Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse

PURPOSE: The aim of this study was to determine the prevalence, severity, a nd associations between urinary incontinence and genital prolapse in female s after surgery for fecal incontinence or rectal prolapse, METHODS: AU pati ents who underwent surgery for fecal incontinence (Group I) or rectal prola pse (Group II) were compared with a control group of females (Group III) by 43 questions regarding demographic data, past medical and surgical history ,and diagnosis and treatment of anal and urinary incontinence and genital a nd rectal prolapse. The type (stress, urge, and total) of urinary incontine nce was determined and graded using an incontinence severity questionnaire (Individual Incontinence Impact Questionnaire). RESULTS: Overall response r ate in the three groups of patients was 40.1 percent. The questionnaire was sent to 240 patients operated on-for fecal incontinence or rectal prolapse , and 83 of them responded (34.5 percent). The patients were distributed in to three groups: Group I consisted of 51 patients (mean age 56.7 +/- 14); G roup II consisted of 32 patients (69.7 +/- 11); and Group III consisted of 40 patients (60.5 +/- 16). The prevalence of urinary incontinence in Group I was 27 (54 percent), in Group II was 21 (65.6 percent), and Group III was 12 patients (30 percent; P = 0.003). Genital prolapse was present in 9 (17 .6 percent), 11 (34.3 percent), and 5 patients (12.5 percent), respectively (P = 0.03). The prevalence of coexistent urinary incontinence and genital prolapse in both study groups was 22.8 percent (19 patients). There were no statistically significant differences between Groups I and II relative to prevalence, type, and severity of urinary incontinence and genital prolapse , but there were significant differences between the two study groups and t he control group. Of the patients in the study group, 67 percent had urinar y incontinence before or at the time of surgery. CONCLUSION: There is a hig her prevalence and severity of urinary incontinence and pelvic genital prol apse in females operated on for either fecal incontinence or rectal prolaps e than in a control group. Therefore, female patients with fecal incontinen ce or rectal prolapse should be evaluated and treated by a multidisciplinar y group of pelvic flour clinicians, including a gynecologist or urologist w ith special training in female pelvic floor dysfunction and a colorectal su rgeon.