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33
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35
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
D. Z. Bliss (ed.), Management of Fecal Incontinence for the Advanced Practice
Nurse, https://doi.org/10.1007/978-3-031-94526-7_3
3
Epidemiology ofFecal Incontinence
MariaHelenaBaenade MoraesLopes
,
JulianaNevesda Costa
,
andVeraLúciaConceiçãode GouveiaSantos
Abstract
This chapter will present an overview of the epidemiology of fecal incontinence
in different populations and countries of the world. Findings are limited to stud-
ies published in the last 12years (2012–2024). The majority of the studies were
carried out with women and adults and in outpatient settings. The prevalence
data vary depending on the population studied and the setting. The variation in
rates also reects the different methodologies adopted for investigating the phe-
nomenon, such as theoretical and operational denitions of the type of inconti-
nence and data collection procedures, among other aspects.
3.1 Prevalence andIncidence ofFecal Incontinence
According to the seventh International Consultation on Incontinence and
International Continence Society, fecal incontinence is the involuntary loss of feces
and anal incontinence is the involuntary loss of feces, and/or, atus, and/or mucus
[1] (see Chap. 1). In addition, the Rome III Diagnostic Criteria for Functional
Gastrointestinal Disorders includes the diagnosis, “Functional fecal incontinence,”
Chapter author from the rst edition of this book:
Jaqueline Betteloni Junqueira, MSc, ETN, Hospital São Luiz—Rede D’Or São Luiz, São
Paulo, BR.
M. H. B. de MoraesLopes (*) · J. N. da Costa
School of Nursing, University of Campinas, São Paulo, Sao Paulo, Brazil
e-mail: mhbaena@unicamp.br
V. L. C. de GouveiaSantos
School of Nursing, University of São Paulo, São Paulo, Sao Paulo, Brazil
e-mail: veras@usp.br
36
dened as “recurrent and uncontrolled elimination of fecal material in an individual
with development corresponding to at least four years of age, associated with one or
more of the following: abnormal functioning of normally enervated and structurally
intact sphincter muscles; discrete structural abnormality and/or innervation of the
sphincter muscles; normal or altered bowel habit (for example, fecal retention or
diarrhea) and psychological causes.” For this classication, it is necessary to exclude
structural or neurogenic abnormalities as causes of incontinence [2].
Frequency rates of fecal incontinence—prevalence and incidence—reect the
different methodologies adopted for investigating the phenomenon, such as the the-
oretical denition of the condition, the population studied, the means of data collec-
tion, among other aspects, besides the real variations of occurrence.
The systematic review by Mack etal. [3] conrms this assertion, showing that
the prevalence of fecal incontinence varied widely depending on the methods used
for data collection and the denition of incontinence adopted (type and frequency of
episodes of fecal incontinence, denition of fecal incontinence). When calculating
the combined prevalence rate of functional fecal incontinence studies, dened
according to ROMA II criteria, the authors obtained 5.4% (95% CI 3.1–7.7) in
global prevalence.
Another systematic review investigated the relationship between obstetric trauma
of the anal sphincter (episiotomy and third and fourth degree perineal laceration)
and anal incontinence after vaginal delivery [4]. Findings showed a signicant rela-
tionship between perineal trauma (episiotomy [OR, 1.74; 95% CI, 1.28–2.38;
Q=8.9; p<0.26; I(2)=21.4] and third- or fourth-degree perineal laceration [OR,
2.66; 95% CI, 1.77–3.98; Q=27.9; p=0.002; I2=64.1]) and anal incontinence [4].
The present chapter will present an overview of the epidemiology of fecal and/or
anal incontinence in different populations and countries of the world established
through a review conducted in the databases Embase, CINAHL, Web of Science,
Lilacs and Pubmed, in the last 12years (2012–2024). Search terms used were fecal
incontinence OR epidemiology AND prevalence OR incidence and the uncontrolled
term anal incontinence. Studies with cross-sectional, cohort, or case-control designs,
clinical trials, or systematic reviews that described the prevalence and/or incidence
of fecal incontinence were included. Editorials or case studies were excluded.
Results were supplemented with published studies known or referred to by the
authors who were not identied by the search. The literature search identied 45
studies, and three additional ones were identied by the authors for a total of 48
studies. Of the total number of studies found, 22 investigated fecal incontinence, 25
anal incontinence, and one investigated both fecal and anal incontinence. Studies
are organized by clinical setting, i.e., community, hospital, and nursing home.
3.2 Community-Living Adults
Prevalence of fecal incontinence in the community in different countries ranged
from 0.98% [5] to 31.6% [6]. In studies conducted only with women, this rate
ranged from 0.5% [7] to 14% [8]. In the only study found with children, the
M. H. B. de MoraesLopes et al.
37
prevalence of fecal incontinence was 0.9% [9]. Prevalence of anal incontinence in
the community, in different countries, ranged from 4.7% (for men) and 7.3% (for
women) to 29% (for men: 21% and for women: 32.2%) [10]. In studies conducted
only with women, this rate ranged from 14% [11] to 62% [12] (see Table3.1).
Table 3.1 Prevalence of fecal and anal incontinence in the community by country, year, and
population
Country
Author, year
of publication Population
Type of
incontinence
Prevalence
USA Brown etal.,
2012 [13]
Women aged
45years or over
(Community)
Anal 18.8%
Australia Halland etal.,
2013 [14]
Older women
(82–87years)
(Community)
Fecal 9.7%
USA McKeown
etal., 2013 [9]
Children with
ADHD (Military
database)
Fecal 0.9%
USA Matthews
etal., 2013
[15]
Women
(Community)
Fecal 4.7%
USA Townsend
etal., 2013
[16]
Adults
(Community)
Anal 20%
Brazil Santos etal.,
2014 [17]
Adults
(Community)
Fecal 3.6% (4% for
women and 3% for
men)
Finland Lehto etal.,
2014 [18]
Adults
(Community)
Anal 58%
Singapore Lim etal.,
2014 [19]
Adults
(Community)
Anal 4.7%
USA Ditah etal.,
2014 [20]
Adults
(Community)
Anal 8.39% (9.4% for
women, 7.3% for
men)
Australia Ng etal., 2015
[21]
Adults
(Community)
(Review)
Fecal 7.7% (2–20.7%)
8.9% (women)
8.1% (men)
USA Wu etal.,
2015 [22]
Adults
(Community)
Anal 8.2% (women) and
8.4% (men)
New Zealand Sharma etal.,
2016 [23]
Adults
(Community)
(Review)
Fecal 1.4–19.5%
USA Noelting
etal., 2016
[24]
Adults
(Community)
Fecal 10%
USA Andy etal.,
2016 [25]
Adults
(Community)
Anal 11.2% (women)
and 8.6% (men)
Netherlands Meinds etal.,
2017 [26]
Adults (National
Database)
Fecal 7.9%
(continued)
3 Epidemiology ofFecal Incontinence
38
Table 3.1 (continued)
Country
Author, year
of publication Population
Type of
incontinence
Prevalence
Brazil Tamanini
etal., 2022
[27]
Old adults
(Community)
Anal 4.7%: for men
7.3%: women
Germany Hussong
etal., 2022
[28]
Children Fecal 1.8% (girls: 1.4%;
boys: 2%)
Germany von Gontard
etal., 2022
[29]
Preschool children Fecal 2.1%
Mexico Salgado,
Zaragoza,
2022 [30]
Female staff in a
high-specialty
hospital
Fecal 6.7% (6.6% double
incontinence)
Saudi Arabia Al-Badr etal.,
2022 [31]
Women
(Community)
Fecal 7.9%
Brazil Bifani etal.,
2023 [32]
Women adults
(SLE)
Anal 59.2%
Flatal: 55.9%
Fecal: 10.8%
Brazil da Costa etal.,
2023 [33]
Older adults Fecal 5.93%
Brazil Dos Santos
etal., 2023
[34]
Women with
bromyalgia
(Community)
Anal 75%
Fecal:15.5%
Flatal: 71.1%
Canada Kciuk etal.,
2023 [35]
Women (EDS) Fecal 24%
China Sun etal.,
2023 [6]
Adults
(Community)
Fecal 10.5% (non-
comorbidity
group);
32.2% had
IBS-associated
fecal incontinence;
36.2% had
constipation-
associated fecal
incontinence;
31.6%: had isolated
fecal incontinence
Eastern
Mediterranean
region
Elbiss etal.,
2023 [8]
Adult women
(Community)
(Review)
Fecal 14%
Japan Matsumoto
etal., 2023
[36]
Inammatory bowel
disease patients
Fecal Ulcerative colitis:
26.1%
Crohn’s disease:
44.1%
Netherlands Verkuijl etal.,
2023 [37]
Toilet-trained
children
(Community)
Fecal 12%
21% double
incontinence
(continued)
M. H. B. de MoraesLopes et al.
39
Table 3.1 (continued)
Country
Author, year
of publication Population
Type of
incontinence
Prevalence
Spain Peinado-
Molina etal.,
2023 [38]
Women
(Community)
Fecal 10.4%
Switzerland Balaphas
etal., 2023
[10]
Collaborators of a
tertiary hospital
Anal 29%
(women: 32.2%
men: 21%)
Turkey Karasu etal.,
2023 [7]
Adult women
(Community—
university students)
Anal/Fecal/
Flatal
29%: atal;
0.5%: fecal;
1.6%: anal
UK Goodoory
etal., 2023
[39]
Adults with IBS
(Community)
Fecal 55.2% (and 26.9%
met Rome IV
criteria)
China Chen etal.,
2024 [5]
Adults
(Community)
Fecal 0.98%
China Wang, Yan
etal., 2024
[40]
Adults with Crohn’s
disease
Fecal 22.3%
Israel Fisher-Yosef
etal., 2024
[12]
Women
(Community)
Anal 62%
Italy Gubbiotti
etal., 2024
[41]
Young autism
spectrum disorder
population
Fecal 7.9%
Nigeria Kumolu-
Johnson etal.,
2024 [42]
Adolescents
(Community)
Fecal 0.9%
Sweden Bronge etal.,
2024 [43]
Older adults with
peripheral
neuropathy
Fecal Women: 13%
Men: 8%
USA Nicola-Ducey
etal., 2024
[11]
Women (nulliparous
4years after
delivery)
Anal 14%
3.3 Hospitals andICUs
The prevalence rate of fecal incontinence in the general adult population has been
identied to be up to 10% [44]. However, the validated prevalence of preexisting
fecal incontinence or incidence of new onset fecal incontinence in acute care is dif-
cult to determine due to the dearth of research in this area. In a prospective study
of 152 patients on acute and critical care units in a US hospital, Bliss etal. [45]
reported a cumulative incidence of fecal incontinence of 33%.
Risk factors for fecal incontinence included loose or liquid stool, severity of ill-
ness, and older age. Nair etal. [46] reported a point prevalence for fecal inconti-
nence of 12% on an audit of older adult patients on medical units in an Australian
3 Epidemiology ofFecal Incontinence
40
hospital, while Garcίa etal. [47] found a prevalence of 9–37% in a large multisite
study of European critical care units. Akpan etal. [48] reported loose stools as more
prevalent in a sample of UK hospitalized older adults with fecal incontinence, than
those in rehabilitation, nursing home, or home settings. These authors also reported
functional disability as more prevalent in the hospitalized group. Factors that are
barriers to assessment and management of fecal incontinence in the acute care set-
ting include: poor understanding and recognition of geriatric syndromes [46], lack
of assessment of fecal incontinence by generalist nurses and physicians [46, 49],
lack of adoption of standardized assessment and protocols on admission and
throughout the patients’ stay in the hospital in the acute care setting [47], and prac-
titioner omission or patient declining a focused physical examination, including a
digital rectal exam [48, 49]. Patients in critical care are at a high risk for fecal incon-
tinence, with most experiencing at least one episode [50, 51].
Prevalence of fecal incontinence from 1.6% [52] to 15.5% was found in outpa-
tients, ranging from 9% to 37% of hospitalized patients. Prevalence of anal inconti-
nence from 8.3% to 31% was found in outpatients, and no prevalence study was
found with inpatients (see Table3.2).
The population of patients (ambulatory or hospitalized) with fecal or anal incon-
tinence was eminently female, with values varying from 2% to 89%, especially in
postpartum women (50%) and those with irritable bowel syndrome (69%) (see
Table3.2). Some health conditions were associated with a high prevalence of fecal
or anal incontinence: multiple sclerosis, normal pressure hydrocephalus, ulcerative
colitis, inammatory bowel disease, spina bida, spinal cord injury and brain inju-
ries. The prevalence of anal incontinence was also high in powerlifters and Olympic
weightlifter adults (Women: 80% Men: 61.8%) [53].
Table 3.2 Prevalence of fecal and anal incontinence in outpatients or hospitalized patients by
country and year
Country
Author, year of
publication Population
Type of
incontinence
Prevalence
Germany
(n=94),
Italy (n=165),
Spain (n=144),
United
Kingdom
(n=127)
García etal.,
2012 [47]
Adults (intensive
care unit)
Fecal General: 9–37%;
Germany: 36.9%;
Italy: 11.7%;
Spain: 8.7%;
UK: 13.6%
South Africa Naidoo etal.,
2012 [54]
Pregnant women
(hospitalized)
Anal 6.1%
South Korea Kang etal.,
2012 [55]
Adults (outpatient) Fecal 6.4%
(6.8% of women;
6.2% of men)
Spain Parés etal.,
2012 [56]
Patients with obesity
(outpatient)
Anal 32.7%
(continued)
M. H. B. de MoraesLopes et al.
41
Table 3.2 (continued)
Country
Author, year of
publication Population
Type of
incontinence
Prevalence
USA Alsheik etal.,
2012 [57]
Adults (outpatient) Anal 12%
Sri Lanka Rajeshkannan
etal., 2013
[58]
Women postpartum
(outpatient)
Anal 16.5%
Brazil Murad-
Regadas etal.,
2014 [59]
Women (outpatient) Anal 79%
Malaysian Roslani etal.,
2014 [60]
Adults (outpatient) Anal 8.3% (women and
men)
Norway Johannessen
etal., 2014
[61]
Pregnant women
(hospitalized)
Anal 24%
Spain Muñoz-Yagüe
etal., 2014
[62]
Adults (outpatient) Fecal 15.5% of men and
58.1% of women
United
Kingdom
Harari etal.,
2014 [49]
Adults (audited in
hospital inpatient
and outpatient,
primary care, and
care homes)
Fecal 56% (patients
incontinent every
day/night at
hospital or
primary care)
Australia Ng etal., 2015
[21]
Adults (outpatient) Fecal 12.1%
Austria Shahin &
Lohrmann,
2015 [63]
Adults (hospitalized) Fecal 6.5%
Chile Guzmán Rojas
et al., 2015
[64]
Women (outpatient) Anal 14%
Denmark Bogeskov
etal., 2015
[65]
Postpartum women
(hospital database)
Anal 50%
USA Meyer etal.,
2015 [66]
Women (outpatient) Anal 10% fecal;
87% anal;
2.3% atus
Chile Sanguineti
etal., 2016
[67]
Adults (outpatient) Anal 31%
Czech Republic Huser etal.,
2017 [68]
Postpartum women
(hospitalized)
Fecal 3.7% after vaginal
delivery; 2.2%
after cesarean
delivery
Lebanon Ghandour
etal., 2017
[69]
Women (outpatient) Anal 39.8%
USA Markland
etal., 2017
[70]
Women with
irritable bowel
syndrome
(outpatient)
Anal 69%
(continued)
3 Epidemiology ofFecal Incontinence
42
Table 3.2 (continued)
Country
Author, year of
publication Population
Type of
incontinence
Prevalence
Belgium
(n=101)
Surmont &
Kindt, 2022
[71]
Adults underwent an
ARM for fecal
incontinence
Fecal Fecal: 77%
Double: 23%
Ethiopia
(n=275)
Benti Terefe
etal., 2022
[72]
Women Fecal 5.9%
Finland
(n=910)
Hellman-
Bronstein
etal., 2022
[73]
Older women treated
for their rst hip
fracture
Double
incontinence
At baseline: 8%
Follow up
(6months): 11%
France
(n=319)
Kurt etal.,
2022 [74]
Patients with
inammatory bowel
disease (IBD)
Fecal 16.4%
Iran
(n=400)
Shahraki etal.,
2022 [75]
Children Fecal Girls: 61.7%
Boys: 62.4%
(Total prevalence:
62.4%)
Israel
(n=270)
Gluck etal.,
2022 [76]
Women undergoing
laparoscopic
sacrohysteropexy
(LSH) to treat apical
prolapse
Anal 23.3%
Italy
(n=6023)
Ferrari etal.,
2022 [77]
Pregnant women and
after delivery
Fecal 3rd trimester:
6.2%;
6months
postpartum: 4.2%
Italy
(n=2007)
Palmieri etal.,
2022 [78]
Pregnant and
postpartum women
Fecal Pregnant 2.7%
Postpartum 2.2%
Malaysian
(n=450)
Nur Farihan
etal., 2022
[79]
Pregnant women
(hospitalized)
Fecal 30%
Netherlands
(n=112)
De Wild etal.,
2022 [80]
Adults with spina
bida
Fecal 35%
Norway
(n=384)
Skaug etal.,
2022 [53]
Powerlifters and
Olympic
weightlifters adults
Anal Women: 80%
Men: 61.8%
Norway
(n=319)
Skaug etal.,
2022 [81]
Female athletes
≥12years of age
Anal 84%
Sweden
(n=9197)
Othman etal.,
2022 [82]
Adult women
(nonpregnant and
nulliparous)
Anal 80%
Thailand
(n=153)
Jaovisidha
etal., 2022
[83]
Women
(pregnant)
Flatal 28.1%
USA
(n=1426)
Gabra etal.,
2022 [84]
Women (outpatient) Anal 14.9%
Fecal: 4.2%
Flatus: 12.8%
(continued)
M. H. B. de MoraesLopes et al.