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Epidemiology of combined urinary and fecal incontinence. The shortage of studies on urinary and fecal incontinence makes difficult the implementation of preventive and therapeutic interventions to address the physical, psychological, and economic problems among patients with these conditions.
The lack of national publications and paucity of international literature on the epidemiology of combined urinary and fecal incontinence led to the performance of this literature review. Currently, the small number of investigations by health professionals, and the limited amount of complaints by individuals make it difficult for geared action towards prevention to be taken.
Both incontinences lead to family and friends isolation and to admission of elderly people into nursing homes 5. Additionally, there are several studies confirming the impact of incontinences on quality of life leading to physical, psychological and social problems 4, 6,7.
The lack of national publications on urinary and fecal incontinence encouraged us to write this article with the objective of presenting the epidemiologic aspects of both incontinences when they are combined. The pelvic floor is a structure similar to a net or trampoline and it is weakened by lateral opening from urethra, vagina and anus. Because of age, urogynecologic and rectal surgeries and sphincter lesions, these structures may present dysfunctions over time and the association of urinary and fecal incontinences is not uncommon 8.
UI is defined as "any kind of unintentional loss of urine" and it is classified into stress incontinence, urge incontinence, mixed incontinence, total urinary incontinence, nocturnal enuresis, overflow incontinence and extra-urethral 9. Although there are several different classifications, in Brazil, we use that proposed by Jorge and Wexner 10 , according to which FI can be mild, moderate and severe. The Fecal Incontinence Index, as it is known, is a scale including characteristics and frequency of loses, the use of protectors and the impact in quality of life, with scores ranging from zero perfect continence to twenty total incontinence.