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43
Table 3.2 (continued)
Country
Author, year of
publication Population
Type of
incontinence
Prevalence
USA
(n=25.425)
Kenne etal.,
2022 [85]
Women
(outpatient)
Anal 12%
USA
(n=13,435)
NHANES
Storz etal.,
2022 [86]
Shift workers Fecal Day workers:
1.16%;
Shift workers:
1.36%
Australia
(n=970)
Campbell
etal., 2023
[87]
Older adults
(hospitalized)
Fecal 2weeks before
hospitalization:
14.7%;
At hospital
discharge: 11.5%;
At 30-day
follow-up: 13%
Brazil
(n=253)
De La Ossa
etal., 2023
[52]
Women and men
(outpatient)
Fecal All participants:
1.6%
(female: 0% and
male: 3.7%)
Italy
(n=927)
Frigerio etal.,
2023 [88]
Women (in the third
trimester of
pregnancy)
(outpatient)
Fecal
Flatal
Flatal: 45.1%
Fecal: 2.8%
Italy
(n=521)
Pelizzari etal.,
2023 [89]
After severe
acquired brain
injuries (SABIS)
Fecal 53.3%
Italy
(n=447)
Tavazzi etal.,
2023 [90]
Women and men
with multiple
sclerosis (outpatient)
Anal 27.3%
Japan (n=213) Harumatsu
etal., 2023
[91]
Adults with
persistent cloaca
(outpatient)
Fecal 48%
Sweden
(n=898)
Jansson etal.,
2023 [92]
Primiparous women
in early and late
pregnancy and
1year postpartum
(outpatient)
Fecal 2% early
pregnancy;
4% late
pregnancy;
6% at 1year
postpartum
United
Kingdom
(n=1598)
Campbell
etal., 2023
[93]
Women (outpatient) Anal 48%
Fecal: 17%
United
Kingdom
(n=255)
Vasant etal.,
2023 [94]
Adults with
ulcerative colitis
(outpatient)
Fecal 20.4%
USA
(n=336)
Dominguez-
Munoz etal.,
2023 [95]
Patients with spina
bida (SB) and
spinal cord injuries
(SCI) (outpatient)
Fecal 70%
(continued)
3 Epidemiology ofFecal Incontinence
44
Table 3.2 (continued)
Country
Author, year of
publication Population
Type of
incontinence
Prevalence
USA
(n=178)
Greer etal.,
2023 [96]
Adults
(outpatients—female
active-duty
servicewomen
(ADSW))
Fecal 73.2%
USA
(n=100)
Kehler &
Petersen, 2023
[97]
Women and men
with NPH
(outpatient)
Fecal Pre shunt: 37.5%
[12] and after
surgery: 31% [9]
Experienced partial
recovery;
10% [3]; did not
show any
improvement
within 6–52weeks
after the operation
USA
(n=509)
Rice-
Townsend
etal., 2023
[98]
Children with
anorectal
malformations
treated (outpatient)
Fecal 59.1% (complete)
USA
(n=458)
Smith etal.,
2023 [99]
Children with
idiopathic or
refractory
constipation
(outpatient)
Fecal 63.8%
France
(n=383)
Rebman etal.,
2024 [100]
Women who had an
OASIS (outpatient)
Anal 86.7%: atus
incontinence;
28.9%: liquid stool
incontinence;
6.7%: solid stool
incontinence
Global
(N=548,316)
Mack etal.,
2024 [3]
Community-
dwelling adults
Fecal 9.8% (pooled)
India
(n=185)
Jha etal., 2024
[101]
Postpartum women
(outpatients)
Fecal
Flatal
Fecal: 8.6%
Flatal: 11.9%
Netherlands
(n=3668)
Ten Hoor
etal., 2024
[102]
Women and men
(hospital database)
Fecal 3.2%
Spain
(n=84)
Molina-Barea,
2024 [103]
Women (outpatient) Fecal 50%
Thailand
(n=1292)
Saraluck etal.,
2024 [104]
Women with POP
(outpatient)
Anal 42.04%
Turkey
(n=68)
Aydin etal.,
2024 [105]
Children with autism
spectrum disorder
(4–10years)
Fecal 29.4%
USA
(n=7606)
Hiromoto
etal., 2024
[106]
Adults Fecal 9.2%
USA (n=341) Roth etal.,
2024 [107]
Adults with spina
bida (outpatients)
Fecal (during
sexual
activity)
41%
M. H. B. de MoraesLopes et al.
45
3.4 Nursing Home, Long-Term Acute Care, Other Long-Term
Care Institutions
Since the review by Wagg etal. [108] some new studies were identied reporting prev-
alence rates of fecal incontinence in nursing homes or long-term care facilities. The
studies conrm the high prevalence rate already known and vary around 42% [45, 46].
Saga etal. [109] reviewed studies from 1980 up to 2011 on prevalence and associations
of fecal incontinence in nursing home patients. Prevalence rates in NHs varied from
10% to 67%, concentrated between 40% and 55%. However, the reported data were
limited by a lack of a coherent denition of fecal incontinence, including different
frequency labeling, poor denition of the institutional units (the nursing homes), and
poor descriptions of patient characteristics [109]. Little is known about the fecal incon-
tinence incidence rates in the nursing home population, with one study reporting a rate
of 20% during a 10-month period [47].
In the population living in long-term care institutions, the prevalence of fecal incon-
tinence has higher rates (2.2–42.6%), compared to other scenarios, as shown in the
studies (see Table 3.3). The prevalence of anal incontinence has even higher rates
(54–57%). This may be explained in part by the fact that both fecal incontinence and
anal incontinence are associated with functional impairment and dementia, which are
more common reasons for the institutionalization of the elderly [48, 49].
Table 3.3 Prevalence of fecal and anal incontinence in long term care facilities by country
and year
Country
Author, year
of publication Population
Type of
incontinence
Prevalence
Australia Halland etal.,
2013 [14]
Older women (82–87years)
(Institutionalized)
Fecal 14.1%
Norway Saga etal.,
2013 [109]
Adults (Institutionalized)
(Review)
Fecal 42.3%
USA Bliss etal.,
2013 [110]
Adults (65years and older)
(Institutionalized)
Fecal Any fecal
incontinence
a
:
35–38%,
Only fecal
incontinence
b
:
8–9%
Brazil Jerez-Roig
etal., 2015
[111]
Adults (Institutionalized) Fecal 42.68%
Czech
Republic
Ihnát etal.,
2016 [112]
Adults (Institutionalized) Anal 57.1%
Norway Blekken etal.,
2016 [113]
Adults (Institutionalized) Anal 42.1–54%
USA Bliss etal.,
2017 [114]
Older (65years and older
with urinary incontinence)
(Institutionalized)
Fecal 2.2%
a
Any fecal incontinence (fecal incontinence with or without urinary incontinence)
b
Only fecal incontinence (without urinary incontinence)
3 Epidemiology ofFecal Incontinence
46
As mentioned previously, it is possible to verify that the prevalence data pre-
sented vary widely depending on the population studied and the place. The majority
of the studies were carried out with women and adults, in outpatient follow-up.
3.5 Incidence ofAnal andFecal Incontinence
A few studies about the incidence of fecal or anal incontinence were found in the
literature in the last 12years. In incidence studies, fecal or anal incontinence is
mainly associated with advanced age, obstetrical injury during labor, depression,
and hospitalization. The incidence rates are presented in Table3.4.
Table 3.4 Incidence of fecal and anal incontinence in different settings by country, year, and
population
Country
Author, year of
publication Population
Type of
incontinence
Incidence
South
Africa
Naidoo etal.,
2012 [54]
Women 6weeks
postpartum (hospital)
Anal 61.1%;
persistence of
symptoms after
6months: 6.4%
USA Alsheik etal.,
2012 [57]
Adults (outpatient) Anal 3%
Finland Lehto etal.,
2014 [18]
Adults (outpatient) Fecal 1% per year (all
women)
Norway Johannessen
etal., 2014
[61]
Women one year after
childbirth
Anal 2.2% with three or
more symptoms
one year
postpartum
USA Richter etal.,
2015 [115]
Primiparous Women with
obstetric anal sphincter
injury 6, 12 and 24weeks
postpartum
Anal 6weeks: 7%
12weeks: 4%
24weeks: 9%
General incidence:
24% (24weeks)
USA Bliss etal.,
2017 [114]
Adults (nursing home
residents)
Fecal 2%
M. H. B. de MoraesLopes et al.
47
3.6 Factors Associated withthePresence ofAnal or
Fecal Incontinence
There are a large number of factors associated with the presence or occurrence of
fecal incontinence or anal incontinence, which include acquired abnormalities or
congenital malformations, degenerative or functional conditions, and neurological
diseases. Table3.5 summarizes these factors.
Table 3.5 Factors associated with the occurrence of anal or fecal incontinence
Fecal incontinence Anal incontinence
Abdominal pain [74]
Advanced age [3, 21, 27, 38, 55, 63, 74, 82, 84, 116, 117]
Anal sphincter injury during labor [65, 118]
Anal sphincter trauma (obstetrical injury, prior surgery) [116]
Anorectal surgery [17]
Birth-related factors (assisted) [31, 119]
Cancer [27, 120] (endometrial cancer)
Cognitive impairment and dementia [121]
Constipation [17, 62]
Chronic illness [116, 121]
Chronic obstructive pulmonary disease (women) [27]
Decreased physical activity [116]
Diabetes Mellitus type 2 [116, 121]
Diarrhea or loose/liquid stool consistency [15, 17, 21, 45, 55,
63, 74, 116]
Depression [27, 122]
Food insecurity [123]
Gastrointestinal pathology [17, 38]
Gynecological surgery (hysterectomy) [17]
Highest BMI [38, 82]
Inappropriate cholecystectomy [116]
Inammatory bowel disease [6, 62, 116]
Limitations in daily activities [27, 33, 121]
Lower urinary tract symptoms and infections in women [121]
Malnutrition [63]
Menopause [121]
Mobility impairment [95, 121]
Multiparity [31, 63, 121]
Neurological disorders [95, 116, 121] (ventriculoperitoneal
shunt)
Obesity [116, 121, 124]
Pelvic oor anatomical disturbances (rectal prolapse) [116]
Pelvic or abdominal radiation therapy [62]
Poor general health (27, 121) (men) [33]
Pressure injury stage 1 [63]
Prostate surgery [121]
Race / Ethnicity (white) [16]
Sarcopenia [125]
Schooling (having up to 8years of schooling) [27]
Sex (women) [3]
Advanced age [19, 22, 60,
53]
Anal sphincter injury during
labor [129, 130]
Birth-related factors (vacuum
extraction) [129]
Cognitive impairment and
dementia [112, 116]
Constipation [131]
Depression [22, 57]
Diabetes Mellitus type 2 [16,
20, 60]
Diarrhea [22]
Strenuous exercise (women)
[53]
Fibromyalgia [34]
Functional limitation [16,
63]
Gestation [16, 131]
Gynecological surgery
(hysterectomy) [22]
Lower urinary tract
symptoms (men) [53]
Multiparity [22]
Multiple comorbidities [20,
84, 112]
Neurological diseases [16]
Exercise-related
(recreational): age,
constipation, and forceps
delivery [93]
Smoking [84, 132]
Systemic lupus
erythematosus [32]
Urinary incontinence [20,
112, 116, 131, 133]
(continued)
3 Epidemiology ofFecal Incontinence
48
3.6.1 Age
The prevalence of fecal incontinence and anal incontinence increases with age, and
advanced age is considered as an independent risk factor for fecal or anal inconti-
nence. Fecal incontinence is present in all age groups in both genders [134] varying
from 0.9% [42] to 62.4% in children [75] to more than 50% in older nursing home
residents [134] and 14.7% in hospitalized older adults [87].
The systematic review by Mack etal. [3] shows that FI prevalence was greater
for persons aged 60years 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).
3.6.2 Sex
In relation to differences in prevalence of anal or fecal incontinence by sex, results
are mixed, with most studies showing no difference by sex while others show a dif-
ference (see Tables 3.1 and 3.2). Differences in the sample studied, incontinence
denition, or other methodological factors may explain variation. Milsom etal.
[134], observed that anal incontinence is almost as common in men as in women.
However, Mack etal. [3] showed that globally, fecal incontinence was more preva-
lent 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).
3.6.3 Race
The prevalence of anal incontinence was 50% less in Black community-living women
than in white women (6% and 12%, respectively) and other variables increased their
chances of occurrence, such as pregnancy, high body mass index, reduced physical
activity, functional limitations, current smoking, type 2 diabetes mellitus, systemic
arterial hypertension, neurological diseases and urinary incontinence [16].
Fecal incontinence Anal incontinence
Smoking [88, 116, 122]
Spinal cord injury [63]
Stroke [17]
Symptom of rectal urgency [116]
Regular Physical activity (women) [126]
Urinary incontinence [33, 95, 127]
Vitamin D deciency [128]
Waist circumference-height ratio [106]
Pregnancy-related: overweight, aged >40, highly educated,
non-Italian women, and those undergoing tears [77, 92]
Factors are listed alphabetically
Table 3.5 (continued)
M. H. B. de MoraesLopes et al.
49
Bliss etal. [110] examined the prevalence of fecal incontinence at nursing home
admission by race and ethnicity using various denitions related to fecal inconti-
nence that have been commonly reported in the literature; these denitions are
“only fecal incontinence, double incontinence (both urinary incontinence and fecal
incontinence), any fecal incontinence (fecal incontinence with or without urinary
incontinence), and any incontinence (urinary incontinence and/or fecal inconti-
nence and/or double incontinence)” [113]. Bliss et al. [110] found differences
among racial/ethnic groups despite different denitions. For example, the preva-
lence of any fecal incontinence in White nursing home admissions (36%) was simi-
lar to that of American Indian admissions (37%), whereas Asian, Black, and
Hispanic admissions had higher rates (54%, 58%, and 49%, respectively) [110].
The rate of having only fecal incontinence was 9–10% in White, Asian, and
American Indian nursing home admissions, but was 13–14% in Black and Hispanic
admissions [110].
3.6.4 Structural andNeurological Impairments
The most common structural causes of fecal or anal incontinence are obstetric inju-
ries, especially associated with vaginal delivery, anorectal surgeries, hemorrhoids,
stulas, ssures, among others [17, 116, 135]. A systematic review showed signi-
cant associations between perineal trauma (episiotomy [OR, 1.74; 95% CI:
1.28–2.38; Q=8.9; p=0.26; I2=21.4] and third- and fourth- degree perineal lac-
eration [OR, 2.66; 95% CI: 1.77–3.98; Q=27.9; p=0.002; I2=64.1]) and anal
incontinence [4]. Despite many studies published investigating the association
between obstetric injuries and fecal or anal incontinence, Milsom etal. [134] con-
cluded in their systematic review that the mode of delivery does not seem to be a
signicant factor in the development of obstetric anal incontinence, because, in non-
randomized trials, anal incontinence develops after caesarean delivery almost as
often as after vaginal delivery.
Among the neurological alterations associated with fecal incontinence, pudendal
neuropathy (arising from radiation, diabetes, and chemotherapy), spinal column
surgeries, dementia, and central nervous system injuries such as stroke, trauma,
tumors, infections, and congenital lesions are identied [17, 135].
Diabetes mellitus is one of the chronic diseases that affect the peripheral nervous
system and has also been identied as a risk factor for fecal or anal incontinence
[15, 20, 60, 121]. In a study conducted with patients seeking treatment at the General
Surgical, Obstetrics and Gynecology, and Antenatal specialist outpatient clinics, the
authors found anal incontinence was more prevalent among diabetics than non-
diabetic patients (13.9% vs. 7.6%, p=0.026) [60].
Milsom etal. [134] concluded that as populations age, co-morbid disease, sur-
gery, neurological diseases, and stroke become a signicant component of fecal
incontinence risk.
3 Epidemiology ofFecal Incontinence
50
3.6.5 Functionality
Cognitive impairment and limitations in activities of daily living are associated with
fecal incontinence [134]. Functional limitations [15, 25], mobility impairment
[121], such as a wheel-chair use [95] and poor general health [27, 33, 121] are also
associated with fecal and incontinence.
3.6.6 Consistency ofFeces
Some health conditions are considered as independent factors associated with the
occurrence of fecal or anal incontinence, such as diarrhea [21, 74] and or loose or
liquid stool consistency [45, 74], altered bowel habits of irritable bowel syndrome
[55, 116], inammatory bowel disease [6], constipation with paradoxical diarrhea
(fecal impaction), and overow incontinence [55].
3.6.7 Urinary Incontinence
The frequent association between anal or fecal incontinence and urinary inconti-
nence [33, 95] probably reects a common etiologic pathway (common innerva-
tions, support structures), and many common factors such as advancing age,
declining function, and neurodegenerative diseases [20]. In a study conducted by
Ditah etal. [20], community-living participants who were incontinent of urine were
over three times more likely to report anal incontinence (OR 3.24, 95% CI 1.73–6.08)
[20]. Similarly, in nursing home residents, Bliss etal. [114] showed that having
urinary incontinence was the strongest predictor of developing subsequent fecal
incontinence (i.e., double incontinence). The hazard of developing double inconti-
nence for residents with urinary incontinence was 1.3 times greater than the hazard
for those who were continent.
3.6.8 Hospitalization
The factors associated with fecal incontinence in the hospital setting were
female sex, advanced age, low body mass index (BMI), hospitalization diagno-
ses such as dementia and spinal cord injury, stage 1 pressure injury, and func-
tional limitation [63].
Pressure injury can be dened as a “localized damage to the skin and underlying
soft tissue usually over a bony prominence or related to a medical or other device
[136]. The injury occurs as a result of intense and/or prolonged pressure or pressure
in combination with shear. The tolerance of soft tissue for pressure and shear may
also be affected by microclimate, nutrition, perfusion, co-morbidities and condition
of the soft tissue” [136]. So, pressure injury would be a consequence of the damage
caused by leaked urine and/or feces to the skin. In fact, the results of Lachenbruch
M. H. B. de MoraesLopes et al.
51
etal. [137], who analyzed data of 176,689 hospital patients from a cross-sectional
cohort database, showed that the prevalence of pressure injuries was 4.1% for con-
tinent and 16.3% for incontinent patients. As wound severity increased, the odds
ratios for pressure injury also increased, mainly in patients with fecal incontinence.
3.6.9 Other Factors
Smoking, obesity, cholecystectomy, and vitamin D deciency [128] emerged as
potentially modiable factors associated with anal incontinence which also included
comorbidities such as diabetes [56, 116, 121] and sarcopenia [27].
References
1. Bliss DZ, Mimura T, Berghmans B, Bharucha A, Carrington E, Engberg S, etal. Assessment
and conservative management of faecal incontinence and quality of life in adults. In:
Cardozo L, Rovner E, Wagg A, Wein A, Abrams P, editors. Incontinence. 15. 7th ed. Bristol:
International Continence Society; 2023. p.1575–673.
2. Apêndice B.Os critérios diagnósticos de Roma III para os distúrbios gastrointestinais funcio-
nais. Arq Gastroenterol. 2012;49(Suppl 1):64–8.
3. 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(4):712–31.e8.
4. LaCross A, Groff M, Smaldone A.Obstetric anal sphincter injury and anal incontinence fol-
lowing vaginal birth: a systematic review and meta-analysis. J Midwifery Womens Health.
2015;60(1):37–47.
5. Chen C, Zhang D-y, Chen S, Huang S, Zeng F, Li D, etal. Prevalence, types, and risk factors
of functional gastrointestinal diseases in Hainan Province, China. Sci Rep. 2024;14(1):4553.
6. Sun G, Trzpis M, Ding H, Gao X, Broens PM, Zhang W.Co-occurrence of fecal incontinence
with constipation or irritable bowel syndrome indicates the need for personalized treatment.
Neurogastroenterol Motil. 2023;35(9):e14633.
7. Karasu AFG, Cetin C, Pasin Ö, Karacabay M, Tanoglu FB, Ilhan G.Prevalence of urinary
incontinence and anal incontinence: an internet-based cross-sectional study of female Turkish
University students. Int Urogynecol J. 2023;34(9):2309–15.
8. Elbiss HM, Rafaqat W, Khan KS. Prevalence of pelvic oor disorders in the Eastern
Mediterranean region: a meta-analysis. Saudi Med J. 2023;44(2):128.
9. McKeown C, Hisle-Gorman E, Eide M, Gorman GH, Nylund CM. Association of con-
stipation and fecal incontinence with attention-decit/hyperactivity disorder. Pediatrics.
2013;132(5):e1210–e5.
10. Balaphas A, Liot E, Meyer J, Toso C, Meurette G, Kassouha A, etal. Prevalence of anal
incontinence in a population of healthcare workers. Br J Surg. 2023;110(Supplement_5):z
nad178.036.
11. Nicola-Ducey L, Allshouse AA, Caneld D, Nygaard IE. Pelvic oor symptoms 4
years after elective labor induction: a randomized clinical trial. Urogynecology (Phila).
2024;30(9):790–6.
12. Fisher-Yosef T, Lidsky Sachs D, Edel SS, Nammouz H, Zoabi AE, Adler L, editors. Pelvic
oor dysfunction among reproductive-age women in Israel: prevalence and attitudes—a
cross-sectional study. In: Healthcare (Basel). 2024; 12(3):390.
3 Epidemiology ofFecal Incontinence
52
13. Brown HW, Wexner SD, Segall MM, Brezoczky KL, Lukacz ES.Accidental bowel leak-
age in the mature women’s health study: prevalence and predictors. Int J Clin Pract.
2012;66(11):1101–8.
14. Halland M, Koloski NA, Jones M, Byles J, Chiarelli P, Forder P, etal. Prevalence correlates and
impact of fecal incontinence among older women. Dis Colon Rectum. 2013;56(9):1080–6.
15. Matthews CA, Whitehead WE, Townsend MK, Grodstein F.Risk factors for urinary, fecal, or
dual incontinence in the Nurses’ Health Study. Obstet Gynecol. 2013;122(3):539–45.
16. Townsend MK, Matthews CA, Whitehead WE, Grodstein F.Risk factors for fecal inconti-
nence in older women. Am J Gastroenterol. 2013;108(1):113–9.
17. Santos VL, Domansky RC, Hanate C, Matos DS, Benvenuto CV, Jorge JM.Self-reported
fecal incontinence in a community-dwelling, urban population in southern Brazil. J Wound
Ostomy Continence Nurs. 2014;41(1):77–83.
18. Lehto K, Ylönen K, Hyöty M, Collin P, Huhtala H, Aitola P. Anal incontinence:
long-term alterations in the incidence and healthcare usage. Scand J Gastroenterol.
2014;49(7):790–3.
19. Lim JW-M, Heng C, Wong MT-C, Tang C-L.Prevalence of faecal incontinence in the com-
munity: a cross-sectional study in Singapore. Singapore Med J. 2014;55(12):640–3.
20. Ditah I, Devaki P, Luma HN, Ditah C, Njei B, Jaiyeoba C, et al. Prevalence, trends, and
risk factors for fecal incontinence in United States adults, 2005–2010. Clin Gastroenterol
Hepatol. 2014;12(4):636–43.
21. Ng K-S, Sivakumaran Y, Nassar N, Gladman MA.Fecal incontinence: community prevalence
and associated factors—a systematic review. Dis Colon Rectum. 2015;58(12):1194–209.
22. Wu JM, Matthews CA, Vaughan CP, Markland AD.Urinary, fecal, and dual incontinence in
older U.S. adults. J Am Geriatr Soc. 2015;63(5):947–53.
23. Sharma A, Yuan L, Marshall R, Merrie A, Bissett I.Systematic review of the prevalence of
faecal incontinence. Br J Surg. 2016;103(12):1589–97.
24. Noelting J, Eaton JE, Choung RS, Zinsmeister AR, Locke G, Bharucha AE.The incidence
rate and characteristics of clinically diagnosed defecatory disorders in the community.
Neurogastroenterol Motil. 2016;28(11):1690–7.
25. Andy UU, Vaughan CP, Burgio KL, Alli FM, Goode PS, Markland AD.Shared risk fac-
tors for constipation, fecal incontinence, and combined symptoms in older US adults. J Am
Geriatr Soc. 2016;64(11):e183–e8.
26. Meinds RJ, van Meegdenburg MM, Trzpis M, Broens PM.On the prevalence of constipa-
tion and fecal incontinence, and their co-occurrence, in the Netherlands. Int J Color Dis.
2017;32(4):475–83.
27. Tamanini JTN, Franceschi Júnior O, Santos JLF, Duarte YAO, Sartori MGF, Girão MJBC,
etal. Fecal incontinence: incidence and risk factors from the SABE (Health, Wellbeing and
Aging) study. Int Urogynecol J. 2022;33(11):2993–3004.
28. Hussong J, Greiner M, Schiedermaier U, Mattheus H, von Gontard A.Anxiety disorders,
depression and incontinence in preschool children—a population-based study. Neurourol
Urodyn. 2022;41(8):1800–8.
29. von Gontard A, Mattheus H, Friese-Jaworsky J, Moritz AM, Thome-Granz S, Roozen S, etal.
Incontinence and sleep disturbances in young children: a population-based study. Neurourol
Urodyn. 2022;41(2):633–42.
30. Salgado D, Zaragoza R. Prevalence of urinary and fecal incontinence in female staff
in a high specialty hospital in Guadalajara Mexico. Int Urogynecol J. 2022;33(Suppl
2):S505-S.
31. Al-Badr A, Saleem Z, Kaddour O, Almosaieed B, Dawood A, Al-Tannir M, etal. Prevalence
of pelvic oor dysfunction: a Saudi national survey. BMC Womens Health. 2022;22(1):27.
32. Bifani BE, Sato TO, Dos Santos GB, Serrao PRMS, Rocha APR, Carvalho C.Pelvic oor
dysfunctions in women with systemic lupus erythematosus: a cross-sectional study. Int
Urogynecol J. 2023;34(5):1025–33.
M. H. B. de MoraesLopes et al.