MONTREAL — Anal incontinence is four times more prevalent than previously thought, and it affects older men and women almost equally, according to what British researchers describe as the first systematic review of the prevalence of this disorder.
“Age, not gender, is the most important factor, and obstetric trauma does not have a major effect,” Philip Toozs-Hobson, M.D., reported at the annual meeting of the International Continence Society.
The review of 29 studies with a total of 69,152 participants found an overall rate of anal incontinence of 3.5% in men and 4.5% in women across all age groups. “It suggests that the 1% rate presumed by government agencies is an underestimate,” said Dr. Toozs-Hobson, a consultant gynecologist at Birmingham (England) Women's Hospital.
Moreover, the effects of obstetric trauma could not be seen in this data, he said.
“It has long been thought that the incidence of anal incontinence is higher in women because trauma occurs to the anal sphincter during childbirth,” Dr. Toozs-Hobson said during the meeting.
“However, this study does not provide evidence that women under 60 years have significantly higher rates of incontinence, when compared with men of similar age.”
When data were broken down according to age, the prevalences for men and women under age 60 years were 0.8% and 1.6%, respectively.
Although the rates were much higher in people over age 60 years, they remained similar across the genders, at 5.1% for men and 6.2% for women, Dr. Toozs-Hobson said.
“Many experts believe that the effects of obstetric trauma may only appear in older age, but we did not find significant interaction between age and gender,” he said.
Inasmuch as anal incontinence is increasingly becoming recognized as a significant cause of physical and psychological morbidity, these data may well have implications for community health care providers, Dr. Toozs-Hobson said.