4.6 Article

Symptom Outcomes Important to Women With Anal Incontinence A Conceptual Framework

Journal

OBSTETRICS AND GYNECOLOGY
Volume 123, Issue 5, Pages 1023-1030

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AOG.0000000000000236

Keywords

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Funding

  1. American Medical Systems
  2. Renew Medical, Inc
  3. Pfizer
  4. Boston Scientific
  5. MedEdicus
  6. Johnson Johnson
  7. Ethicon
  8. National Institutes of Health (NIH)
  9. Eunice Kennedy Shriver National Institute of Child Health and Human Development
  10. NIH
  11. National Institute of Diabetes and Digestive and Kidney Diseases
  12. AUGS

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OBJECTIVE: To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective. METHODS: A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semi-structured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment success; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews. RESULTS: Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: primary bowel leakage symptoms and ancillary bowel symptoms. Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort. CONCLUSION: Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence.

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