Bowel Disturbances Are the Most Important Risk Factors for Late Onset Fecal Incontinence: A Population-Based Case-Control Study in Women
Bowel Disturbances Are the Most Important Risk Factors for Late Onset Fecal Incontinence: A Population-Based Case-Control Study in Women
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DOI：
10.1053/j.gastro.2010.07.056
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发表时间：
2010-11-01
期刊：
影响因子：
29.4
通讯作者：
Melton, L. Joseph, III
中科院分区：
文献类型：
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作者：
Bharucha, Adil E.;Zinsmeister, Alan R.;Melton, L. Joseph, III
背景与目的：年龄、腹泻和某些慢性疾病是尿失禁（FI）的危险因素。然而，产科损伤对生命后期FI发展的贡献尚不清楚。我们试图更好地了解FI的风险因素。方法：通过罗切斯特流行病学项目，对来自明尼苏达州奥姆斯特德县的176名随机选择的FI女性（病例，平均年龄58岁）和176名年龄匹配的社区对照进行了巢式病例对照研究。通过回顾住院和门诊医疗（包括原始产科）记录，评估FI的危险因素。分析的重点是在索引日期（每对配对病例的FI发病日期）之前的情况。结果：88%的FI开始于40岁；严重程度分为轻度（37%）、中度（58%）和重度（5%）。通过多变量分析，当前吸烟（优势比[OR]， 4.7； 95%可信区间[CI]， 1.4-15）、体重指数（单位OR， 1.1; 95% CI, 1.004-1.1）、腹泻（OR, 53; 95% CI, 6.1-471）、肠易激综合征（OR, 4.8; 95% CI, 1.6-14）、胆囊切除术（OR, 4.2; 95% CI, 1.2-15）、直肠膨出（OR, 4.9; 95% CI, 1.3-19）和应激性尿失禁（OR, 3.1; 95% CI, 1.4-6.5）是FI的独立危险因素，但产科事件除外。结论：肠道紊乱而非既往产科损伤是FI的主要危险因素。在对患有FI的女性进行肛门显像之前，应采取措施改善肠道紊乱和其他潜在的可逆危险因素。
BACKGROUND & AIMS: Age, diarrhea, and certain chronic illnesses are risk factors for fecal incontinence (FI). However, the contribution of obstetric injury to the development of FI later in life is unclear. We sought to better understand the risk factors for FI. METHODS: Through the Rochester Epidemiology Project, a nested case-control study of 176 randomly selected women with FI (cases; mean age, 58 years) and 176 age-matched community controls was conducted in a population-based cohort from Olmsted County, Minnesota. Risk factors for FI were evaluated by reviewing inpatient and outpatient medical (including original obstetric) records. Analyses focused on conditions that preceded the index date (incidence date of FI for case in each matched pair). RESULTS: In 88% of cases, FI began at age >= 40 years; severity was mild (37%), moderate (58%), or severe (5%). By multivariable analysis, current smoking (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.4-15), body mass index (OR per unit, 1.1; 95% CI, 1.004-1.1), diarrhea (OR, 53; 95% CI, 6.1-471), irritable bowel syndrome (OR, 4.8; 95% CI, 1.6-14), cholecystectomy (OR, 4.2; 95% CI, 1.2-15), rectocele (OR, 4.9; 95% CI, 1.3-19), and stress urinary incontinence (OR, 3.1; 95% CI, 1.4-6.5), but not obstetric events, were independent risk factors for FI. CONCLUSIONS: Bowel disturbances rather than prior obstetric injury are the main risk factors for FI. Measures to ameliorate bowel disturbances and other potentially reversible risk factors should be implemented before anal imaging is performed on women with FI.