Fecal Incontinence in Nulliparous and Primiparous Women: Prevalence and Severity

Importance Parity has long been considered a major contributor to fecal incontinence (FI), primarily attributed to obstetric trauma. However, this assumption is largely based on studies of patient populations, which may introduce selection bias. In addition, recent studies suggest that FI prevalence is distributed equally between men and women. Objectives We aimed to compare the prevalence and severity of FI between nulliparous and primiparous women in a general Dutch population, with a secondary focus on identifying risk factors for FI in primiparous individuals. Study Design This retrospective, cross-sectional study used a validated, anonymized digital survey (Groningen Defecation and Fecal Continence questionnaire) conducted in 2016 and 2020 among Dutch-speaking adults (≥18 years) from all regions of the Netherlands, recruited via an external survey agency and sampled to reflect the national population distribution. Results The study included 3,522 individuals, 2,790 of whom were nulliparous and 732 were primiparous. Nulliparous women were younger than primiparous women (mean age: 39.5 vs 47.3 years, P <0.001) and had a significantly lower body mass index (BMI) (25.3 vs 27.0, P <0.001). This study population represented the General Dutch population, based on the Netherlands’ statistical pyramid, with demographic factors taken into account. We observed no statistically significant difference in the prevalence of FI between nulliparous and primiparous women (9.1% vs 7.0%, 95% CI for difference in proportion [−0.002; 0.041], P =0.076). In addition, there was no significant difference in FI severity between these groups, as measured by the Jorge & Wexner score. Conclusions We found no evidence that primiparous women have a higher prevalence or severity of FI than nulliparous women in a general Dutch population. Nonobstetric factors, particularly constipation and BMI, emerged as significant determinants of FI. These findings highlight the importance of looking beyond parity alone when assessing the etiology and risk of FI.