Fecal incontinence is the result of preventable problems and is usually managed conservatively. The prevalence of fecal incontinence ranges from approximately one percent in people older than 65 years living in the community to 10 to 17 percent in nursing home residents and nearly 50 percent in hospitalized elderly patients. The higher rate of incontinence in hospitalized and institutionalized elderly patients reflects the high prevalence of dementia and delirium in those settings.
Several factors contribute to the pathophysiology of fecal incontinence.
Changes with aging, neurologic disorders, and impaired anorectal function may all contribute to the occurrence of fecal incontinence. With aging, weakness of the external and internal sphincters is common and is often associated with impaired anal and rectal sensation. In women, aging is also associated with decreased maximal sphincter pressures. Chronic constipation is most often associated with physical inactivity, the use of drugs with anticholinergic properties, inadequate dietary fiber intake, and neuromuscular disorders that cause generalized muscle weakness or rectoanal incoordination. Some patients with irritable bowel syndrome, endocrine disorders, or diverticular disease may present with both constipation and fecal incontinence.