Epidemiology and Mechanisms of Fecal Incontinence

大便失禁(FI)是老年妇女的一种社会破坏性症状，可能会导致制度化。“特发性”FI的流行病学和病理生理学尚不完全清楚。目前基于三级护理研究的概念非常强调肛门内超声所显示的肛门括约肌缺陷的作用。初步研究表明，奥姆斯特县大于或等于50岁的妇女中FI的患病率为17.8%，发病年龄中值为61岁。产科事件、腹泻/紧迫症和肥胖是FI的危险因素。我们新颖的“透视”单次快速自旋回波核磁共振技术可以实时显示排便时盆底下沉的情况。与US相反，肛门内MRI显示外括约肌缺陷和萎缩、耻骨直肠肌变薄和盆底整体松弛。假说是，大便失禁不仅仅是产科创伤造成的，而是产科创伤、过度劳累、肥胖、衰老和更年期以及腹泻等因素造成的盆底无力的累积结果。这一假设将通过将罗切斯特流行病学项目的数据基础设施与社区样本中最先进的生理测量相结合来解决。调查问卷将邮寄给先前接受调查的大约1,000名妇女队列，以确定FI的发生率和自然病史，并将向新的5,000名妇女样本邮寄，以确定FI的患病率和频率。盆底损伤(产科创伤、慢性劳累、肥胖和雌激素耗竭)和FI(腹泻和直肠紧迫症)的可能危险因素将在一项病例对照研究中进行评估，该研究涉及大约200名FI患者，每月至少一次，另有大约200名对照组。大约100名FI患者和大约100名对照组将接受MRI透视检查，以表征与FI相关的特定的盆底整体异常(即肛门括约肌缺陷、括约肌萎缩、耻骨直肠肌变薄和盆底松弛)。这些研究将加深我们对FI流行病学的理解，确定导致盆底损伤延迟表现的产科危险因素，即FI，强调非产科危险因素对FI的重要性，并为社区中与FI相关的盆底损伤的具体模式提供新的见解。这些步骤对于通过调整危险因素来减少盆底损伤的发生率，识别进展为症状性FI的高风险患者，以及设计适当的干预措施来阻止这一过程是必要的。

Fecal incontinence (FI) is a socially devastating symptom in older women and may contribute to institutionalization. The epidemiology and pathophysiology of "idiopathic" FI is incompletely understood. Current concepts based on tertiary-care studies heavily emphasize the role of anal sphincter defects visualized by endoanal ultrasound. Preliminary studies suggest that the prevalence of FI in Olmsted County in women greater than or equal to 50 years is 17.8 percent with a median age of onset of 61 years. Obstetric events, diarrhea/urgency and obesity are risk factors for FI. Our novel "fluoroscopic" single-shot fast spin-echo MRI techniques visualize pelvic floor descent during defecation in real-time. In contrast to US, endoanal MRI depicts external sphincter defects and atrophy, puborectalis thinning and global pelvic floor laxity. The hypothesis is that fecal incontinence is not attributable to obstetric trauma alone, but the cumulative result of pelvic floor weakness caused by obstetric trauma, excessive straining, obesity, aging and menopause, compounded by diarrhea. This hypothesis will be addressed by combining the data infrastructure of the Rochester Epidemiology Project with state- of-the-art physiological measurements in a community-based sample. A questionnaire will be mailed to a cohort of approximately 1,000 women surveyed previously to ascertain the incidence and natural history of FI, and, a new sample of 5,000 women to determine the prevalence and frequency of FI. Putative risk factors for pelvic floor injury (obstetric trauma, chronic straining, obesity and estrogen depletion) and FI (diarrhea and rectal urgency) will be evaluated in a case-control study of approximately 200 patients with FI at least once a month and approximately 200 controls. approximately 100 patients with FI and approximately 100 controls will have MRI fluoroscopy to characterize the specific global pelvic floor abnormality (i.e., anal sphincter defects, sphincter atrophy, puborectalis thinning and pelvic floor laxity) associated with FI. These studies will refine our understanding of the epidemiology of FI, identify the obstetric risk factors responsible for delayed manifestations of pelvic floor injury, i.e. FI, underscore the importance of non- obstetric risk factors for FI and provide novel insights into the specific pattern of pelvic floor injury associated with FI in a community. These steps are necessary for reducing the incidence of pelvic floor damage by risk factor modification, identifying patients at higher risk of progressing to symptomatic FI, and designing appropriate interventions to halt this process.