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Association Between Constipation and Fecal Incontinence in Community-Dwelling Older Adults in Japan
Hiroaki Nakagawa1, Hajime Yamazaki2, Akihiro Ozaka3
1Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan; Department of General Internal Medicine and Family Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan.
Objectives:
With a close relation between constipation and fecal incontinence, constipation is thought to be a risk factor for fecal incontinence in older adults. However, the limited number of studies available have provided inconsistent results. We conducted a large-sample population-based study to evaluate the association between constipation and fecal incontinence.
Design:
Cross-sectional community-based survey.
Setting And Participants:
Independent community-dwelling older adults in Japan ≥75 years of age in 2023 who were not using laxatives, enemas, or undergoing fecal disimpaction.
Methods:
Constipation and fecal incontinence were measured using a self-administered questionnaire. Constipation severity was evaluated using the Constipation Scoring System. Constipation-related symptoms were assessed based on the Roma IV criteria and Constipation Scoring System. Logistic regression models were used to evaluate the odds ratio (OR) and 95% CI for fecal incontinence, with adjustment for potential confounders.
Results:
We enrolled 2561 participants with a median age of 79 years (interquartile range, 76-83 years), with similar numbers of male and female participants. The prevalence of fecal incontinence was 7.4% (122 of 1658) in the group without constipation, and 18.3% (165 of 903) in the group with constipation. Constipation was associated with fecal incontinence (adjusted OR, 2.29; 95% CI, 1.76-2.98; P < .001). Constipation severity was associated with fecal incontinence in a dose-response manner. Of constipation-related symptoms, a sensation of incomplete evacuation was most strongly associated with fecal incontinence (adjusted OR, 2.51; 95% CI, 1.81-3.47; P < .001).
Conclusions And Implications:
Constipation was significantly associated with fecal incontinence in older adults ≥75 years of age. To reduce the risk of fecal incontinence, appropriate constipation management may be important.
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