Clin Gastroenterol Hepatol. 2023 Sep 19:S1542-3565(23)00715-2.doi: 10.1016/j.cgh.2023.09.004. Online ahead of print.

Isabelle Mack ¹, Heiko Hahn ¹, Celina Gödel ¹, Paul Enck ¹, Adil E Bharucha ²

Author information

¹Department of Psychosomatic Medicine and Psychotherapy (Mack, Hahn, Gödel, and Enck), University Medical Hospital, Tübingen, Germany, and Division of Gastroenterology and Hepatology (Bharucha), Mayo Clinic, Rochester, Minnesota.

²Department of Psychosomatic Medicine and Psychotherapy (Mack, Hahn, Gödel, and Enck), University Medical Hospital, Tübingen, Germany, and Division of Gastroenterology and Hepatology (Bharucha), Mayo Clinic, Rochester, Minnesota. Electronic address: bharucha.adil@mayo.edu.

Abstract

Background & aims: Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age.

Methods: We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI.

Results: Of the 5,175 articles identified, the final analysis included 80 studies; the median response rate was 66% (IQR, 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% CI, 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3% [95% CI, 6.6%-12.0%]) compared with younger persons (4.9% [95% CI, 2.9%-6.9%]) (odds ratio [OR], 1.75 [95% CI, 1.39-2.20]), and it was more prevalent among women (9.1% [95% CI, 7.6%-10.6%]) than men (7.4% [95% CI, 6.0%-8.8%]) (OR, 1.17 [95% CI, 1.06-1.28]). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I²=99.61%) was partly explained by age.

Conclusions: Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.