Author overestimated need in community population with faecal incontinence

Editor—In his review on advances in the understanding of faecal incontinence Kamm focused on structural damage as an aetiological factor and surgical intervention as a treatment.¹ A review of epidemiological evidence suggests that this focus is misplaced for several reasons.

Kamm states that the prevalence of faecal incontinence is 2% in the adult population and 7% in healthy independent adults aged over 65. These figures probably relate to anal incontinence (loss of gas or mucous as well as solid or liquid faeces) rather than just faecal incontinence and to episodic rather than frequent (daily or weekly) incontinence.² These figures may therefore overestimate the level of need in a community population. The literature suggests that faecal incontinence occurs on a weekly to monthly basis in less than 1% of the population aged under 65.²,³ Faecal incontinence, however, is closely associated with age (prevalence about 15% in adults aged ⩾85 living at home) and is even more common in residential and nursing homes (prevalence ranges from 10% to 60%).⁴ It is surprising, then, that attention is given to disorders in children and adolescents even though the condition is much greater in elderly people and those living in residential homes.

There is also little epidemiological evidence of a higher prevalence of faecal incontinence in women than men.³,⁵ It is unlikely, therefore, that childbirth is a major cause of faecal incontinence in the community. Kamm fails to mention that isolated faecal incontinence is relatively rare compared with double incontinence (urinary and faecal) and that both need to be considered when urinary incontinence is presented.²,⁵

Research studies have consistently reported that factors associated with increased risk of faecal incontinence are age, poor general health, limited physical activities, dementia, and stroke.²,⁵ Faecal incontinence in elderly people is often curable and preventable. Relatively conservative medical treatments aimed at the relief of faecal impaction, increased mobility, regular toileting, and normalisation of faecal consistency are generally successful.⁴ Similarly, the prescription of aids and adaptations to improve access to toilet facilities is a simple but effective means of preventing incontinence. Discussion of these topics by Kamm in more depth would have been helpful. The emphasis on sphincter damage and surgical treatments is misleading when much faecal incontinence is secondary to faecal impaction, diarrhoea, and disability and can be treated effectively by the general practice team.