Jackson S L, Weber A M, Hull T L, Mitchinson A R, Walters M D
Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, Ohio, USA.
Obstet Gynecol. 1997 Mar;89(3):423-7. doi: 10.1016/S0029-7844(96)00499-1.
To determine the prevalence of and factors associated with fecal incontinence in women with urinary incontinence or pelvic organ prolapse.
Study subjects were recruited prospectively, and all participants received questionnaires regarding bowel function and underwent a standardized history and physical examination. Fecal incontinence was defined as the involuntary loss of feces sufficient to be considered a problem by the patient.
Forty-two subjects had fecal incontinence, an overall prevalence of 17%. One hundred seventy women had urinary incontinence, pelvic organ prolapse, or both, and 36 of these (21%) had fecal incontinence. One hundred (40%) women had urinary incontinence, of whom 31 also had fecal incontinence. Seventy women had isolated pelvic organ prolapse and five (7%) were incontinent of feces. Univariate analysis revealed that any degree of pelvic organ prolapse, increasing degrees of prolapse within each vaginal segment, urinary incontinence, advanced age, postmenopausal status, increased vaginal parity, prior hysterectomy, history of irritable bowel syndrome, and abnormal sphincter tone were associated significantly with fecal incontinence. Multiple logistic regression analysis indicated that only urinary incontinence (odds ratio [OR] 4.6, P < .001, 95% confidence interval [CI] 1.9, 11.2), abnormal anal sphincter tone (OR 2.3, P = .04, 95% CI 1.1, 5.1), and irritable bowel syndrome (OR 8.3, P = .002, 95% CI 2.1, 32.8) were associated with fecal incontinence.
There is a high rate of fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Clinicians providing health care to a similar group of women should inquire routinely and specifically about fecal incontinence.
确定尿失禁或盆腔器官脱垂女性中粪便失禁的患病率及相关因素。
前瞻性招募研究对象，所有参与者均接受关于肠道功能的问卷调查，并接受标准化的病史采集和体格检查。粪便失禁定义为粪便不自主排出，严重程度足以被患者视为问题。
42名受试者存在粪便失禁，总体患病率为17%。170名女性存在尿失禁、盆腔器官脱垂或两者皆有，其中36名（21%）存在粪便失禁。100名（40%）女性存在尿失禁，其中31名也有粪便失禁。70名女性存在孤立性盆腔器官脱垂，5名（7%）存在粪便失禁。单因素分析显示，任何程度的盆腔器官脱垂、每个阴道节段脱垂程度增加、尿失禁、高龄、绝经后状态、阴道分娩次数增加、既往子宫切除术、肠易激综合征病史以及括约肌张力异常均与粪便失禁显著相关。多因素逻辑回归分析表明，仅尿失禁（比值比[OR]4.6，P<.001，95%置信区间[CI]1.9，11.2）、肛门括约肌张力异常（OR 2.3，P =.04，95%CI 1.1，5.1）和肠易激综合征（OR 8.3，P =.002，95%CI 2.1，32.8）与粪便失禁相关。
尿失禁和盆腔器官脱垂女性中粪便失禁发生率较高。为这类女性提供医疗保健的临床医生应常规且专门询问粪便失禁情况。
