Original Contribution | Published:

Functional GI Disorders

Anal Intercourse and Fecal Incontinence: Evidence from the 2009–2010 National Health and Nutrition Examination Survey

The American Journal of Gastroenterology volume 111, pages 269274 (2016) | Download Citation

Abstract

Objectives:

The aim of this study was to assess the prevalence and associations between anal intercourse and fecal incontinence.

Methods:

Analyses were based on data from 6,150 adults (≥20 years) from the 2009–2010 cycle of the National Health and Nutrition Examination Surveys. Fecal incontinence was defined as the loss of liquid, solid, or mucus stool occurring at least monthly on a validated questionnaire. A gender-specific sexual behavior questionnaire assessed any anal intercourse via an audio computer-assisted personal interview. Co-variables included: age, race, education, poverty income ratio, body mass index, chronic illnesses, depression, loose stool consistency (Bristol Stool Scale types 6 or 7), and reproductive variables in women. Prevalence estimates and prevalence odds ratios (PORs) were analyzed in adjusted multivariable models using appropriate sampling weights.

Results:

Overall, 4,170 adults aged 20–69 years (2,070 women and 2,100 men) completed sexual behavior questionnaires and responded to fecal incontinence questions. Anal intercourse was higher among women (37.3%) than men (4.5%), P<0.001. Fecal incontinence rates were higher among women (9.9 vs. 7.4%, P=0.05) and men (11.6 vs. 5.3%, P=0.03) reporting anal intercourse compared with those not reporting anal intercourse. After multivariable adjustment for other factors associated with fecal incontinence, anal intercourse remained a predictor of fecal incontinence among women (POR: 1.5; 95% confidence interval (CI): 1.0–2.0) and men (POR: 2.8; 95% CI: 1.6–5.0).

Conclusions:

The findings support the assessment of anal intercourse as a factor contributing to fecal incontinence in adults, especially among men.

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Author information

Affiliations

  1. Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA

    • Alayne D Markland
    •  & Camille P Vaughan
  2. Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA

    • Alayne D Markland
  3. Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

    • Alayne D Markland
  4. Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA

    • Gena C Dunivan
    •  & Rebecca G Rogers
  5. Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia, USA

    • Camille P Vaughan

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Competing interests

Guarantor of the article: Alayne D. Markland, DO, MSc.

Specific author contributions: Conception, initiation, and writing: Alayne D. Markland; conception, writing and editing of manuscript: Gena C. Dunivan, Camille P. Vaughan and Rebecca G. Rogers. Rebecca G. Rogers receives royalties from UptoDate and McGraw Hill for educational writings; she is the DSMB chair for the TRANSFORM trial sponsored by American Medical Systems. Gena C. Dunivan receives research support from Pelvalon.

Financial support: This study was supported in part from a Veterans Health Administration Career Development Award (CDA-2) to Alayne D. Markland and Camille P. Vaughan (1 IK2 RX000747-01).

Potential competing interests: None.

Corresponding author

Correspondence to Alayne D Markland.

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DOI

https://doi.org/10.1038/ajg.2015.419