Authors' objectives:

"To assess the prevalence of and risk factors for urinary (UI) and fecal (FI) incontinence in adults in long-term care (LTC) settings and in the community, the effectiveness of diagnostic methods to identify adults at risk and patients with incontinence, and to review the effectiveness of clinical interventions to reduce the risk of incontinence." (Structured abstract)

Authors' results and conclusions: The prevalence of UI, FI, and combined incontinence increased with age and functional dependency. Cognitive impairment, limitations in daily activities, and prolonged institutionalization in nursing homes were associated with a higher risk of incontinence. Stroke, diabetes, obesity, poor general health, and comorbidities were associated with UI and FI in community dwelling adults. Parity, anal trauma, and vaginal prolapse in women and urological surgery and radiation for prostate cancer in men are risk factors for UI and FI. Intensive individualized management and rehabilitation programs improved continence status in nursing home residents and adults after stroke. Self-administered behavioral interventions including pelvic floor muscle training with biofeedback and bladder training resolved UI in incontinent women. Electrical stimulation and sacral neuromodulation improved urge UI, but improvement for FI was inconsistent. Tension-free vaginal tape procedures and modified surgical techniques for prolapse to support the bladder neck resolved stress UI in the majority of treated women. Behavioral treatments of FI resulted in small improvements in severity and quality of life related to incontinence. The effects on FI of surgical techniques for hemorrhoids, rectal prolapse, rectal cancer, and anal fissures are not consistent across studies. Surgical interventions in patients with ulcerative colitis resulted in the same rates of fecal continence when compared to each other. The few clinical interventions to treat FI that were tested in well-designed trials had no clear evidence of better effects of the compared treatments. Instrumental outcomes to evaluate the effectiveness of treatments did not correlate with patient outcomes. Epidemiologic surveys to detect persons at risk and patients with undiagnosed UI have the same diagnostic value and less cost compared to professional examinations and diagnostic tests. Self-reported questionnaires and scales have unsatisfactory validity to diagnose FI.

Authors' recommendations: Epidemiologic surveys are cost-effective ways to estimate the prevalence of UI in large nationally representative population groups. Routine clinical evaluation should include an assessment of the risk factors, symptoms, and signs of incontinence. Pregnant or menopausal women, women with vaginal prolapse, males treated for prostate disease, patients with rectal prolapse, and frail elderly and nursing home residents are high risk groups. Individualized management programs can improve continence in LTC facilities but are hard to sustain. Regular monitoring and documentation of the continence status in relation to implemented continence services should be quality of care indicators for nursing homes. Pelvic floor muscle trainings with biofeedback can resolve incontinence and improve quality of life. Surgery is effective in curing stress UI in females. Clinical interventions for UI in males and for FI in adults need future investigation. A list of research recommendations is offered.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/fuiadtp.htm

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)