-year history of DSM-IV schizophrenia, paranoid type, was admitted to the inpatient unit in September 2005 with psychotic symptoms after 1-month cessation of his medication (200 mg/day of clozapine). We decided to restart clozapine with a titration of 25 mg every 2 days in addition to flupen-thixol depot once every 2 weeks. After 5 weeks of hospitalization, Mr. A was discharged on treatment with 350 mg/day of clozapine in combination with flupenthixol depot once every 2 weeks. On his first outpatient visit after 3 weeks, his father reported development of double incontinence once every 2 days for the previous 2 weeks. His medical history and physical examination results were normal, so we decided to wait for his second outpatient visit in another 3 weeks and informed him that it might be a time-limited side effect and resolve spontaneously. On his second visit, it was noted that the double incontinence had remitted. Four months after Mr. A's discharge, the depot antipsychotic treatment has been stopped, and for the last 3 months he has been on treatment with clozapine 350 mg/day and has not experienced these side effects again. Although the prevalence of clozapine-induced urinary incontinence is reported to range from 2.4% to 42%,2 double incontinence has never been reported. It has been documented that patients with chronic psychotic disorders have high rates of urinary incontinence, but it is still not well understood whether the urinary incontinence is due to the severity of the mental illness or to the medication.3 Our patient had been suffering from schizophrenia for 16 years and had been on clozapine treatment for the last 2 years at a maximum dose of 200 mg/day without reporting such symptoms. It is impossible to directly link our patient's double incontinence to clozapine, as he was receiving 2 neuroleptics; however, he did not develop such side effects when he was on treatment with flupenthixol depot and clozapine titration doses of less than 350 mg/day. Clozapine-induced urinary incontinence has been shown to be dose dependent.3 Previous treatment with clozapine doses lower than 350 mg/day did not result in incontinence in our patient, which supports that double incontinence might also be dose related. The adrenergic blockade effect of clozapine is suggested to be the cause of fecal and urinary incontinence by decreasing the tonus of the internal anal sphincter4 and internal bladder sphincter,3 respectively. As the incontinence may be time-limited and resolve spontaneously,3 waiting and monitoring may be an option before starting any adjunct medication or switching to another antipsychotic. Urinary incontinence alone is an embarrassing side effect for patients to report to staff, and double incontinence would certainly be underreported, with more negative effects on patients' compliance to treatment. Thus, clinicians should consider these facts more thoroughly during their daily practice.

To review recent, significant contributions to the medical literature regarding the identification of factors which are associated with urinary, fecal, and double incontinence in women. Approximately one out of five women suffers from moderate to severe urinary incontinence, one out of 10 has fecal incontinence, and 2.5% have double incontinence of urine and stool. Obesity is primarily associated with urinary incontinence, whereas diabetes mellitus is a stronger risk factor for fecal incontinence. Double incontinence is primarily associated with advanced age, depression, and decompensating medical conditions that denote frailty. Knowledge regarding which clinical conditions and patient characteristics are strongly associated with each type of incontinence helps identify those patients who are at risk and aids in targeted screening and treatment programs.

Patients suffering from faecal incontinence may be reluctant to seek medical advice and the true prevalence is uncertain. The aim of the study was to determine the prevalence of faecal incontinence and to correlate this with possible risk factors. A standardized questionnaire was posted to 955 subjects randomly selected from a local Sydney electoral role of 68 821 voters. The response rate was 71% (M:F = 259:359). The overall prevalence of faecal incontinence, defined as answering in the affirmative to at least two of three questions which incorporated stool leakage, wearing a pad because of bowel incontinence and frequent incontinence of flatus, was 15% and was more prevalent in men (20%) than women (11%) (P < 0.015). The prevalence of urinary stress incontinence in women was 31%, and similarly 31% for urge incontinence. In men the prevalence of stress and urge urinary incontinence was 4% and 12%, respectively. Overall, there was a significant association between faecal incontinence and a sensation of incomplete rectal evacuation (P < 0.001), obstructed defaecation (P < 0.001), and subjective patient assessment of being constipated (P < 0.001). In women there was a significant association between faecal incontinence and episiotomy (P < 0.01), forceps delivery (P < 0.01), perineal tears (P < 0.01) and hysterectomy (P < 0.049). There was also a strong association between stress urinary incontinence and parity (P < 0.001), episiotomy (P < 0.001), forceps (P < 0.01), perineal tears (P < 0.01) and hysterectomy (P < 0.003). Using logistic regression models, independent risk factors for faecal incontinence were gender (male, odds ratio (OR) = 3.9, 95% confidence interval (CI) = 2.0-7.5), constipation (OR = 27.1, 95% CI = 12.3-59.5), straining (OR = 0.24, 95% CI = 0.1-0.6) and episiotomy (OR = 2.9, 95% CI = 1.4-6.0). A higher prevalence of faecal incontinence than previously reported was observed, particularly in males. The prevalence of urinary incontinence was consistent with other studies. Faecal and urinary incontinence are important community health problems in both sexes.

Introduction

To estimate prevalence and correlates of urinary and anal incontinence in morbidly obese women undergoing evaluation for laparoscopic weight loss surgery. From October 2003 to February 2005, 180 women with body mass index (BMI) of 40 or greater underwent evaluation for laparoscopic weight loss surgery. Using an established Web site, questionnaires were completed to assess symptoms of urinary incontinence, including the Medical, Epidemiological, and Social Aspects of Aging Questionnaire (MESA). Anal incontinence was assessed by asking, "Do you have any uncontrolled anal leakage?" A number of clinical and demographic variables were examined as potential risk factors for urinary incontinence and anal incontinence. Mean age was 39.8 years (range 16-55). Body mass index ranged from 40 to 81 (mean 49.5). Prevalence of urinary incontinence was 66.9% and anal incontinence was 32.0% (45.6% loss of gas only, 21.1% liquid stool only, 24.6% gas and liquid stool only, 8.8% solid stool). In simple logistic regression, presence of urinary incontinence was associated with age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09), number of children (OR 1.54, 95% CI 1.15-2.07), anal incontinence (OR 6.34, 95% CI 2.52-15.93), arthritis (OR 6.04, 95% CI 1.76-20.78), and sleep apnea (OR 2.30, 95% CI 1.21-4.37). Multivariable logistic regression identified 3 factors independently associated with urinary incontinence: number of children (OR 1.55, 95% CI 1.12-2.12), arthritis (OR 5.46, 95% CI 1.51-19.73), and anal incontinence (OR 6.27, 95% CI 2.42-16.26). Presence of anal incontinence was associated only with the presence of urinary incontinence (OR 6.34, 95% CI 2.52-15.93). Prevalence of urinary and anal incontinence is high in this group of morbidly obese women as compared with the general population. Studies are needed to determine the effect of weight loss on urinary and anal incontinence symptoms in the morbidly obese woman.

This study aimed to identify the prevalence of urinary, fecal and double incontinence among Japanese residents aged ≥65 years living in long-term care facilities. Furthermore, the association between baseline characteristics and changes in toileting activity after a 3-month comprehensive care among older individuals was investigated. We examined the prevalence of incontinence and its significant predictors. The association between the Functional Independence Measure score at baseline and each type of incontinence (urinary, fecal or double incontinence) was examined using a logistic regression model. Similarly, the association between the Functional Independence Measure score at baseline and improvement in toileting activity after a 3-month comprehensive care was examined. In total, 2517 residents (670 men and 1847 women) were recruited. The prevalence rates of urinary, fecal and double incontinence were 66.9%, 42.8% and 41.1%, respectively. In multivariate analysis, the sum of the motor subscales after removing four continence items and the sum of the cognitive subscales of the Functional Independence Measure score at baseline were significantly associated with all types of incontinence. The sum of the motor subscales after removing four continence items of the Functional Independence Measure score was associated with improved toileting activity. This study presented the prevalence of urinary, fecal and double incontinence among residents living in long-term care facilities in Japan. The Functional Independence Measure items at baseline were associated with not only continence status, but also improved toileting activity after 3-month comprehensive care. Geriatr Gerontol Int 2020; 20: 285-290.

ObjectivesTo estimate the prevalence of urinary incontinence and anal incontinence in Tunisian women and to identify their risk factors. Subjects and methodsA cross-sectional study was conducted among 402 female doctors and nurses randomly selected from 3 large hospitals in the center of Tunisia. The prevalence of urinary incontinence and anal incontinence were measured using validated questionnaires. ResultsOverall 45.3% of women experienced incontinence (urinary incontinence or anal incontinence). The overall prevalence of urinary incontinence, anal incontinence and double incontinence were 45%, 6.3% and 6%, respectively. Factors associated with incontinence were postpartum urinary incontinence (OR 11.91, CI 4:72–30:04, P<0.001), menopausal status (OR 11.72, CI 3:8–36:07, P<0.001), arterial hypertension (OR 4.17, CI 1:61–10.81, P=0.003), nurse occupation (OR 3.22, CI 1:62–6:36, P=0.001) and constipation (OR 1.71, CI 1:02–2:87, P=0.041). Medical help seeking was taken only by 21% of the incontinent women. ConclusionForty five percent of Tunisian women suffered from urinary or anal incontinence. A primary prevention for modifiable risk factors, such as postpartum pelvic floor physiotherapy and hypertension control, should be advised to women in order to optimize their quality of life.