on December 2, 2002
Published online before print December 2, 2002, doi: 10.1161/01.STR.0000044169.54676.F5
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Submitted on July 12, 2002
From the Departments of Healthcare of the Elderly (D.H.) and Public Health (C.C., C.D.A.W.), King's College, and the Elderly Care Unit (A.G.R.), Guy's and St Thomas' Hospitals Trust, London, UK. * To whom correspondence should be addressed. E-mail: danielle.harari{at}kcl.ac.uk.
Background and Purpose—Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. Methods—Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. Results—Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI,1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). Conclusions—New-onset FI in stroke survivors is common but may be transient. Modifiable risk factors for FI 3 months after stroke are constipating drug use and difficulty with toilet access, raising implications for developing treatment and prevention strategies.
Accepted on July 30, 2002
New-Onset Fecal Incontinence After Stroke. Prevalence, Natural History, Risk Factors, and Impact
Danielle Harari FRCP*;
Key words: constipation • fecal incontinence • outcome • prevalence • stroke
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