Anorectal incontinence among a working-age population: A cross-sectional survey of prevalence and epidemiology.

Abstract

Anorectal incontinence is a major health issue due to its economic burden and impact on quality of life. Its true prevalence remains under-estimated and a matter of debate. Our aim was to evaluate the prevalence of anal incontinence among the collaborators of a tertiary hospital. An anonymous survey was distributed to all collaborators of a tertiary hospital using a standardized electronic questionnaire, incorporating Jorge-Wexner and LARS scores and items covering different definitions of anorectal incontinence, along with demographic characteristics and specific medical history. Among 14,270 collaborators, 2535 filled the questionnaire. This sample was comparable to the total hospital staff concerning age, gender and occupation. Anorectal incontinence (defined by a Jorge-Wexner score ≥ 3) was present in 20.9% of participants. However, only 2.3% fulfilled the strict Rome IV criteria for faecal incontinence. The presence of anorectal incontinence was higher in women (16.2% vs. 4.7%, p = 0.001), but the Rome IV criteria were comparable. In women, vaginal delivery was not associated with anal incontinence in univariate and multivariate analyses or with Rome IV criteria after adjustment. Diabetes was markedly associated with the presence of Rome IV criteria (OR: 3.3, 95% CI: 1.09-10.08, p = 0.035). History of proctological procedure was also substantially associated with anorectal incontinence and Rome IV criteria (OR: 4, 95% CI: 1.86-8.6, p < 0.001). Prevalence of anal incontinence was higher than expected in an active population, and in this medically sensitized working cohort, traditional obstetric factors appeared less strongly associated with anorectal incontinence than anticipated, suggesting a more complex risk profile.