Epidemiology of anal incontinence

The prevalence of anal incontinence, including gas, liquid and/orsolid stools, is about 10 percent in general community if we considerall the patients whatever frequency of incontinence and itsadverse consequences on patients’ well-being, interpersonal relationshipsand social role fulfilment. Daily or weekly anal incontinenceaffects about 1 percent of the general population living athome. The prevalence of anal incontinence increases significantlybut slightly with age. Indeed the most prominent risk factors forfecal incontinence in elderly are physical disability and poor generalhealth and the prevalence approaches 50 percent among nursinghome residents. Surprisingly epidemiological studies fail toclearly demonstrate that women are more willing to report analincontinence than men in general population. However during thelast ten years several prospective studies demonstrated that childbirthleads to anal incontinence 1 to 2 percent of women immediatelyafter pregnancy and long after pregnancy.There are few data available on the direct costs of treatment of analincontinence. A series of detailed studies of direct health care costsfor urinary incontinence demonstrated that incontinence is a veryexpensive symptom responsible of tens of billions of Euros everyyear. For example the estimated national costs of incontinence accountsfor 0.5 percent of the total costs of Swedish health care and0.05 percent of the Gross National Product. Even if surgery is themost expensive treatment (9000 € for an artificial sphincter), thecosts generated by anal incontinence are mainly due to medicaltreatment, especially with respect to elderly patients admitted tonursing homes (nursing time, laundry, incontinence supplies). Theenormous economic costs of incontinence suggest 1- the need forgeneral practitioners and gastroenterologists to detect, to prevent,and to treat anal incontinence in order to delay or avoid admittingpatients to medical facilities such as nursing homes for example 2-to promote research and development to define the best medical andeconomical management strategies