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Prevention of Urinary and Fecal Incontinence in Adults
Evidence Reports/Technology Assessments, No. 161
Investigators: Tatyana Shamliyan, MD, MS, Jean Wyman, PhD, Donna Z Bliss, PhD, RN, FAAN, Robert L Kane, MD, and Timothy J Wilt, MD, MPH.
Structured Abstract
Objectives:
To assess the prevalence of and risk factors for urinary (UI) and fecal (FI) incontinence in adults in long-term care (LTC) settings and in the community, the effectiveness of diagnostic methods to identify adults at risk and patients with incontinence, and to review the effectiveness of clinical interventions to reduce the risk of incontinence.
Data Sources:
MEDLINE® (PubMed), CINAHL, and Cochrane Databases.
Review Methods:
Observational studies were reviewed to examine the prevalence and incidence of UI and FI and the association with risk factors. The effects of treatments on patient outcomes were analyzed from randomized controlled and multicenter clinical trials. The diagnostic values of the tests were compared from the original epidemiologic studies of different designs. Of the 6,097 articles identified, 1,077 articles were eligible for analysis.
Results:
The prevalence of UI, FI, and combined incontinence increased with age and functional dependency. Cognitive impairment, limitations in daily activities, and prolonged institutionalization in nursing homes were associated with a higher risk of incontinence. Stroke, diabetes, obesity, poor general health, and comorbidities were associated with UI and FI in community dwelling adults. Parity, anal trauma, and vaginal prolapse in women and urological surgery and radiation for prostate cancer in men are risk factors for UI and FI. Intensive individualized management and rehabilitation programs improved continence status in nursing home residents and adults after stroke. Self-administered behavioral interventions including pelvic floor muscle training with biofeedback and bladder training resolved UI in incontinent women. Electrical stimulation and sacral neuromodulation improved urge UI, but improvement for FI was inconsistent. Tension-free vaginal tape procedures and modified surgical techniques for prolapse to support the bladder neck resolved stress UI in the majority of treated women. Behavioral treatments of FI resulted in small improvements in severity and quality of life related to incontinence. The effects on FI of surgical techniques for hemorrhoids, rectal prolapse, rectal cancer, and anal fissures are not consistent across studies. Surgical interventions in patients with ulcerative colitis resulted in the same rates of fecal continence when compared to each other. The few clinical interventions to treat FI that were tested in well-designed trials had no clear evidence of better effects of the compared treatments. Instrumental outcomes to evaluate the effectiveness of treatments did not correlate with patient outcomes. Epidemiologic surveys to detect persons at risk and patients with undiagnosed UI have the same diagnostic value and less cost compared to professional examinations and diagnostic tests. Self-reported questionnaires and scales have unsatisfactory validity to diagnose FI.
Conclusions:
Epidemiologic surveys are cost-effective ways to estimate the prevalence of UI in large nationally representative population groups. Routine clinical evaluation should include an assessment of the risk factors, symptoms, and signs of incontinence. Pregnant or menopausal women, women with vaginal prolapse, males treated for prostate disease, patients with rectal prolapse, and frail elderly and nursing home residents are high risk groups. Individualized management programs can improve continence in LTC facilities but are hard to sustain. Regular monitoring and documentation of the continence status in relation to implemented continence services should be quality of care indicators for nursing homes. Pelvic floor muscle trainings with biofeedback can resolve incontinence and improve quality of life. Surgery is effective in curing stress UI in females. Clinical interventions for UI in males and for FI in adults need future investigation. A list of research recommendations is offered.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Question 1. What are the Prevalence and Incidence of UI in the Community and LTC Settings?
- Question 1. What are the Prevalence and Incidence of FI in the Community and LTC Settings?
- Question 2. What are the Independent Contributions of Risk Factors for Urinary, Fecal, and Combined Urinary and Fecal Incontinence?
- Risk Factors for UI in Community Dwelling Men
- Question 3. What is the Evidence to Support Specific Clinical Interventions to Reduce the Risk of UI and FI?
- Question 4. What are the Strategies to Improve the Identification of Persons at Risk and Patients who have UI and FI?
- 4. Discussion
- Detection of UI
- Detection of FI
- Treatment
- Definitions of Incontinence and Measures of Success
- Clinical Effectiveness to Reduce the Risk of Incontinence
- Strength of the Evidence
- Policy Implications
- Question 5. What are the Research Priorities for Identifying Effective Strategies to Reduce the Burden of Illness in these Conditions?
- List of Acronyms/Abbreviations
- Appendixes
- References and Included Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0009. Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota.
Suggested citation:
Shamliyan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ. Prevention of Fecal and Urinary Incontinence in Adults. Evidence Report/Technology Assessment No. 161 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 08-E003. Rockville, MD. Agency for Healthcare Research and Quality. December 2007.
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0009, Task Order #5). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
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540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women.[Cochrane Database Syst Rev. 2020]Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women.Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Cochrane Database Syst Rev. 2020 May 6; 5(5):CD007471. Epub 2020 May 6.
- Behavioural interventions for urinary incontinence in community-dwelling seniors: an evidence-based analysis.[Ont Health Technol Assess Ser....]Behavioural interventions for urinary incontinence in community-dwelling seniors: an evidence-based analysis.Medical Advisory Secretariat. Ont Health Technol Assess Ser. 2008; 8(3):1-52. Epub 2008 Oct 1.
- What characteristics predispose to continence in nursing home residents?: a population-based cross-sectional study.[Neurourol Urodyn. 2015]What characteristics predispose to continence in nursing home residents?: a population-based cross-sectional study.Saga S, Vinsnes AG, Mørkved S, Norton C, Seim A. Neurourol Urodyn. 2015 Apr; 34(4):362-7. Epub 2014 Jan 28.
- Review Can incontinence be cured? A systematic review of cure rates.[BMC Med. 2017]Review Can incontinence be cured? A systematic review of cure rates.Riemsma R, Hagen S, Kirschner-Hermanns R, Norton C, Wijk H, Andersson KE, Chapple C, Spinks J, Wagg A, Hutt E, et al. BMC Med. 2017 Mar 24; 15(1):63. Epub 2017 Mar 24.
- Review Conservative management for postprostatectomy urinary incontinence.[Cochrane Database Syst Rev. 2012]Review Conservative management for postprostatectomy urinary incontinence.Campbell SE, Glazener CM, Hunter KF, Cody JD, Moore KN. Cochrane Database Syst Rev. 2012 Jan 18; 1:CD001843. Epub 2012 Jan 18.
- Prevention of Urinary and Fecal Incontinence in AdultsPrevention of Urinary and Fecal Incontinence in Adults
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