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Hou J, Zhao Y, Zhuang S, Ma X, Hou Y, Li X, Wang Y. Visit rates and risk factors of healthcare-seeking behavior for urinary incontinence, fecal incontinence, and pelvic organ prolapse among women: A systematic review and meta-analysis. Geriatr Nurs 2025; 63:307-319. [PMID: 40239392 DOI: 10.1016/j.gerinurse.2025.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 02/02/2025] [Accepted: 03/31/2025] [Indexed: 04/18/2025]
Abstract
INTRODUCTION Female pelvic floor dysfunction(FPFD), including urinary incontinence, fecal incontinence, and pelvic organ prolapse, is an expanding global health problem among women, declining their quality of life. Healthcare-seeking behavior of FPFD patients plays a vital role in preventing symptom deterioration and reducing future burdens. Poor healthcare-seeking behavior has resulted in lower visit rates than prevalence. This study aimed to investigate the visit rate and risk factors of healthcare-seeking behavior in patients with FPFD and to provide a basis for developing prevention strategies against risk factors. METHODS An exhaustive systematic literature search was undertaken using the following databases: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL, published from inception to June 2022. Two investigators independently extracted data and assessed the quality of the studies using the Health Care Quality and Research (AHRQ) or Newcastle-Ottawa Scale (NOS). A meta-analysis was performed by using Review Manager 5.3. RESULTS Eighty studies were selected, including 83,996 participants. Data were extracted from 71 studies for urinary incontinence, 5 for pelvic organ prolapse, and 4 for fecal incontinence. Meta-analysis results indicated that the visit rates of urinary incontinence, pelvic organ prolapse, and fecal incontinence were lower, at 29%(95%CI:27% to 32%, I2=99%, P<0.00001), 42%(95%CI:18% to 65%, I2=99%, p=0.0005), and 35%(95%CI:16% to 54%, I2=99%, p=0.0004), respectively. The study shows that there are a variety of factors affecting the healthcare-seeking behavior of FPFD women, including sociodemographic factors(treatment and diagnosis costs are high, lack of time, type of UI, duration of UI, symptom severity, and impact of UI), psychological factors(shame, fear of medical treatment side effects, fear of examination, and fear of surgery), cognitive factors(considering it as the normal status of aging, the perception that symptoms are not treatable, believing that symptoms could recover naturally, lack of knowledge of available treatment, believing they should cope with the problem themselves, do not think it is serious enough), healthcare service factors(the physician said it was not necessary, other health problems taking priority). Age, fear of hospitals/doctors, and fear of diagnosis do not affect healthcare-seeking behavior. CONCLUSION Patients with urinary incontinence, pelvic organ prolapse, and fecal incontinence have a low visit rate. Many risk factors affect the healthcare-seeking behavior of female pelvic floor dysfunction diseases, mainly sociodemographic, psychological, cognitive, and healthcare service factors. However, due to a lack of data, high-quality studies are still required to confirm. In the future, attention should be paid to policy guidance and ethical changes, strengthening the training of medical personnel and comprehensive medical education on the diagnosis, treatment and management of FPFD as well as appropriate nursing pathways. In addition, public information campaigns on the comprehensive prevention of FPFD should be strengthened to raise women's awareness of the comprehensive prevention of FPFD, especially health education.
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Affiliation(s)
- Jiawen Hou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China; Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanan Zhao
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Simin Zhuang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Ximei Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Yijing Hou
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Xiuling Li
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China.
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Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2024; 22:712-731.e8. [PMID: 37734583 PMCID: PMC10948379 DOI: 10.1016/j.cgh.2023.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. METHODS We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. RESULTS Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%-12.0%) compared with younger persons (4.9%; 95% CI, 2.9%-6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39-2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%-10.6%) than men (7.4%; 95% CI, 6.0%-8.8%]) (OR, 1.17; 95% CI, 1.06-1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. CONCLUSIONS Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Heiko Hahn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Celina Gödel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Abstract
Background: Fecal incontinence (FI) has been shown to be a common symptom in Western countries; however, there is few researches focusing on its epidemic condition in Chinese women. We conducted this national population-based epidemiology study to estimate the prevalence and risk factors of FI among adult Chinese women living in urban regions. Methods: This is a subgroup analysis of a national population-based epidemiology study of FI. Total 28,196 adult women from urban regions of six provinces and municipalities participated in this research from 2014 to 2015. They finished the questionnaire under the direction of trained interviewers. FI was defined as accidental leakage of flatus and/or liquid or solid stool at least once in the past. The FI prevalence trend and risk factors were identified by the Cochran-Armitage test, Chi-square test, and multivariable logistic regression. Results: The prevalence of FI in adult females in urban China was 0.43% (95% confidence interval: 0.35%–0.51%). Among women with FI, 42.96%, 82.96%, and 42.22% reported having leakage of solid, liquid stool, and gas, respectively. The overall FI prevalence and the incidence rate of solid stool/liquid stool/gas leakage increased with age. The mean Wexner score was 4.0% and 12.0% FI patients reported Wexner score ≥9. Body mass index ≥24 kg/m2, pelvic organ prolapses, chronic constipation, chronic cough, alcohol consumption, physical diseases including chronic bronchitis and cancer, gynecological diseases like gynecological inflammation are risk factors for FI. Vaginal delivery was the risk factor for FI in females with labor history. Conclusions: FI was not a common symptom in adult Chinese women living in urban areas and there were some potential modifiable risk factors. Trial Registration: Chinses Clinical Trial Registry: ChiCTR-OCS-14004675; http://www.chictr.org.cn/showproj.aspx?proj=4898
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Islam RM, Oldroyd J, Rana J, Romero L, Karim MN. Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis. Int Urogynecol J 2019; 30:2001-2011. [DOI: 10.1007/s00192-019-03992-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
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Ibarra A, Latreille-Barbier M, Donazzolo Y, Pelletier X, Ouwehand AC. Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial. Gut Microbes 2018; 9:236-251. [PMID: 29227175 PMCID: PMC6219592 DOI: 10.1080/19490976.2017.1412908] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 02/03/2023] Open
Abstract
Bifidobacterium animalis subsp. lactis HN019 (HN019) ameliorates chronic idiopathic constipation. Our aim was to determine the efficacy and safety of 28-day supplementation with 1 × 109 or 1 × 1010 CFU of HN019/day for constipation. A total of 228 adults who were diagnosed with functional constipation according to the Rome III criteria were randomized in a double-blind and placebo-controlled trial. Colonic transit time (CTT), the primary outcome, and secondary outcomes that were measured using inventories-patient assessment of constipation symptoms (PAC-SYM) and quality of life (PAC-QoL), bowel function index (BFI), bowel movement frequency (BMF), stool consistency, degree of straining, bowel emptying, bloating, and pain severity-were assessed. Ancillary parameters and harms were also evaluated. There were no statistically significant differences in the primary or secondary outcomes between interventions. A post hoc analysis of 65 participants with fewer than 3 bowel movements per week (BMF ≤ 3/week) showed a physiologically relevant increase in weekly BMF in the high- (+2.0) and low-dose (+1.7) HN019 groups-by RMANOVA, the HN019 groups with BMF ≤ 3/week, pooled together, had a higher BMF versus placebo (P value = 0.01). Thus, improving low stool frequency could be a target of future interventions with HN019. High-dose HN019 also decreased the degree of straining at Day 28 versus placebo in those with BMF ≤ 3/week (P value = 0.02). Three unlikely related AEs-2 with low-dose HN019 and 1 with placebo-were followed until full recovery. In conclusion, although there were no differences in the primary analysis, HN019 is well tolerated and improves BMF in adults with low stool frequency.
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Affiliation(s)
- Alvin Ibarra
- E.I. DuPont de Nemours & Co., DuPont Nutrition and Health, Global Health and Nutrition Science, Kantvik, Finland
| | | | | | | | - Arthur C. Ouwehand
- E.I. DuPont de Nemours & Co., DuPont Nutrition and Health, Global Health and Nutrition Science, Kantvik, Finland
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Joh HK, Seong MK, Ahn HJ. Fecal incontinence knowledge, attitudes, and help-seeking behaviors among community-dwelling adults in Korea. Neurourol Urodyn 2018; 37:1474-1484. [PMID: 29331051 DOI: 10.1002/nau.23480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Fecal incontinence (FI) is a common debilitating disorder that tends to be underreported. Although low health literacy likely contributes to the underreporting, studies on FI knowledge among the general population remain scarce. We investigated how FI knowledge is associated with attitudes and help-seeking behaviors. METHODS We conducted a cross-sectional survey among community-dwelling adults undergoing national health screening in Korea. A structured, self-administered questionnaire was used to assess FI knowledge, attitudes, and help-seeking behaviors. Odds ratios (ORs; 95% confidence intervals, CIs) were estimated using logistic regression with adjustment for covariables. RESULTS Of the 601 participants completing the survey, only 29.8% were aware of the term FI, and their knowledge levels were insufficient. As for FI-related attitudes, 24.6% considered FI to be very rare, and 22.3% considered it to be moderately or less distressing. Individuals who knew the term FI tended to consider FI more common (OR: 2.45; 95%CI: 1.49-4.02) and distressing (OR: 1.68; 95%CI: 1.07-2.63) than those without knowledge. Assuming future FI occurrence, those considering FI to be distressing were less willing to ignore or self-manage the condition (OR: 0.25; 95%CI: 0.11-0.58). Among patients with FI (n = 83), only 30.1% had sought help and 8.4% had consulted doctors. Knowing the term FI was significantly associated with overall help-seeking behavior (OR: 9.23; 95%CI: 2.09-40.77). CONCLUSIONS FI knowledge levels and help-seeking rates were low among community-dwelling adults. FI knowledge was significantly associated with attitudes and help-seeking behaviors. Future public education programs are warranted to improve FI knowledge, attitudes, and help-seeking behaviors.
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Affiliation(s)
- Hee-Kyung Joh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Family Medicine, Seoul National University Health Service Center, Seoul, South Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Moo-Kyung Seong
- Department of Colorectal Surgery, Konkuk University Medical Center, Seoul, South Korea.,Department of Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun-Jun Ahn
- Department of Colorectal Surgery, Konkuk University Medical Center, Seoul, South Korea
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Scientific and Clinical Abstracts From the 2016 WOCN® Society & CAET Joint Conference. J Wound Ostomy Continence Nurs 2016. [DOI: 10.1097/won.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study. Neurourol Urodyn 2015; 35:959-964. [DOI: 10.1002/nau.22836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/01/2015] [Indexed: 12/17/2022]
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Jerez-Roig J, Souza DLB, Amaral FLJS, Lima KC. Prevalence of fecal incontinence (FI) and associated factors in institutionalized older adults. Arch Gerontol Geriatr 2015; 60:425-30. [PMID: 25721982 DOI: 10.1016/j.archger.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/18/2022]
Abstract
The objective of this work is to determine the prevalence of FI and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December 2013, in 10 nursing homes (NHs) of the city of Natal (Northeast Brazil). Individuals over the age of 60 were included in the study, while those hospitalized or in terminal phase were excluded. Data collection included sociodemographic information, FI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). FI was verified through the Minimum Data Set (MDS) 3.0, which was also used to assess toileting programs. The Chi-square test and the linear Chi-square test were performed for bivariate analysis, as well as logistic regression for multivariate analysis. The final sample consisted of 321 elderly, mostly females, with mean age of 81.5 years. The prevalence of FI was 42.68% (CI 95%, 37.39-48.15). Most residents presenting FI were always incontinent (83.9%) and the most frequent incontinence type was total FI (solid and liquid stools). Incontinence control measures were applied only to 9.7% of the residents. The final model revealed a statistically significant association between FI and functional and cognitive impairments. It is concluded that FI is a health issue that affects almost half of the institutionalized elderly, and is associated with functional and cognitive disability.
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Affiliation(s)
- Javier Jerez-Roig
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho 1787, CEP: 59010-000 Lagoa Nova, Natal-RN, Brazil; Servicio de Rehabilitación, Hospital Can Misses, Calle Corona s/n, 07800 Ibiza, Illes Baleares, Spain.
| | - Dyego L B Souza
- Department of Collective Health, Federal University of Rio Grande do Norte, Campus Universitário s/n, CEP: 59078-970, Lagoa Nova, Natal-RN, Brazil
| | - Fabienne L J S Amaral
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho 1787, CEP: 59010-000 Lagoa Nova, Natal-RN, Brazil
| | - Kenio C Lima
- Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho 1787, CEP: 59010-000 Lagoa Nova, Natal-RN, Brazil
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