C. Seth Landefeld
National Institutes of Health State-of-the-Science Conference Statement: Prevention of Fecal and Urinary Incontinence in Adults
nih conferences18 march 2008national institutes health stateofthescience conference statement prevention fecal urinary incontinence adultsfreec seth landefeld md barbara j bowers phd rn andrew feld md jd katherine e hartmann md phd eileen hoffman md melvin j ingber phd joseph king jr md msce w scott mcdougal md heidi nelson md endel john orav phd michael pignone md mph lisa h richardson robert rohrbaugh md hilary c siebens md bruce j trock phdc seth landefeld mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author barbara j bowers phd rnfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author andrew feld md jdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author katherine e hartmann md phdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author eileen hoffman mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author melvin j ingber phdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author joseph king jr md mscefrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author w scott mcdougal mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author heidi nelson mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author endel john orav phdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author michael pignone md mphfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author lisa h richardsonfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author robert rohrbaugh mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author hilary c siebens mdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers author bruce j trock phdfrom university california san francisco san francisco veterans affairs medical center san francisco california university wisconsinmadison madison wisconsin university washington seattle washington vanderbilt institute medicine public health nashville tennessee new york university school medicine new york new york rti international washington dcveterans affairs connecticut healthcare system yale university school medicine new connecticut massachusetts general hospital brigham womens hospital boston massachusetts mayo medical school rochester minnesota university north carolina hospital chapel hill north carolina crohns colitis foundation america houston texas university virginia charlottesville virginia johns hopkins university school medicine baltimore marylandsearch papers authorauthor article disclosure informationhttpsdoiorg10732600034819148620080318000210 sectionsaboutvisual abstractpdf toolsadd favoritesdownload citationstrack citationspermissions sharefacebooktwitterlinkedinredditemail national institutes health consensus stateofthescience statements prepared independent panels health professionals public representatives basis 1 results systematic literature review prepared contract agency healthcare research quality ahrq 2 presentations investigators working areas relevant conference questions 2day public session 3 questions statements conference attendees open discussion periods part public session 4 closed deliberations panel remainder second day morning third statement independent report panel policy statement national institutes health us governmentfecal incontinence urinary incontinence conditions ramifications extend well beyond physical manifestations many individuals find withdrawing social lives attempting hide problem families friends even doctors shame embarrassment stigma associated conditions pose significant barriers seeking professional treatment resulting many persons suffer conditions without help baby boomers approach sixties incidence public health burden incontinence likely increasefecal incontinence syndrome involves unintentional loss solid liquid stool serious embarrassing fecal incontinence may affect individuals living home well many living nursing homes although fecal incontinence affects individuals ages common women older persons bowel function controlled 4 factors rectal sensation rectal storage capacity anal sphincter pressure established bowel habits compromised fecal incontinence occur despite serious effects patients families society fecal incontinence often ignored studied less many conditionsurinary incontinence affect persons ages common childbearing women older men women urinary incontinence generally classified urge incontinence person sudden urge urinate cannot get bathroom time stress incontinence person leaks urine strains laughing coughing sneezing lifting mixed incontinence person urge stress incontinence incontinence example urine continues leak urination leaks constantly urinary incontinence studied extensively fecal incontinence magnitude problem urinary incontinence disproportionate amount research prevention treatmentit difficult identify persons risk affected incontinence condition often reported diagnosed prevention fecal urinary incontinence hindered limited research incomplete knowledge biological causes interacting social environmental factorsto promote work reduce suffering fecal urinary incontinence well costs preventing occurrence national institute diabetes digestive kidney diseases office medical applications research national institutes health convened stateofthescience conference 10 12 december 2007 assess available scientific evidence relevant following questions 1 prevalence incidence natural history fecal urinary incontinence community longterm care settings 2 burden illness impact fecal urinary incontinence individual society 3 risk factors fecal urinary incontinence 4 done prevent fecal urinary incontinence 5 strategies improve identification persons risk patients fecal urinary incontinence 6 research priorities reducing burden illness conditionsat conference invited speakers presented information pertinent questions systematic literature review prepared contract ahrq wwwahrqgovclinictpfuiadtphtm summarized conference attendees provided oral written statements response key questions panel members weighed evidence addressed conference questionsthis conference focused preventing fecal urinary incontinence detecting persons risk persons untreated incontinence treatment incontinence surgery drugs beyond scope conference1 prevalence incidence natural history fecal urinary incontinence community longterm care settingsthe occurrence fecal urinary incontinence described terms prevalence number individuals incontinence point time incidence number individuals newly develop incontinence period time natural history whether incontinence improves stays worsens time measures varies factors whether individual living community nursing home individuals sex age racial ethnic groupseverity incontinence varies frequency amount addition incontinence many different causes little information describes rates incontinence due specific cause severity therefore section describes prevalence incidence natural history causes incontinence combined provide sense impact fecal urinary incontinence provide estimates incontinence rates derived several studies rates vary considerably across studies provide rates consistent largest body data category incontinence important limitations information include underreporting symptoms lack consistency definition incontinence limited numbers studies specific topicsfecal incontinencemany definitions fecal incontinence exist include flatus passing gas others confined stool following data refer incontinence stool prevalence fecal incontinence women living community increases age 6 younger 40 years age 15 older women among men living community fecal incontinence experienced 6 10 rate increasing slightly age among men women fecal incontinence approximately 50 also urinary incontinence severity fecal incontinence increases age studies comparing racial ethnic groups find differencesin nursing homes prevalence fecal incontinence varies widely according physical mental status residents overall prevalence 45 rate low 10 15 independent residents 70 dependent combined fecal urinary incontinence occurs large proportion nursing home residentsdata incidence fecal incontinence community sparse permit estimates generalized population similarly natural history fecal incontinence well studied therefore meaningful conclusions cannot made regarding rate development fecal incontinence rates improvement worseningurinary incontinenceprevalence urinary incontinence women living community increases age 19 age younger 45 years 29 age 80 years older rate levels age 50 70 years prevalence increases current national estimates 20 million women urinary incontinence experienced point lives women stress incontinence decreases age whereas urge incontinence increases age information comparing prevalence racial ethnic groups suggests urinary incontinence prevalent ethnic groups suggestion higher rates among white womenthe epidemiology urinary incontinence men studied extent women men living community prevalence urinary incontinence 5 15 exhibits steady increase age among women 5 younger 45 years age 21 men age 65 years older increase primarily reflects urge incontinence mixed urinary incontinence stress incontinence decreasing age 65 years nationally prevalence urinary incontinence men lifetime approximately 6 million studies examined racial ethnic differences prevalence urinary incontinence among men reliable comparisons cannot madeprevalence urinary incontinence nursing homes much higher community rates 60 78 women 45 72 men increase age may due part impaired mobility difficulty getting toilet urinary incontinence also reason admission nursing home complication conditions prompt admission studies evaluated racial ethnic differences suggest differences minimaldata incidence urinary incontinence considerably sparse prevalence data community annual incidence women increases age less 2 age younger age 45 years 8 age 80 years older overall annual rate 6 4 studies evaluated incidence men overall annual rate 4 increases age comparisons incidence data race ethnicity type urinary incontinence limitedlittle known sex age affect natural history urinary incontinence urinary incontinence resolves individuals whether resolution resulted treatments unclear known whether resolution temporary permanent whether differs type incontinenceother populations considercase reports smaller series may identify previously unrecognized behaviors communities risk fecal urinary incontinence example injuries incurred sports work sexual activity may identify unique causes incontinence causes could generate new hypotheses fecal urinary incontinence occursstrength evidencewith exception prevalence urinary incontinence estimates incidence prevalence incontinence adults based relatively studies studies used varying definitions incontinence different methods population sampling preceding statistics considered fairly crude estimates areas particular need studies incidence fecal urinary incontinence studies type severity incontinence comparisons racial ethnic groups larger sample sizes ability evaluate cultural differences risk factors studies natural history2 burden illness impact fecal urinary incontinence individual societythe burdens fecal urinary incontinence fall economic noneconomic categories complex use term costs referring economic dimension burden referring noneconomic dimension quality evidence cost burden limited economic cost obscured often lifethreatening comorbid conditions current estimates based older data modified estimates inflation studies burden limited paucity validated instruments measuring quality life variability personal response condition also individuals incontinent live variety situationsfrom independent community living community living home care living nursing homewith different implications costs personal stresses interventions reduce burden incontinence address costs stressesfor individuals costs reduced absolutely even current state knowledge many others however tradeoff reductions burden increased costs although total costs society great costs burden range widely individual level spectrum incontinence itselfburden individuals incontinentindividuals incontinent may emotional burden shame embarrassment well physical discomfort disruption lives occur episodes incontinence impact incontinence individuals varies age sex type incontinence individual differences coping skills quality social support emotional social burdens easily measured example persons may experience stresses relationships low productivity work job difficulties arranging daily activities bathroom location avoiding activities provoke incontinenceindividuals incontinent may experience anxiety accidents depression social isolation social exclusion management incontinence burdensome quality life subjective measure difficult associate physiologic measures urinary incontinence bears investigation urinary fecal incontinence objective data exist effect incontinence quality relationships sexual parentchild sibling employeremployee stress may result relationships involve caregivingcaregiver burdenincontinence requires greater amounts informal formal caregiving informal caregivers usually family members friends give unpaid assistance formal caregivers paid provide assistance caregiver responsibilities range helping stock refrigerator preparing food supervising taking medicine helping toileting major source stress caregivers physical mental effort needed tasks unpleasantness dealing incontinence despite large numbers informal caregivers research examining impact incontinence caregiver burden limited th