# Anal incontinence in adults under 65 years: a survey based on social networks

Aurélien Venara, Mathieu Levaillant, Maëlig Poitevin, Veronique Vitton, Jean-François Hamel

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Aurélien Venara, Mathieu Levaillant, Maëlig Poitevin, Veronique Vitton, Jean-François Hamel. Anal incontinence in adults under 65 years: a survey based on social networks. Clinics and Research in Hepatology and Gastroenterology, 2025, 49 (5), pp.102577. 10.1016/j.clinre.2025.102577. hal-05028695

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Original article

# Anal incontinence in adults under 65 years: A survey based on social networks

<figure><img src="image_2.png" /></figure>

Aurélien Venara<sup>a,b,c,d,*</sup>,1 ID, Mathieu Levaillant<sup>a</sup>, Maëlig Poitevin<sup>a,b</sup>, Véronique Vitton<sup>1,e</sup>,
Jean-Francois Hamel<sup>a,f</sup>

## ARTICLE INFO

### Keywords:

Anal incontinence

Young people

Male

Female

Quality of life

## ABSTRACT

**Introduction:** The frequency of anal incontinence in the general population is likely an underestimation, particularly among adults ≤65 years, for whom personal and professional considerations limit their utilization of medical care. The objective of this study was to assess the prevalence of anal incontinence in the young population and to address the reasons why such individuals do not seek care.

**Methods:** This was a public health survey conducted using personal and professional social networks between April and November 2023. Participants between the ages of 18 and 65 were invited to respond a survey about their experience of anal incontinence (AI). The survey collected data on the Vaizey's score and the Anal Incontinence Quality of Life Index (FIQL).

**Results:** Of the 481 individuals who completed the survey, 176 (36.6 %) reported experiencing AI. The majority of respondents exhibited mild incontinence (46 %), while 15.8 % experienced severe or major AI. Among those with AI, only 27.3 % consulted a physician, and in nearly 40 % of cases, no treatment was proposed. The primary reasons for not seeking consultation were embarrassment about the condition (63 %) and perceived stigma surrounding treatment (28 %), including a lack of awareness about available treatments. Multivariate analysis revealed that individuals between the ages of 26 and 45 were more likely to seek medical attention.

**Conclusion:** The prevalence of incontinence of the anal nature among young adults remains significantly underestimated, despite its impact on their quality of life. Enhanced public health communication regarding the management of incontinence, particularly among young individuals and healthcare providers, is imperative.

## Introduction

Recent meta-analyses report the prevalence of fecal incontinence (FI) between 1.4 % and 19.5 % in the general population [1–3]. In these metanalyses, the prevalence of FI was greater in females and in people ≥60 years old [1,2]. It can reach up to 28.4 % in women seeking gynecological care [4], 13.1 % in individuals undergoing gastroenterological procedures [5], and as high as 40.5 % in women afflicted with urinary incontinence [6].

The majority of studies examining FI management report an average

age of approximately 60 years among individuals with FI [7,8]. Recent reports indicate that the prevalence of FI among women is highest between the ages of 20 and 59, while it tends to be higher among men over 60. Despite the relatively high prevalence of FI, a study of general practice consultations published in 2014 reported that FI accounts for less than 1.5 % of consultations in France [10].

Consequently, it is plausible that FI is undertreated, particularly among young adults, despite its capacity to adversely impact quality of life [11]. A recent study in the United States of America by Moureau et al. revealed that, among men, barriers to seeking care were associated

<footnote><sup>a</sup> Department of Medicine, University Hospital of Angers, Angers, France</footnote>

<footnote><sup>b</sup> Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, Angers 49933, France</footnote>

<footnote><sup>c</sup> The Enteric Nervous System in Gut and Brain Disorders, INSERM, TENS, IMAD, Université de Nantes, Nantes, France</footnote>

<footnote><sup>d</sup> IHFIH, UPRES EA 3859, University of Angers, Angers, France</footnote>

<footnote><sup>e</sup> Gastroenterology Unit, Assistance Publique- Hopitaux de Marseille, France</footnote>

<footnote><sup>f</sup> Ester | Irset INSERM UMR 1085, Angers, France</footnote>

<footnote>* Corresponding author at: Department of Visceral Surgery, CHU Angers (Angers University Hospital), 4 rue Larrey, Angers CEDEX 09 49933, France.
E-mail address: auvenara@chu-angers.fr (A. Venara).</footnote>

<footnote n="1">¹ For the French National Society of ColoProctology (Société National Française de Coloproctologie, SNFCP).</footnote>
with normative thinking and perceived minimal life impact, while, among women, these barriers were more frequently linked to fear, avoidance, and discouragement [12].

A paucity of studies has addressed the quality of life in untreated anal incontinence (AI) patients under 65 or the reasons why such individuals do not seek medical assistance. However, such information could inform the adaptation of communication strategies and the targeting of groups, such as young adults, whose quality of life would likely be enhanced by seeking medical advice. The objectives of this study were: (i) to compare the quality of life between individuals experiencing AI and those not experiencing A, (ii) to assess the quality of life of individuals experiencing AI according to their gender and age and (iii) to assess the characteristics of patients seeking care.

## Methods

A public health survey was conducted between April 13 and November 30, 2023, using the social networks Facebook and Twitter, to which the authors, the authors' University Hospital and France Assos Santé (association of the users of health services in France) have access. The University of the authors and the Haute Autorité de la Santé (National Health Authority) sent a link to the survey via a newsletter to the personal of their structure. Medical students were asked to respond to the survey via Facebook. A link to the survey hosted in a Google form was provided and the users were asked to respond to the survey and to forward the link. To improve the visibility of the survey the National French Society of Coloproctology and the University shared the link via a newsletter. Several medical centers displayed posters featuring a QR code in medical units and in waiting rooms requesting responses to the survey. All these means of diffusion of the link to the survey aimed to reach the largest population of people under 65 years.

All people aged between 18 and 65 years were asked to respond to the questionnaire. The only exclusion criterion was an age > 65 years. Incomplete surveys were excluded from the final analysis.

The design of the study was approved by our local ethics committee prior to sharing the link (2023–054).

### Data collected

Firstly, respondents were asked to indicate their gender and age (18–25/26–45/46–65 years). Then, respondents were asked whether they had experienced AI during the previous year, with AI defined as at least one episode of leakage of flatus and/or stools during the past year.

In the second part, the questionnaire asked about the management of AI:

- Did you consult a physician regarding your troubles?

- If so, what was the physician's conclusion?

- If not, why?

- Have you ever taken sick leave for your condition?

The third part of the questionnaire asked questions related to Vaizey's scores [13]. The severity of AI was light (score: 0–4), moderate (score: 5–12), severe (score: 13–19) and total (score ≥ 20). The fourth part of the questionnaire asked questions related to the Fecal Incontinence Quality of Life (FIQL) [14].

### Statistical analysis

Categorical data were expressed as effective and percentages, and compared using exact Fisher tests. Continuous data were expressed as median and inter-quartile range, and compared using Mann & Whitney tests. The relationship between lifestyle, behavior, depression or embarrassment scores, and its considered risk factors (Vaizey score, gender and age) were studied considering linear regressions. Validity of these regressions were assessed through the analysis of residuals

distributions. The relationship between consultation and it's considered risk factors Vaizey score and the 4 dimensions of the FIQL (lifestyle, behavior, depression and embarrassment), gender and age) was studied through a logistic regression. The type I error threshold was set at 0.05. all the tests were two-sided.

## Results

During the period of inclusion, 481 people responded to the questionnaire. Among the respondents, 128 were male (26.6 %) and 353 were female (73.4 %). The majority of the respondents were between the ages of 26 and 45 years (n = 241; 50.1 %) (Table 1). In this survey, 176 respondents (36.6 %) had experienced at least one episode of AI within the last year. Of these respondents, 125 (26 %) reported experiencing fecal incontinence, 48 (28.4 %) reported consulting a physician about it, and 5 (2.8 %) reported requiring sick leave due to their condition.

The survey population included 24/110 respondents aged 18 to 25 (21.8 %), 76/241 respondents aged 26 to 45 (31.5 %), and 76/130 respondents aged 45 to 60 (58.5 %) who experienced AI. Notably, five patients reported a sick leave during the last year due to fecal incontinence, and all of them required medical care.

Of the patients who underwent consultation, 37.5 % (18 cases) were referred to a specialist, 30 % (15 cases) did not receive any treatment recommendations, 16.7 % (8 cases) were recommended abdominal operational physiotherapy, and 8.3 % (4 cases) were prescribed a constipating treatment. The remaining 10.4 % (5 cases) received other treatments.

The 63 subjects who did not seek consultation reported the following reasons for their decision: embarrassment (n = 63, 49.2 %), shame (n = 15, 11.7 %), belief that there was no treatment available (n = 13, 10.1 %), and lack of time to make an appointment with a physician (n = 5, 3.9 %), believed themselves to have already identified the cause of their problems (n = 2, 1.6 %), experienced a sudden cessation of their troubles (n = 1, 0.8 %), believed it was a fairly normal occurrence (n = 1, 0.8 %), or had experienced their problems postpartum (n = 1, 0.8 %). People did not respond in 26 cases (20.3 %).

<caption>**Table 1**</caption>

Comparison between the group of responders with anal incontinence and the group of responders without anal incontinence. FIQL: Fecal incontinence quality of life.

<table><thead><tr><th></th><th>No anal incontinence n = 305 (63.4 %)</th><th>Anal incontinence n = 176 (36.6 %)</th><th>Overall population n = 481</th><th>p</th></tr></thead><tbody><tr><td><strong>Vaizey's score</strong></td><td>0.00 (0.00–1.00)</td><td>7.00 (3.00–11.00)</td><td>1.00 (0.00–6.00)</td><td>&lt;0.001</td></tr><tr><td><strong>FIQL score</strong></td><td></td><td></td><td></td><td></td></tr><tr><td>Lifestyle</td><td></td><td>39.00 (32.00–40.00)</td><td></td><td></td></tr><tr><td>Coping/Behavior</td><td></td><td>31.00 (22.00–35.00)</td><td></td><td></td></tr><tr><td>Depression/ Self-perception</td><td></td><td>28.00 (22.00–29.50)</td><td></td><td></td></tr><tr><td>Embarrassment</td><td></td><td>9.00 (7.50–11.00)</td><td></td><td></td></tr><tr><td><strong>Gender</strong></td><td></td><td></td><td></td><td>0.02</td></tr><tr><td>Female</td><td>213 (69.84 %)</td><td>140 (79.55 %)</td><td>353 (73.39 %)</td><td></td></tr><tr><td>Male</td><td>92 (30.16 %)</td><td>36 (20.45 %)</td><td>128 (26.61 %)</td><td></td></tr><tr><td><strong>Age</strong></td><td></td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>18–25 years</td><td>86 (28.20 %)</td><td>24 (13.64 %)</td><td>110 (22.87 %)</td><td></td></tr><tr><td>26–45 years</td><td>165 (54.10 %)</td><td>76 (43.18 %)</td><td>241 (50.10 %)</td><td></td></tr><tr><td>46–65 years</td><td>54 (17.70 %)</td><td>76 (43.18 %)</td><td>130 (27.03 %)</td><td></td></tr><tr><td>Consultation of a physician</td><td>2 (0.77 %)</td><td>48 (27.27 %)</td><td>50 (11.44 %)</td><td>&lt;0.001</td></tr></tbody></table>
## Symptoms of AI

Among the 176 respondents experiencing AI, 44 reported AI of solid stools (25 %), 114 of liquid stools (64.8 %), and 168 of flatus (95.5 %). A decline in quality of life was reported by 129 respondents (73.3 %). The utilization of pads or anal plugs was reported by 22 respondents (12.5 %), and the use of drugs that reduce the speed of gastrointestinal transit was reported by 28 (15.9 %). Fecal urge was reported by 90 respondents (51.1 %). The majority of respondents experienced mild incontinence (n = 81, 46 %). Light incontinence was reported by 67 people (38.1 %), whereas severe incontinence was reported by 24 people (13.6 %), and total incontinence by 4 people (2.3 %).

## Comparison between respondents experiencing incontinence and respondents who did not experience incontinence

Respondents reporting AI were older and more likely to be female than respondents who did not report any anal incontinence.

### The impact of anal incontinence on quality of life

Among the 176 patients diagnosed with AI, the FIQL exhibited an inverse correlation with the severity of AI as measured by the Vaizey score (supplementary material) in univariate analysis. Intriguingly, in multivariate analysis, the Vaizey score was the sole parameter associated with an alteration in all four dimensions of the FIQL (Table 2). An age between 26 and 45 years was not significantly associated with an improvement in feelings of embarrassment as compared to those aged 18–25 years (Coeff=0.69; 95 %CI=-0.05 – 1.44).

### Profile of the patients consulting for anal incontinence

In univariate analysis, no statistically significant differences were observed between patients seeking treatment for AI and those not seeking treatment with regard to age and gender. There was a significant decline in quality of life across all parameters. The multivariate analysis (Table 3) identified a notable disparity in patient age as a contributing factor to this decline. Specifically, individuals between the ages of 26 and 45 exhibited a higher propensity to seek medical consultation

### Table 2

Multivariate analysis of the factors influencing the quality of life in patients with anal incontinence.

<table><thead><tr><th></th><th>Coef.</th><th>95 % Confidence Interval</th><th>p</th></tr></thead><tbody><tr><td><strong>Lifestyle</strong></td><td></td><td></td><td></td></tr><tr><td>Vaizey's Score</td><td>-1.134</td><td>-1.311 - -0.958</td><td>0.000</td></tr><tr><td>Gender Male (Ref: Female)</td><td>-1.111</td><td>-3.290 - 1.068</td><td>0.316</td></tr><tr><td>Age (Ref: 18-25 years)</td><td></td><td></td><td></td></tr><tr><td>26-45 years</td><td>-0.602</td><td>-3.324 - 2.120</td><td>0.663</td></tr><tr><td>46-65 years</td><td>0.349</td><td>-2.420 - 3.118</td><td>0.804</td></tr><tr><td><strong>Coping/Behavior</strong></td><td></td><td></td><td></td></tr><tr><td>Vaizey's Score</td><td>-1.323</td><td>-1.450 - -1.196</td><td>0.000</td></tr><tr><td>Gender Male (Ref: Female)</td><td>0.773</td><td>-0.796 - 2.342</td><td>0.332</td></tr><tr><td>Age (Ref: 18-25 years)</td><td></td><td></td><td></td></tr><tr><td>26-45 years</td><td>-0.033</td><td>-1.993 - 1.927</td><td>0.973</td></tr><tr><td>46-65 years</td><td>0.429</td><td>-1.564 - 2.423</td><td>0.671</td></tr><tr><td><strong>Depression/</strong></td><td></td><td></td><td></td></tr><tr><td><strong>Self perception</strong></td><td></td><td></td><td></td></tr><tr><td>Vaizey's Score</td><td>-0.783</td><td>-0.902 - -0.663</td><td>0.000</td></tr><tr><td>Gender Male (Ref: Female)</td><td>0.377</td><td>-1.096 - 1.849</td><td>0.614</td></tr><tr><td>Age (Ref: 18-25 years)</td><td></td><td></td><td></td></tr><tr><td>26-45 years</td><td>-0.564</td><td>-2.403 - 1.275</td><td>0.546</td></tr><tr><td>46-65 years</td><td>-0.119</td><td>-1.989 - 1.752</td><td>0.900</td></tr><tr><td><strong>Embarrassment</strong></td><td></td><td></td><td></td></tr><tr><td>Vaizey's Score</td><td>-0.310</td><td>-0.358 - -0.261</td><td>0.000</td></tr><tr><td>Gender Male (Ref: Female)</td><td>-0.013</td><td>-0.610 - 0.584</td><td>0.966</td></tr><tr><td>Age (Ref: 18-25 years)</td><td></td><td></td><td></td></tr><tr><td>26-45 years</td><td>0.693</td><td>-0.053 - 1.439</td><td>0.068</td></tr><tr><td>46-65 years</td><td>-0.084</td><td>-0.843 - 0.675</td><td>0.827</td></tr></tbody></table>

### Table 3

Multivariate analysis of the factors associated with a consultation with a physician.

<table><thead><tr><th></th><th>Odds Ratio</th><th>95 % Confidence Interval</th><th>p</th></tr></thead><tbody><tr><td>Vaizey's Score</td><td>1.06</td><td>0.91 - 1.24</td><td>0.42</td></tr><tr><td><strong>GIQLI</strong></td><td></td><td></td><td></td></tr><tr><td>Lifestyle</td><td>1</td><td>0.88 - 1.13</td><td>0.99</td></tr><tr><td>Coping/Behavior</td><td>0.88</td><td>0.76 - 1.01</td><td>0.07</td></tr><tr><td>Depression/</td><td>0.94</td><td>0.80 - 1.11</td><td>0.48</td></tr><tr><td><strong>Self-perception</strong></td><td></td><td></td><td></td></tr><tr><td>Embarrassment</td><td>0.91</td><td>0.66 - 1.25</td><td>0.56</td></tr><tr><td>Gender Male (Ref: Female)</td><td>0.61</td><td>0.16 - 2.31</td><td>0.47</td></tr><tr><td><strong>Age (Ref: 18-25 years)</strong></td><td></td><td></td><td></td></tr><tr><td>26-45 years</td><td>10.27</td><td>1.49 - 70.62</td><td>0.02</td></tr><tr><td>46-65 years</td><td>3.79</td><td>0.57 - 25.34</td><td>0.17</td></tr></tbody></table>

compared to those between 18 and 25 years of age (OR=10.3; 95 %CI: 1.5–70.6).

## Discussion

Among the 481 people who completed the questionnaire, 176 reported AI (36.6 %) of which 125 reported fecal incontinence (26 %). Most of the respondents experienced mild incontinence (46 %) and 15.8 % experienced severe or major incontinence. Quality of life was impacted across all the dimensions explored by the FIQL in the people experiencing AI as compared to those without AI. Interestingly, amongst those with AI, only the Vaizey's score was associated with an alteration in the 4 dimensions of quality of life. Amongst those with AI, only 27.3 % consulted a physician. In multivariate analysis, only an age between 26 and 45 years was associated with consulting a physician. An alteration in the parameter "behavior" of the FIQL was non-significantly associated with the need to consult a physician.

This survey documented a high prevalence of AI, contrasting with the findings reported in the extant literature. Previous studies have reported a range of prevalence rates for AI in the general population, ranging from 2 % to 20.7 % [2,15,16], and up to 42.7 % among institutionalized older adults [17]. A recent review has elucidated that the observed discrepancy between these studies stems from the utilization of varying definitions of FI by researchers and the diverse methodologies employed in survey administration [2]. For instance, face-to-face or telephone interviews reported a prevalence of FI between 8.3 % and 8.4 %, while postal surveys reported rates between 11.2 % and 11.4 % [2]. The present study was conducted using an internet-based survey, a method that has been shown to elicit objective responses. However, this result should be interpreted with caution, as the survey design may have led to an overestimation of the prevalence of FI due to the attraction of respondents with FI who are concerned about the condition, while those without FI may have been largely overlooked [18].

The high frequency of AI can also be attributed to the inclusion of flatus in the definition of incontinence, which would increase the prevalence [2]. Some studies reporting the prevalence of FI with this definition report a prevalence between 15 % and 20 % [19,20], which is closer to the prevalence reported in this study. While this survey reports a probable overestimation of AI and FI, it presents strong evidence that AI remains a serious problem among adults ≤65 years and that AI impacts the quality of life similarly in all age groups.

Despite the documented impact of AI on quality of life, there is a paucity of treatment seeking [11], as evidenced by a recent nationwide French study reporting that less than 1 % of the general population seeks treatment for FI [9]. Furthermore, Brown et al. state that less than 30 % of women with FI seek care [21]. This prompts inquiries into the significance of the impairment to quality of life caused by FI in determining whether to seek care and the motivations behind non-seeker behavior. Our study, consistent with extant literature, finds that all four dimensions of the FIQL are altered in individuals with AI compared to
those without AI. Additionally, it documents that the quality of life level is inversely associated with the severity of AI, a finding that aligns with existing literature [22,23].

Contrary to previous findings, the present study reveals that individuals who consulted a physician did not exhibit greater alterations to their quality of life compared to those who did not seek medical attention. Moureau et al. report that men exhibited a longer delay in seeking care if their quality of life was conserved [12]. Another study focusing on women indicates that impaired quality of life prompts healthcare utilization in women with moderate to severe symptoms [24]. The present study focuses on individuals aged between 18 and 65 years, with the objective of elucidating these discrepancies. It is plausible that respondents who had consulted a physician may have already experienced improvements in their quality of life, thereby explaining the absence of differences or an improved quality of life in the population of patients seeking care. Additionally, the survey on the use of care was concise and did not allow for determination of whether a treatment had been offered or the timing of the interview in relation to treatment initiation. While this may introduce a bias, this last parameter is also optimistic because it may illustrate that treatment for FI improves quality of life.

The undertreatment of FI in young adults may have a number of reasons. Moureau et al. reported that, amongst men, normative thinking and believing that a healthcare provider cannot help represented a significant barrier to accessing consultation, while, in women, avoidance, care and discouragement were barriers to seeking medical assistance [12]. The present study corroborates these findings, irrespective of gender. A noteworthy finding is the observation that 21.8 % of patients did not seek treatment due to feelings of shame or a lack of awareness regarding available treatment options. Furthermore, the study notes a higher proportion of consultations among individuals aged 26–45 years, which might be attributable to enhanced information dissemination in this demographic concerning childbirth. As pregnancy has been identified as a risk factor for FI [25,26], postpartum consultations inform women of the risk of FI and the possibilities of treatment [27]. The information imparted to women during this stage of their lives can be transmitted to their spouses and friends, thereby explaining the absence of differences between men and women in this age group. As demonstrated by Joh et al., research conducted within a Korean population has indicated an association between FI knowledge and attitudes toward seeking assistance [28].

The present study is subject to several limitations inherent to its design. These include the potential for overestimation of the prevalence of AI, as discussed above, as well as the limited number of patients with total or severe AI, which constrained the study's power and may have resulted in non-significant differences. Additionally, the study was not designed to collect medical information. This hinders the study's capacity to accurately select a population that would benefit from specific information. Additionally, the survey did not collect data on living area or education level, which could have enhanced understanding of the factors contributing to the underutilization of care. Notwithstanding these limitations, the present study offers evidence suggesting the necessity for enhanced communication on AI to target young adults, who exhibit higher than expected AI prevalence.

## Conclusion

Despite the pervasive impact of AI on young adults, less than 30 % of them seek medical assistance to manage this condition, which significantly impacts their quality of life between the ages of 25 and 60. Barriers to consultation include patients' feelings of shame regarding their experience with AI and their limited knowledge about treatment options. Public health policy should prioritize developing targeted communication strategies for younger adults regarding AI, similar to the approach taken with urinary incontinence.

## Data availability

Data are available from reasonable request to the corresponding author.

## Funding source

None.

## Ethics approval

The protocol was approved by the local ethics committee (Number 2023-054).

## Informed consent

Being a social network survey, no patients were involved. Informed consent was therefore not required.

## Clinical trial registration

Being a social network survey and not properly a clinical trial, no registration was made prior beginning the study.

## Artificial intelligence

No AI was used in this manuscript.

## CRediT authorship contribution statement

**Aurélien Venara:** Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization. **Mathieu Levaillant:** Writing – review & editing, Methodology, Data curation. **Maëlig Poitevin:** Writing – review & editing, Data curation. **Véronique Vitton:** Writing – review & editing, Methodology, Formal analysis, Conceptualization. **Jean-François Hamel:** Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Conceptualization.

## Declaration of competing interest

The authors declare that they have no relevant financial, personal, political, intellectual, or religious interests related with the present manuscript.

## Acknowledgment

The authors acknowledge the university of Angers, the National Health Authority, *France Assos Santé* and the university hospital of Angers for having shared the survey.

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