University of Groningen
New insights into the pathophysiology and evaluation of fecal incontinence
van Meegdenburg, Maxime
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2018
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van Meegdenburg, M. (2018). New insights into the pathophysiology and evaluation of fecal incontinence.
Rijksuniversiteit Groningen.
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Tot al gr oup (N = 680) Health y subgr oup (n = 572) Comorbidity subgr oup (n = 108) Nullipar ous (n = 291) Par ous (n = 389) Nullipar ous (n = 260) Par ous (n = 312) Nullipar ous (n = 31) Par ous (n = 77) n % P n % n % P n % n % P n % Ag e (y ear s) <.001 <.001 .045 18-38 126 43.3 60 15.4 119 45.8 52 16.7 7 22.6 8 10.4 39-54 100 34.4 132 33.9 88 33.8 112 35.9 12 38.7 20 26.0 55-80 65 22.3 197 50.6 53 20.4 148 47.4 12 38.7 49 63.6 BMI (kg /m2) <.001 <.001 .691 <18.5 11 3.8 5 1.3 11 4.2 5 1.6 0 0.0 0 0 18.5-25 153 52.6 158 40.6 143 55.0 126 40.4 10 32.3 32 41.6 25-30 81 27.8 126 32.4 70 26.9 103 33.0 11 35.5 23 29.9 >30 46 15.8 100 25.7 36 13.8 78 25.0 10 32.3 22 28.6 Residence .066 .038 .999 Rural 98 33.7 159 40.9 86 33.1 130 41.7 12 38.7 29 37.7 Urban 193 66.3 230 59.1 174 66.9 182 58.3 19 61.3 48 62.3 Highes t educ ational le vel <.001 <.001 .744 Primar y 49 16.8 119 30.6 42 16.2 96 30.8 7 22.6 23 29.9 Sec ondar y 102 35.1 164 42.2 89 34.2 135 43.3 13 41.9 29 37.7 Tertiar y 140 48.1 106 27.2 129 49.6 81 26.0 11 35.5 25 32.5 emplo yed <.001 <.001 .263 No 131 45.0 238 61.2 113 43.5 184 59.0 18 58.1 54 70.1 Ye s 160 55.0 151 38.8 147 56.5 128 41.0 13 41.9 23 33.3 Table 1 .
Tot al gr oup Health y subgr oup Comorbidity subgr oup N % FI 95% CI P n % FI 95% CI P n % FI 95% CI P Ov er all 680 7.9 5.9-10.0 572 5.8 3.9-7.7 108 19.4 11.9-27.0 Ag e (y ear s) .141 .091 .740 18-38 186 9.1 5.0-13.3 171 7.6 3.6-11.6 15 26.7 13.0-52.0 39-54 232 5.2 2.3-8.0 200 3.0 0.6-5.4 32 18.8 4.5-33.0 55-80 262 9.5 6.0-13.1 201 7.0 3.4-10.5 61 18.0 8.1-28.0
Body Mass Inde
x .018 .097 .560 <18.5 16 0.0 -16 0.0 -0 0.0 -18.5-25 311 5.1 2.7-7.6 269 3.7 1.4-6.0 42 14.3 3.2-25.3 25-30 207 9.7 5.6-13.7 173 6.9 3.1-10.8 34 23.5 8.5-38.6 >30 146 12.3 6.917.7 114 9.6 4.1-15.2 32 21.9 6.7-37.0 Residence .109 .360 .141 Rural 257 10.1 6.4-13.8 216 6.9 3.5-10.4 41 26.8 12.7-41.0 Urban 423 6.6 4.2-9.0 356 5.1 2.9-7.3 67 14.9 6.2-23.7 Highes t educ ational le vel .087 .262 .258 Primar y 168 11.9 7.0-16.9 138 8.7 3.9-13.5 30 26.7 9.9-43.5 Sec ondar y 266 6.0 3.1-8.9 224 4.9 2.1-7.8 42 11.9 1.7-22.1 Tertiar y 246 7.3 4.0-10.6 210 4.8 1.9-7.7 36 22.2 8.0-36.5 emplo yed .118 .591 .440 Ye s 311 6.1 3.4-8.8 275 5.1 2.5-7.7 36 13.9 2.0-25.8 No 369 9.5 6.5-12.5 297 6.4 3.6-9.2 72 22.2 12.4-32.1 Table 2 .
Total group Healthy subgroup N % FI 95% CI P n % FI 95% CI P Overall 680 7.9 5.9-10.0 572 5.8 3.9-7.7 Pregnancy .570 .857 Nulliparous 291 7.2 4.2-10.2 260 5.4 2.6-8.1 Parous 389 8.2 5.7-11.3 312 6.1 3.4-8.8 Parity .562 .999 1 delivery 88 5.7 0.7-10.6 73 5.5 0.1-10.8 2 deliveries 205 9.8 5.7-13.9 163 6.1 2.4-9.9 ≥ 3 deliveries 96 8.3 2.7-14.0 76 6.6 0.9-12.3 Mode of delivery .503 .151 Vaginal 344 8.1 5.2-110 278 5.4 2.7-8.1 Cesarean section 25 8.0 -3.4-19.4 20 10.0 -4.4-24.4 Both 20 15.0 -2.1-32.1 14 14.3 -6.7-35.3 Longest straining duration .248 .296 < 1 hour 163 6.1 2.4-9.9 129 3.9 0.5-7.3 1-2 hours 100 9.0 3.3-14.7 85 5.9 0.8-11.0 > 2 hours 100 12.0 5.5-18.5 77 9.1 2.5-15.7 Use of instrument .066 .217 No 265 6.8 3.7-9.8 217 4.6 1.8-7.4 Yes 81 13.6 6.0-21.2 65 9.2 2.0-16.5 Obstetrical laceration or episiotomy .845 .999 No 128 7.8 3.1-12.5 98 6.1 1.3-11.0 Yes 235 8.9 5.3-12.6 193 5.7 2.4-9.0 Table 3.
Total group (N = 54) Healthy subgroup (n = 33) Nulliparous
(n = 21) (n = 33)Parous Nulliparous (n = 14) (n = 19)Parous
n % P n % n % P n % Use of laxatives 3 14.3 .202 11 33.3 3 21.4 .698 6 31.6 Use of anti-diarrhea medicine 2 9.5 .999 3 9.1 2 14.3 .172 0 0.0 Constipation 10 47.6 .392 11 33.3 7 50.0 .472 6 31.6 Urine incontinence 14 66.7 .775 20 60.6 9 64.3 .723 10 52.6 Healthy subgroup (n = 33) Total group (n = 54) Wexner score 20 15 10 5 0 Parous Nulliparous Page 1 A B Figure 1. Table 4. Healthy subgroup (n = 33) Total group (n = 54) Vaizey score 20 15 10 5 0 Parous Nulliparous Page 1
Total group (N = 680) Healthy subgroup (n = 572) Nulliparous Parous Nulliparous Parous
(n = 291) n (%) P (n = 389) n (%) (n = 260) n (%) P (n = 312) n (%)
Bristol stool chart .610 .928
1-2 44 (15.1) 50 (12.9) 34 (13.1) 39 (12.5)
3-5 222 (76.3) 300 (77.1) 206 (79.2) 251 (80.4)
6-7 25 (8.6) 39 (10.0) 20 (7.7) 22 (7.1)
Defecation frequency .134 .390
< 3 times per week 35 (12.0) 37 (9.5) 31 (11.9) 28 (9.0)
Once every 2 days
up to twice a day 234 (80.4) 334 (85.9) 213 (81.9) 269 (86.2)
> 3 times a day 22 (7.6) 18 (4.6) 16 (6.2) 15 (4.8)
Feels urge before
defecating .682 .466
Yes 225 (77.3) 311 (79.9) 199 (76.5) 251 (80.4)
Sometimes 57 (19.6) 66 (17.0) 52 (20.0) 50 (16.1)
No 9 (3.1) 12 (3.1) 9 (3.5) 11 (3.5)
Duration of being able to
control bowels after urge .792 .987
< 1 minute 35 (12.0) 51 (13.1) 29 (11.2) 37 (11.9)
< 5 minutes 64 (22.0) 88 (22.6) 55 (21.2) 65 (20.8)
< 10 minutes 62 (21.3) 71 (18.3) 55 (21.2) 63 (20.2)
Never needs to rush 130 (44.7) 179 (46.0) 121 (46.5) 147 (47.1)
Fecal urgency
at least monthly 30 (10.3) .053 61 (15.7) 22 (8.5) .027 46 (14.7) Can differentiate between
stool types .701 .545 Yes 239 (82.1) 316 (81.2) 215 (82.7) 256 (82.1) Difficult 35 (12.0) 44 (11.3) 29 (11.2) 30 (9.6) No 17 (5.8) 29 (7.5) 16 (6.2) 26 (8.3) Abdominal pain 93 (32.0) .058 98 (25.2) 77 (29.6) .184 76 (24.4) Table 5.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.
20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33.
