Lopes M C, Teixeira M G, Jacob Filho W, Carvalho Filho E T, Habr-Gama A, Pinotti H W
Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1997 Jan-Feb;52(1):1-12.
The aim of the present work was to assess the prevalence of anal incontinence in the elderly population attended in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo". The method employed was of individual interviews with patient attended in the Geriatric Ambulatory. As part of the assessment patients were classified as to sex, age, color, social-economical class and education, and compared to available data on the elderly population of the State and the City of São Paulo. Besides the question on signs and symptoms related to anal incontinence, associated factors such as bowel habit, sensation of incomplete evacuation, urgency to evacuate and soiling were also analysed, as well as, factors possibly related to anal incontinence such as urinary incontinence, use of medication as laxatives, associated diseases, such as neurological affections and diabetes mellitus, number of child births, and assistance received, previous anorectal or perineals operations, and locomotions limiting factor. The statistical method of test of proportion was used to analyse the proportions of the populations interviewed, as to sex and literacy compared to the elderly population of the State and City of São Paulo. To analyse the social-economical class of the population interviewed compared to the elderly population economically and non economically active, of the State of São Paulo, the test of qui-square adjusted was used. The test of qui-square was used to verify if the population of incontinent and continent, by sex; incontinent and continent in relation to bowel habit, by sex; incontinence sufferer of continuous and descontinuous anal incontinence, by sex; incontinent sufferer of anal incontinence to gas, liquid or solid, and the association of these manifestations, by sex; patients who complained of soiling, by sex; incontinent and continent, previously submitted to anorectal or perineal operations; and continent and incontinent with diabetes mellitus, are equal. To verify the proportions of women who had vaginal delivery in the continent and incontinent group, the test of Mann-Whitney was used. One hundred fourty six patients were interviewed, 43 men of an average 75 years old (62 to 91) and 103 women of an average 72 years old (60 to 88); as to colours, 69.9% were white, 18.5% were mullato, 9.6% were black and 2% were yellow. The comparative analysis with populational data indicated that the population interviewed was representative of the elderly population of the State and the City of São Paulo, as to age, color, social-economical class and education. The prevalence of anal incontinence was of 10.9% with no difference between the sexes, intestinal obstipation referred by 15.4% of the men and 28.1% of the women, sensation of incomplete evacuation referred by 21.2% of the patients, and the association of both referred by 13.7% were the most frequently observed functional gastrointestinal alterations. Soiling was referred by 10.3% of the patients with no difference related to sex. The use of medication or laxatives, the presence of diabetes mellitus, neurological affections, previews anorectal or perineal operations, or locomotion limiting factors, have no relation to anal incontinence. The prevalence of urinary incontinence was of 30.1%, and double continence of 6.3% with no statistical difference between sexes. There was statistical evidence of association between childbearing and anal incontinence.
本研究的目的是评估在圣保罗大学医学院临床医院就诊的老年人群中肛门失禁的患病率。采用的方法是对老年门诊的患者进行个人访谈。作为评估的一部分，对患者按性别、年龄、肤色、社会经济阶层和教育程度进行分类，并与圣保罗州和圣保罗市老年人群的现有数据进行比较。除了询问与肛门失禁相关的体征和症状外，还分析了相关因素，如排便习惯、排便不尽感、排便紧迫感和弄脏情况，以及可能与肛门失禁相关的因素，如尿失禁、使用泻药、相关疾病，如神经疾病和糖尿病、分娩次数、接受的护理、既往肛肠或会阴手术以及行动限制因素。采用比例检验的统计方法分析受访人群在性别和识字率方面与圣保罗州和圣保罗市老年人群的比例。为了分析受访人群的社会经济阶层与圣保罗州经济活跃和不活跃的老年人群的比较，使用了校正卡方检验。使用卡方检验来验证按性别划分的失禁和非失禁人群；按性别划分的与排便习惯相关的失禁和非失禁人群；按性别划分的持续性和间歇性肛门失禁的失禁患者；按性别划分的肛门失禁患者对气体、液体或固体的失禁情况以及这些表现的关联；按性别划分的主诉弄脏的患者；既往接受过肛肠或会阴手术的失禁和非失禁患者；以及患有糖尿病的非失禁和失禁患者是否相等。为了验证在非失禁组和失禁组中阴道分娩的女性比例，使用了曼 - 惠特尼检验。共访谈了146名患者，43名男性，平均年龄75岁（62至91岁），103名女性，平均年龄72岁（60至88岁）；在肤色方面，69.9%为白人，18.5%为混血儿，9.6%为黑人，2%为黄种人。与人口数据的比较分析表明，受访人群在年龄、肤色、社会经济阶层和教育程度方面代表了圣保罗州和圣保罗市的老年人群。肛门失禁的患病率为10.9%，男女之间无差异，15.4%的男性和28.1%的女性有便秘，21.2%的患者有排便不尽感，13.7%的患者同时有这两种情况是最常观察到的功能性胃肠改变。10.3%的患者主诉有弄脏情况，与性别无关。使用药物或泻药、患有糖尿病、神经疾病、既往肛肠或会阴手术或行动限制因素与肛门失禁无关。尿失禁的患病率为30.1%，双重失禁的患病率为6.3%，男女之间无统计学差异。有统计学证据表明生育与肛门失禁之间存在关联。
