Writing in the August edition of the journal Diseases of the Colon and Rectum, researchers from the Departments of Surgery, and Community Health, at the University of Auckland, New Zealand, were interested to determine if there was a reason for the wide variations in reported prevalence estimates fecal incontinence among community-dwelling adults.
They used a systematic review to investigate the studies prevalence of fecal incontinence in the community. The researchers also explored the different study designs and sources of bias that they felt might explain the variability in estimates.
Using a predetermined search strategy, the researchers located all the studies published that reported the prevalence of fecal incontinence in a community-based sample of adults.
They then extracted data onto a proforma for sampling frame and method, as well as sample size, response rate, definition of fecal incontinence used, data-collection method, and prevalence rates.
|"Further cross-sectional studies are required that minimize bias in their design and use validated self-administered questionnaires."|
|Diseases of the Colon & Rectum|
In addition, those studies included in the literature review were critically appraised for possible sources of selection bias, information bias, and imprecision.
In total, 16 studies were identified that met the inclusion criteria. These could be grouped those with definitions of incontinence that either included or excluded incontinence of flatus.
The estimated prevalence of anal incontinence (including flatus incontinence) varied from 2 to 24%, and the estimated prevalence of fecal incontinence (excluding flatus incontinence) varied from 0.4 to 18%.
Only 3 studies were found to have a study design that minimized significant sources of bias, and only one of these used a validated instrument for data collection. The prevalence estimate of fecal incontinence from these studies was 11 to 15%.
No pooling of estimates was undertaken because there was wide variation in study design.
Alexandra K. Macmillan, lead author of the report, commented, "A consensus definition of fecal incontinence is needed that accounts for alterations in quality of life."
She concluded, "Further cross-sectional studies are required that minimize bias in their design and use validated self-administered questionnaires."