An Epidemiology Study of Fecal Incontinence in Adult Chinese Women Living in Urban Areas

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An Epidemiology Study of Fecal Incontinence in Adult Chinese Women Living in Urban Areas

Fecal incontinence (FI), defined as the involuntary loss of gas, liquid, or solid stool, is a debilitating condition associated with reduced quality of life, social isolation, and psychological distress. While FI has been extensively studied in Western populations, data on its epidemiology in China, particularly among urban-dwelling women, remain sparse. This study addresses this gap by presenting the first large-scale, population-based investigation into the prevalence, clinical characteristics, and risk factors of FI among adult women in urban China.

Study Design and Methodology

The research was conducted as a sub-analysis of a national pelvic floor disorder survey conducted between 2014 and 2015. A total of 28,196 adult women from urban regions across six Chinese provinces (Liaoning, Gansu, Guangdong, Jiangsu, Shanxi, and Guizhou) were included. These regions were selected to reflect China’s geographic and socioeconomic diversity. Participants were recruited via a stratified random sampling method during a free cervical and breast cancer screening program. Exclusion criteria included pregnancy, lactation, or residency of less than five years in the area.

Trained interviewers administered structured questionnaires to collect demographic, medical, and obstetric histories. FI was defined as accidental leakage of gas, liquid, or solid stool at least once in the past. Severity was assessed using the Wexner score (0–20), which evaluates frequency of leakage, pad use, and lifestyle impact. Clinical examinations, including Pelvic Organ Prolapse Quantification (POP-Q) staging, were performed by physicians. Statistical analyses employed Cochran-Armitage trend tests, chi-square tests, and multivariable logistic regression to identify risk factors.

Prevalence and Clinical Characteristics of FI

The age-adjusted prevalence of FI among urban Chinese women was 0.43% (95% CI: 0.35%–0.51%), significantly lower than rates reported in Western countries (e.g., 5%–14.4% in the U.S.). Regional variations were observed, with the highest prevalence in Gansu (0.86%) and the lowest in Guangdong (0.04%).

Liquid stool leakage was the most common symptom (82.96% of FI cases), followed by gas (42.22%) and solid stool (42.96%). A strong age-dependent trend was noted: prevalence increased from 0.16% in women aged 20–29 years to 1.28% in those ≥70 years (P for trend <0.001). Severity, assessed via the Wexner score, averaged 4.0 (range 0–20), with 12% of patients scoring ≥9, indicative of severe functional impairment.

Risk Factor Analysis

Multivariable logistic regression identified several modifiable and non-modifiable risk factors for FI:

  1. Demographic and Lifestyle Factors

    • Age: Women aged 60–69 years (OR 3.29, 95% CI 1.11–9.74) and ≥70 years (OR 3.70, 95% CI 1.21–11.33) had significantly higher risks.
    • Body Mass Index (BMI): Overweight (BMI 24–27.9 kg/m²: OR 1.59, 95% CI 1.07–2.35) and obesity (BMI ≥28 kg/m²: OR 1.86, 95% CI 1.02–3.38) were independently associated with FI.
    • Alcohol Consumption: Drinkers faced a 2.7-fold increased risk (OR 2.70, 95% CI 1.51–4.83).

  2. Medical Comorbidities

    • Chronic Constipation: A nearly doubled risk (OR 1.90, 95% CI 1.24–2.92).
    • Chronic Cough: Associated with a 2.04-fold increase (95% CI 1.14–3.65).
    • Pelvic Organ Prolapse (POP): POP-Q stage II (OR 3.20, 95% CI 2.13–4.80) and stages III–IV (OR 3.03, 95% CI 1.58–5.82) significantly elevated FI risk.
    • Systemic Diseases: Chronic bronchitis (OR 2.15, 95% CI 1.13–4.08) and cancer (OR 4.10, 95% CI 1.98–8.45) were strong predictors.

  3. Gynecological and Obstetric Factors

    • Vaginal Delivery: Among parous women, vaginal delivery conferred a 4.31-fold higher risk (95% CI 2.03–9.15) compared to cesarean section.
    • Gynecological Inflammation: Linked to a 2.25-fold increase (95% CI 1.44–3.53).

Discussion and Implications

The low prevalence of FI in urban Chinese women contrasts sharply with Western data. Cultural factors, such as underreporting due to stigma, and methodological limitations, including the exclusion of bedridden individuals, may contribute to this disparity. Additionally, dietary differences, genetic factors, and variations in pelvic floor resilience across populations warrant further investigation.

The identification of modifiable risk factors—such as obesity, chronic constipation, and alcohol use—provides actionable targets for prevention. For instance, weight management programs and dietary interventions to alleviate constipation could reduce FI burden. Clinicians should prioritize screening for FI in high-risk groups, including elderly women, those with POP, and individuals with chronic respiratory or oncological conditions.

The strong association between vaginal delivery and FI underscores the need for targeted postpartum pelvic floor rehabilitation. Obstetric practices that minimize perineal trauma and promote early intervention for pelvic floor dysfunction may mitigate long-term FI risk.

Limitations and Future Directions

This study has several limitations. First, reliance on self-reported data may underestimate true prevalence due to social desirability bias. Second, the cross-sectional design precludes causal inferences. Longitudinal studies are needed to elucidate temporal relationships between risk factors and FI onset. Third, rural populations were not included, limiting generalizability to non-urban settings.

Future research should explore FI prevalence in rural China, incorporate objective diagnostic measures (e.g., anorectal manometry), and evaluate the impact of culturally tailored interventions. Qualitative studies examining barriers to healthcare-seeking behavior among FI patients are also warranted.

Conclusion

This large-scale epidemiologic study reveals that FI is relatively uncommon among urban Chinese women but carries significant clinical implications for affected individuals. The findings highlight age, obesity, chronic diseases, and vaginal delivery as key risk factors, offering a foundation for preventive strategies and clinical surveillance. By addressing modifiable risks and enhancing awareness, healthcare providers can improve detection and management of this underreported condition.

doi.org/10.1097/CM9.0000000000000552

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