Definitions and Epidemiology

Fecal incontinence is defined as the impaired ability to control gas or stool to allow evacuation at a socially acceptable time and place. It has been shown in a number of studies that incontinence affects self-confidence and personal image, and can lead to social isolation causing a significant impact on quality of life.1-5 The true prevalence of fecal incontinence is unknown because it is thought to be greatly underreported. In a community survey of 7000 patients in the United States, 2.2% of patients reported incontinence to liquid or solid stool or gas.2 In other pop ulation studies, the prevalence of some form of incontinence has been reported to approach 60%, particularly higher in women than men (4 to 1) because of the trauma of vaginal delivery.1,6 Fecal incontinence is the second leading cause of nursing home placement, and up to 45% of patients in nursing homes are estimated to have some fecal incontinence.6

There are many different methods to measure the severity of fecal incontinence; the Cleveland Clinic Florida Fecal Incontinence (CCFFI) score is the most popular and widely cited.7 This scale is a measure of frequency of incontinence to gas, liquid, and solid stool, alteration in lifestyle, and use of a protective pad. In one of several validation studies of this scoring system, it was shown that a CCFFI score greater than 9 is consistent with a significant alteration in quality of life and can be used as an indication for surgical therapy.4 This score is equivalent to losing stool more than once a week, needing a diaper, and feeling significantly restricted in daily functioning.4

Besides being a social burden, fecal incontinence places a significant financial burden on United States health care. In a study of 63 patients, treatment charges were $559,341 over an average of 10 years.8

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