Talk:Fecal incontinence

Distinguishing between anal incontinence, fecal incontinence and flatulance incontinence

Currently Anal incontinence redirects to the Fecal incontinence article. I edited the first to be its own page, see this revision, because there is an actual difference according to the source included. The revision was undone because to some AI and FI are the same. This is what the source has to say:

"Anal incontinence (AI) may be defined as any involuntary loss of stool or gas via the anus.¹ Specifically, feacal incontinence (FI) is loss of stool, wheter liquid or solid."

There are subjects with flatulance incontinence without fecal incontinence. Those with flatulance incontinence will not identify themselves with fecal incontinence, therfor it is import differentiate between anal incontinence, fecal incontinence and flatulance incontinence.

Currently there is a draft for fecal body odor and I wanted to redirected 'flatulance incontinence' to this article. Maybe splitting the 'fecal body odor' and 'flatulance incontinence' articles in the future. — Preceding unsigned comment added by Candide124 (talk • contribs) 21:10, 23 August 2017 (UTC)

Hello, you are correct that some sources seem to make a distinction between anal incontinence and fecal incontinence.

It seems the logic was that anal incontinence is loss of control of the sphincters. So, for example, a spinal injury. Hence loss of control of even gas (in terms of continence, it is easiest for the muscles to retain solids, but harder to retain liquids). Such sources contrast their definition of anal incontinence with "fecal incontinence" which may or may not be caused by loss of control of the sphincters. For example, some lesion which impairs the function of otherwise normal sphincters.

However, some other sources don't follow this definition of "anal incontinence", and instead define it as equivalent to "flatus incontinence".

Yet more sources do not seem to make any distinction, or avoid using the term "anal incontinence" completely, instead using a broader definition of fecal incontinence, stating that it may include involuntary loss of gas. From what I can see from looking at many sources, this last situation seems to the most common in the sources. This assertation is supported by consulting google ngram viewer, which shows that the term "fecal incontinence" is more common by about 8 times than "anal incontinence". Therefore I suggest keeping a single, broad definition in the intro and putting all the discussion of variation of terminology in the "types" section of the body of the article. Moribundum (talk) 10:14, 10 September 2024 (UTC)

I appreciate I am replying to a very old comment, but I'll make some observations incase these issues arise again in future:

In some internet forums of patients, there seems to be a popular idea of "fecal body odor" which is linked to IBS, constipation or "candida". From reading many sources on topics in this field, there is no real support for this idea in scientific sources.

• If there is abnormal body odor (not from the anus), it is termed bromhidrosis.
• If there is odor from the anus without any impairment in continence function, it is best to think of this in terms of rectal discharge, or maybe obstructed defecation syndrome, depending on the exact cause. Here we are talking about failure of complete evacuation of stool for some reason, or some other process which is making bowel contents smell unusually bad (infections, and so on).
• If there is odor from the anus caused by impairment of continence, it should be thought of as part of this topic, fecal incontinence.

Making an article about "fecal body odor" is not really sensible since there are no scientific sources, and this term originates from non experts making their own theories in forums.

Splitting the idea of "flatulence incontinence" from the main FI article is not a good idea, in my opinion. Mainly for the reason that that term is even less commonly used than "anal incontinence" (see above comment). As supported by the FI sources, there is a spectrum of severity, and discussion of that "milder" form of FI is best done in the context of FI as a larger concept. Moribundum (talk) 10:31, 10 September 2024 (UTC)

IAS damage from unwanted anal penetration

@Zenomonoz Hello I think this is notable to include because it is discussed in the paper in the context of fecal incontinence:

Pathology > Low pressure > Anal penetration

In the section "Pathology": "The IAS is reported to contribute between 50 and 85% of the resting anal tone, the remainder being from the vascular anal cushions and the EAS,23 illustrating IAS's crucial role in maintaining continence. The IAS disease spectrum comprises of symptoms due to alteration in pressure and as such can be divided into two sub groups, i.e. low-pressure group and high pressure group."

In the section "Low pressure" : "The low pressure most often results in varying degree of incontinence to different rectal components, i.e. solid stool, liquid/semi-formed stool, gas. The common causes of low pressure are mentioned in Table 1." Their table 1 explicitly states "Trauma due to anal penetration"

Therefore it is clear the authors of this source considered that damage from anal penetration is a potential cause of low pressure in the anal canal, which they state is most often expressed as some degree of incontinence. If there is no response in 24 hr on talk I will restore the content as non controversial. Thank you Moribundum (talk) 12:49, 25 January 2025 (UTC)

Further note. They incorrectly cited this source

It's not 0. Engel AF, Kamm MA, Talbot IC. Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence. Gut 1994;35:857e9. as they erroneously cited, but this paper by the same author: https://pubmed.ncbi.nlm.nih.gov/7866814/

Engel AF, Kamm MA, Bartram CI. Unwanted anal penetration as a physical cause of faecal incontinence. Eur J Gastroenterol Hepatol. 1995 Jan;7(1):65-7. PMID: 7866814

"Seven patients (two men and five women) with a history of sexual abuse, including anal penetration, and faecal incontinence. ... Unwanted anal penetration can cause permanent structural anal sphincter damage." Moribundum (talk) 13:35, 25 January 2025 (UTC)

Moribundum, I oppose. The paragraph above the one on sexual activity already includes mention of ‘anal sexual abuse’ as a potential cause of trauma and incontinence. There is no need to repeat this again with mention of 7 case reports. This isn’t an article on anal sex, keeping this brief is most sensible. We also don’t do our own original editor analysis of sources to string together conclusions. We simply reflect what the secondary sources say. Your own analysis constitutes WP:SYNTH. Engel is a primary source, so we defer to secondary sources (as I noted, the article already mentions sexual abuse as a cause of incontinence).

Also please see WP:NNC, as notability does not apply to content within articles, but whether or not a topic should have an article in the first place.

Zenomonoz (talk) 19:18, 25 January 2025 (UTC)

Hello, I am not sure about NNC as applied here? What is your point?

I don't understand how I did any new analysis of the source. It is 100% clear when reading the article that the authors consider that trauma from anal penetration is a possible cause of FI. Do you have the full text or only this "snippet view" that you put in the url? Please look at the full text (e.g. on sci hub). Moribundum (talk) 19:42, 25 January 2025 (UTC)

Moribundum, NCC isn't my point, that was just in response your comment "I think this is notable to include".

My point is that the article already states that anal sexual abuse can contribute to fecal incontinence. The article states: "Rare causes of traumatic injury to the anal sphincters include military or traffic accidents complicated by pelvic fractures, spine injuries or perineal lacerations, insertion of foreign bodies in the rectum, and anal sexual abuse". Why repeat this again down the page?

Second, the secondary source (Kumar et al.) review does not discuss incontinence with respect to the Engel study, only damage. This is an article on incontinence. Yes, I have the full source, perhaps you should read the paragraph in the Kumar review again. WP:STICKTOSOURCE. Zenomonoz (talk) 20:45, 25 January 2025 (UTC)

We add a little more detail. How does this cause FI? Damage to IAS is involved.

The kumar source states clearly that "Trauma due to anal penetration" is a common cause of low resting anal pressure which they state "most often results in varying degree of incontinence" Moribundum (talk) 21:48, 25 January 2025 (UTC)

You can state what Kumar states about incontinence, but referencing the 7 cases is not appropriate because it clearly doesn't refer to those cases with respect to incontinence. The Kumar review is not specific to incontinence, it is about anal pathology in general. Zenomonoz (talk) 22:39, 25 January 2025 (UTC)

It very clearly is about incontinence. I've explained why twice, in detail. You're not responding to my points, only repeating that it doesn't refer to incontinence without any justification. Just saying a thing does not make it true.

For a third time:

1. The authors divide all pathology of IAS into high pressure and low pressure.

2. Defining low pressure, they state: "low pressure most often results in varying degree of incontinence"

3. The section "Anal penetration" is listed under low pressure. Further, in table 1 the authors list "Trauma due to anal penetration" as a cause of low resting anal pressure. Again I remind that low pressure = incontinence. Indeed, every pathology they list under "low pressure" is linked to incontinence.

This is not original research or synthesis, it is just reading what the authors have clearly stated.

I don't understand how this is not extremely clear. If it still is not clear, the source the authors are referring to (https://pubmed.ncbi.nlm.nih.gov/7866814/) even more explicitly links to incontinence. If you have any actual argument about why this is not about incontinence, please state it.

Otherwise I have to suspect that you have non neutral point of view here. You are happy to introduce content if is says anal penetration has no connection to incontinence, but oppose content which suggests otherwise. From the same source. Moribundum (talk) 23:22, 25 January 2025 (UTC)

Leaving automatic msgs on my talk page warning me to discuss on the talk page when it is you who will not discuss on talk? Accusing me of attacks?

Where is personal attack? Saying non neutral point of view or ideologically motivated editing? These are not attacks, so kindly stop unfounded accusation

I looked at edit history. Edit history would seem to suggest the explanation for your behavior on that article... that you have non neutral point of view and want to push a narrative that anal penetration has no correlation to incontinence. If you cannot stop your personal ideologies from affecting your editing, you should not edit, or at least not edit on those topics for which you are unable to suspend your bias. Moribundum (talk) 11:54, 26 January 2025 (UTC)

Moribundum, you are edit warring and making personal attacks ("ideologically motivated", see WP:ACCUSATIONOFMALICE) so I've placed a warning on your talk page to start.

This is a medical topic, so WP:MEDRS applies. That means you need to be using SECONDARY sources here. The original Engel study is a PRIMARY source. Kumar review is secondary, and does not mention incontinence with respect to the Engel study. Indeed, the line you continue to reinsert into the article does not mention fecal incontinence, which is the topic of this article. Your continued insistence that "No arguments on talk page" are indicating that you are not actually understanding what I have explained. You cannot insert what is written in Engel, because it is a primary source. That is how this works. The Kumar review does not mention incontinence in Engel, so it has no place on this article. You need to revert your edit, and stop edit warring. Zenomonoz (talk) 11:55, 26 January 2025 (UTC)

Ideological motivation is not a person attack. Please be serious.

Engel study is not cited in the article? I am referring to the source which the secondary source cites. What are you talking about? We are not adding content based on Engel.

Kumar 100% links this info to incontinence as I have described many times. You just keep repeating over and over that it is not connected to incontinence despite very clear evidence otherwise.

The simple explanation for this is non neutral point of view Moribundum (talk) 12:02, 26 January 2025 (UTC)

"I looked at edit history... you have non neutral point of view and want to push a narrative that anal penetration has no correlation to incontinence – what? This is a blatant WP:ACCUSATIONOFMALICE and WP:PERSONALATTACK.

It's also blatantly false. I was the editor who first inserted coverage on anal sex and incontinence to begin with as shown in this edit. So that is completely untrue and totally uncalled for. Zenomonoz (talk) 11:59, 26 January 2025 (UTC)

There has been info on this topic in the article for over 10 years

Pasting links to pages about attacks does not make it true that there was a personal attack. Repeating things ad nauseum does not constitute an argument Moribundum (talk) 12:03, 26 January 2025 (UTC)

False, it only covered "anal sexual abuse". Three words. Zenomonoz (talk) 12:06, 26 January 2025 (UTC)

Excuse me but no. There has been info on anoreceptive sex since at least 2012 Moribundum (talk) 12:10, 26 January 2025 (UTC)

It wasn't there when I inserted it. Historic versions of an article are completely irrelevant. Not sure why an editor who joined in 2022 would have awareness of the 2012 article. Zenomonoz (talk) 12:42, 26 January 2025 (UTC)

Also at least quote me correctly. I said suggests non neutral point of view. Moribundum (talk) 12:05, 26 January 2025 (UTC)

Moribundum – read the Kumar source properly. You have inserted: "In one study, all 7 included individuals with history of unwanted anal penetration had structural damage to the internal anal sphincter". This has nothing to do with fecal incontinence?

Kumar et al. also state: In contrast to passive AI, unwanted anal penetration was found to be associated with structural internal anal sphincter damage in all the 7 patients who were studied by Engel et al.

Again, nothing to do with fecal incontinence. This is no surprise, given the Kumar review covers a variety of pathologies of the internal anal sphincter, not just incontinence. So why are you repeatedly inserting mention of this 7 person study in an article about fecal incontinence, when the Kumar review does NOT mention incontinence regarding these seven cases? Zenomonoz (talk) 12:12, 26 January 2025 (UTC)

I have explained 3 times why this section is connected directly with incontinence and you do not respond.

1. The authors divide all pathology of IAS into high pressure and low pressure

2. They state low pressure pathology manifests as incontinence

3. They discuss this section in the low pressure pathology section

4. There is also a table which lists trauma from anal penetration as an example of low pressure pathology

Can you at least say at which point in this logical chain you do not understand? Because I can't understand how someone can read this paper and get the conclusion that it is not connected to incontinence Moribundum (talk) 12:17, 26 January 2025 (UTC)

5. Also, in the "high pressure" section, they state: "Low pressure in the anal canal due to the above mentioned pathological disorders usually leads to FI." Moribundum (talk) 12:19, 26 January 2025 (UTC)

Nope. How does the specific sentence you wrote: "In one study, all 7 included individuals with history of unwanted anal penetration had structural damage to the internal anal sphincter" (Engel et al) have anything to do with the topic of the article, fecal incontinence? Are you seriously not getting it? You can't just insert some unrelated sentence into the article using a source, and assume it's fine because OTHER areas of the article discuss incontinence (unrelated to unwanted penetration). This is a blatant WP:SYNTH issue: "do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source". Zenomonoz (talk) 12:22, 26 January 2025 (UTC)

It is you who are "not getting it". Again you just repeat that it is not related. Tell me please which point you disagree with 1-6

6. If there was any doubt from 1-5, the source the authors are referring to is called "Unwanted anal penetration as a physical cause of faecal incontinence" https://pubmed.ncbi.nlm.nih.gov/7866814/

Claiming that it doesn't refer to incontinence is v strange behavior. Moribundum (talk) 12:26, 26 January 2025 (UTC)

Are you trolling? I already clearly explained that Engel is a primary source. You can only use what is written in secondary source Kumar. So no, this is not "strange behaviour", it is a WP:MEDRS requirement. Just above you wrote "Engel study is not cited in the article? I am referring to the source which the secondary source cites. What are you talking about? We are not adding content based on Engel." and now you're arguing based on Engel. Which is it? Zenomonoz (talk) 12:29, 26 January 2025 (UTC)

I'm not suggesting we use Engel.

It is part of the evidence that this info is connected to FI

Re your comment that it is not related to the article: IAS damage causes passive FI, which we state in the article already with sources.

This content is connected to FI also by the authors in Kumar.

I have been studying these topics for over a decade so some things are v obvious to me, and I have tried repeatedly to explain. If you still can't see the logic suggest wait for comment from other editors, although this article rarely attracts any attention Moribundum (talk) 12:33, 26 January 2025 (UTC)

"IAS damage causes passive FI, which we state in the article already with sources", so what? There is no need to mention the 7 cases because Kumar makes no mention of incontinence in these cases. That is just WP:SYNTH. The article already mentions "anal sexual abuse" from a secondary source, so why repeat it again? I've politely asked you to revert your edit, and you refuse to apologise for casting aspersions. Zenomonoz (talk) 12:39, 26 January 2025 (UTC)

Still claiming that it is not related to incontinence with no justification and no response to all the evidence. It is literally a waste of time to interact with you. You don't make any argument, just repeat the same nonsense conclusion over and over, and you don't respond to evidence.

1. The authors divide all pathology of IAS into high pressure and low pressure

2. They state low pressure pathology manifests as incontinence

3. They discuss this section, including reference of Engel, in the low pressure pathology section. Meaning that it is a low pressure pathology which manifests as incontinence. If I am writing an article about diabetes, and I write a causes section. Then I write a subsection about some factor in the causes section, I wrote it in that position because that factor is a cause of diabetes. How can anyone not understand this concept?

4. There is also a table which lists trauma from anal penetration as an example of low pressure pathology

5. Also, in the "high pressure" section, they state: "Low pressure in the anal canal due to the above mentioned pathological disorders usually leads to FI." In case it was not clear, "the above mentioned pathological disorders" includes the section in question. And you still claim this is not explicitly linked to FI?

6. The source the authors are referring to is called "Unwanted anal penetration as a physical cause of faecal incontinence" https://pubmed.ncbi.nlm.nih.gov/7866814/

This is not synth. It is called reading the article. There is no doubt whatsoever that that section is related to FI. Kindly give some evidence to disprove these points 1-6 above. Or you will just repeat the same claim again with zero justification and continue disruptive behavior>

It is not repeating the same info. It adds more detail. And since that section is so short, why not a scrap more detail. We are not adding undue weight since the other more common causes have longer sections. Moribundum (talk) 20:33, 26 January 2025 (UTC)

No, this is WP:SYNTH: do not combine different parts of one source to state or imply a conclusion not explicitly stated by the source. The title of the Engel paper does not mean you can cite these cases, because Kumar have not discussed fecal incontinence when citing these 7 Engel cases.

"There is also a table which lists trauma from anal penetration as an example of low pressure pathology" – so what? Low resting pressure does not guarantee a person will have fecal incontinence. You are stringing different parts of the source, with is synth. The table isn't about incontinence.

"They state low pressure pathology manifests as incontinence" – it can cause this. Still no reason to mention the 7 cases, given Kumar do not mention incontinence in them. Again, you need to WP:STICKTOSOURCE.

"If I am writing an article about diabetes, and I write a causes section. Then I write a subsection about some factor in the causes section, I wrote it in that position because that factor is a cause of diabetes. How can anyone not understand this concept?", except I am not saying that unwanted penetration cannot cause incontinence. I am saying that Kumar et al. do not discuss Engels seven cases with respect to incontinence, so they have no place in the article using the Kumar source. This is about mention of the 7 cases. The Kumar review is about a variety of different complications, not just incontinence.

The article already uses the Wolff source and states "anal sex abuse" may contribute to fecal incontinence. You are trying to force in a sentence that does not mention incontinence, which is a WP:MEDRS problem. You might want to consider that I've got a longer editing history than you, and I might know something you do not. Zenomonoz (talk) 22:45, 26 January 2025 (UTC)

Your arguments that it is not related to FI are not valid. See points 1-6 which you still have not disproven

It says in 2 places:

"The low pressure most often results in varying degree of incontinence"

and

"Low pressure in the anal canal due to the above mentioned pathological disorders usually leads to FI'."

Kumar discuss this Engel reference "Unwanted anal penetration as a physical cause of faecal incontinence" in the context of FI. You don't have a leg to stand on

You're also not using the term complications correctly.

And actually I've been editing wiki pretty much the same number of years. I strongly suspect my contributions were far more productive instead of nonsensical, time wasting arguments on talk pages. Moribundum (talk) 09:03, 27 January 2025 (UTC)

And if we are resorting to arguments from authority, my edits have been almost exclusively focused on medical articles. By your logic I should rather know some that you do not. Moribundum (talk) 09:06, 27 January 2025 (UTC)

Causes section

Currently this is a bit of a mess. Originally I believe it was organized into sections according to anatomic site (i.e., anal canal, rectum, pelvic floor, CNS). Mixed in to this system we now have specific etiological headings like "birth trauma", "Diarrhea", etc. This is causing some duplication of content. Therefore I will rename and reorganize the anatomic site sections into more specific causes Moribundum (talk) 19:45, 25 January 2025 (UTC)

Most of the article mirrors the headings used in the ASCRS textbook... Zenomonoz (talk) 20:48, 25 January 2025 (UTC)

Hello, it doesn't. Again this is not the complete book (+ old edition-- The content on FI seems to have been completely reorganized in the new version). We don't have "iatrogenic" section. Our pelvic floor section is a combination of different factors related to the pelvic floor (anatomic), their section is specifically about denervation (etiologic).

Even this snippet view of the old version of ASCRS may illustrate what I am trying to say: they organize the causes according to specific etiologies, not according to anatomic site. What we have at the moment is an illogical mess... It should be organized according to etiology or according to anatomy. The former system is more common usually, and here is better for readers to find different causes. Moribundum (talk) 21:20, 25 January 2025 (UTC)

I reorganized the causes section to be more logical. Now we have more concrete causes each discussed in own section. This should make it easier for readers to find different causes, and also easier for future editors to add info to the relevant sections (I think the original anatomic organization, which I think was the basis about 10 years ago, was not clear to readers over the years, and so different sections for specific etiologies started appearing).

Existing issue is now we cite both an old version of ASCRS and the newer. I note that the content on FI has been significantly reorganized in new ASCRS, including into different chapters. Ideally all old citations of ASCRS need to be updated to new (after checking that they are still supported of course) Moribundum (talk) 21:51, 25 January 2025 (UTC)

Anal sex section

I did a quick literature review and this source [1] (which is currently in the article) appears to be the best source available.

I also found this review [2] which could be relevant since it cites both the study discussed below and this large study [3] covering females, but can't assess as no full text. It doesn't mention FI in abstract, but I'd imagine they say something about FI in the full article.

Current section:

“ Some correlational research indicates that anal sex may contribute the development of fecal incontinence, although the majority of people who receive anal sex report no issues with fecal incontinence. Associations between receptive anal sex and fecal incontinence are stronger for practices such as anal fisting. A 2024 review concluded that exercises (e.g. Kegel exercises which strengthen the external anal sphincter and pelvic floor muscles) may be sufficient for the prevention and treatment of incontinence this population. In a clinical study of 28 anoreceptive homosexual males, Chun et al. found reduced anal canal pressures, but no evidence of fecal incontinence. ”

Comments -

1. I would remove the part saying "contribute to FI" and change to simply "may cause". I couldn't find support for that in the source.
2. I would remove word "majority" and change to "most cases" to use exact wording of source.
3. Also I think we should give exact figures, and let readers judge for themselves.
4. I would also point out that source says this with regards to recommendations: "Pelvic floor treatments for fecal incontinence include an explanation of the anatomy and physiology of the pelvic organs and muscles, education as to healthy bowel and bladder habits, recommendations as to reducing the frequency of engaging in anal intercourse, and pelvic floor muscle training." The only part which is directly connected to anal sex is to reduce frequency. It is not clear, but to me it seems that the authors are giving general advice about how to manage FI here rather than specifically stating this is tailored advice which will work in cases of FI caused by anal sex (also confirmed by checking the sources it cites which don't seem to mention anal sex). I was banned for a similar "great crime" but never mind I suppose. Since all of that is general advice for FI, arguably it is duplication of management section (already covered in detail I think).

Below is proposed content of anal sex section, which gives more detail, including exact figures and more detail available in the source. It's also including the v important info that females are at higher risk of FI caused by anal sex. Worth mentioning. While this section would arguably be a little too long, I would support inclusion of it all because I deem it as essential info for this aspect of FI

“ Receptive anal sex is safe in most cases, but it may cause several anorectal dysfunctions, including FI. This may be related to anal dilation, reduced resting pressure in the anal canal, reduced sensitivity of the anal mucosa, and disruption of the internal and external anal sphincters. Anal penetration may damage the anal sphincters. One small 1993 study found that on average, 40 men who had receptive anal sex had lower resting pressure in the anal canal and higher risk of minor FI compared to 18 men who didn’t have receptive anal sex. Another small study in 1997 confirmed that resting pressure of the anal canal was reduced in 28 men who engaged in receptive anal sex, but found no disruption of the anal sphincters using endoanal ultrasound and also that none of the men complained of FI.

In a 2021 survey involving over 21,000 men who had performed anal sex with other men, 8% reported that they had experienced FI at least once in the prior month. Self reported FI was more likely with older men (average age 38.5 compared to 32). Males who engaged in anal sex only once per week did not show excess risk of FI, but the risk was more than double for those who had anal sex more frequently. FI was significantly higher in those who took psychoactive drugs during sex, in those who engaged in “hard practices” (BDSM), and considerably higher in those who engaged in anal fisting. Another 2016 survey reported that 8.3% of females who engaged in anal sex reported FI compared to 5.6% of men who engaged in anal sex. This suggests that females in this group are at higher risk of FI. Another 2018 survey reported that 28.3% of females who had had anal sex during the previous month reported FI. A 2024 review recommended to reduce the frequency of anal sex as part of treatment for FI. Another 2024 review stated that it is safe for patients with FI to have anal sex, and sacral nerve stimulation may be useful in this group.

”

Moribundum (talk) 22:39, 30 January 2025 (UTC)

Trauma section:

“ Non consensual anal sex was found to be associated with structural damage to the internal anal sphincter in 7 individuals. ”

Hi Moribundum, I agree with most of your comment, although it probably does need trimming. Can implement the general changes in the article if you like, unless you prefer to wait. Zenomonoz (talk) 00:17, 31 January 2025 (UTC)

Also the Chun et al. study mentioned on the article probably should stay, because it is the only clinical one that actually assessed the anorectal region, and is interesting with respect to anal canal pressure. Zenomonoz (talk) 03:56, 31 January 2025 (UTC)

First I recommend not to use Harvard style citation, unless it is standard for the whole subject (psychology, maybe history). It takes up space and the names of researchers are rarely notable, unless it is landmark paper representing a paradigm shift, or otherwise important (first publication to describe a condition).

Re this study yes it should probably be included. But the original study is from 1997. Studies from late 80s and 90s which included homosexual people (especially males) sometimes had over-representation of HIV/AIDS, because of the nature of those times. A late feature of that condition is muscle wasting, which would impact FI. Treatment was also probably not great at that time.

I will put a separate section re Kumar to get wider consensus about exactly what that source should be used for. Moribundum (talk) 09:54, 31 January 2025 (UTC)

I agree with these two comments made by Zenomonoz. IntentionallyDense ^(Contribs) 10:51, 31 January 2025 (UTC)

The Nature portfolio paper you provided does not seem particularly relevant to this article. It's a little too niche because it's discussing RAI in those with gastrointestinal diseases. There may be something in there that is important so I've provided an access link if you want to read it. It may be useful on other articles. Zenomonoz (talk) 03:19, 31 January 2025 (UTC)

Hello thanks for full text. This review is not that useful agree. Over 450 references, broad scope but mostly focusses on cancer patients (so much money gets thrown at cancer research, such niche papers are common). What is interesting is that even though they cite to multiple papers which suggest a link between anal sex and FI, they don't acknowledge or even dispute such a link exists. They cite these papers only to say that anal sex is common in different groups in the intro. I wouldn't say that was the key message from those papers... It's strange, but maybe authors considered this question out of the scope of their review.

However there is this content which appears to give advice specifically for patients who have FI and who want to engage in anal sex (but again paper does not acknowledge anal sex as potential cause of FI):

Can engage in RAI; consider sacral nerve stimulator. (in table, about FI)

Sacral nerve stimulator. Sacral nerve stimulation can be used to treat problematic RAI from sphincter dysfunction. Indications include colorectal surgeries (including J-pouch reconstructions), cancer-directed therapies, rectal prolapse and other aetiologies of faecal incontinence

So the usefulness of this paper with regards to FI boils down to "It is safe for patients with FI to have anal sex, and sacral nerve stimulation may be useful in this group." Note this partially contradicts the other review which recommended that patients with FI should reduce frequency of anal sex. Moribundum (talk) 09:42, 31 January 2025 (UTC)

Yeah. The contradictions and limitations are probably one of the reasons it might be safer to keep things somewhat trimmed. This is an area with limited research. The reviews also aren't super clear about communicating some remaining questions: e.g. is incontinence a long-term risk? Or is it largely a temporary side effect that can be reversed upon cessation of RAI? Some of the discussion in Garros and the review seem to suggest this, but don't explicitly state it. It is probably information a layperson would be curious about, but oh well – thats okay though. It will be sorted out in the long run. Zenomonoz (talk) 09:54, 31 January 2025 (UTC)

Yes such cautions from the 2024 review would be good.

Re length of section, yes it's long but, human nature being what it is, this topic is likely to attract interest of readers. Over the years this article has had a few instances of people adding primary sources regarding anal sex and FI. If the section is fully developed and reader gets full info, I think future editors would feel less of a need to add primary sources. Moribundum (talk) 09:58, 31 January 2025 (UTC)

As far as I am aware, we should generally avoid such statements as "More research is needed". Also if we have concerns that there are limitations, this should be expressed via the critique of the secondary sources.

Chen states: "It is essential to continue this type of research, as many questions remain unanswered. For example, why are women more prone to fecal incontinence, and for how long does fecal incontinence continue? " I note in Engle the word permanent is used. Re females, the anal canal is shorter and the resting pressure is lower, combined with effect of detected and occult obstetric injury that doesn't seem to be much of a mystery, but again we need a source to state that. We could say something like "The authors cautioned that the link between anal sex and FI is not fully understood, and called for more research" Moribundum (talk) 14:28, 31 January 2025 (UTC)

Kumar 2017 review

• Kumar, L; Emmanuel, A (August 2017). "Internal anal sphincter: Clinical perspective". The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 15 (4): 211–226. doi:10.1016/j.surge.2016.10.003. PMID 27881288.

Anal penetration: Anal penetration is another factor reported to cause damage to the anal sphincters. A study comparing 40 anoreceptive to 18 non-anoreceptive males by Miles et al. concluded that anal intercourse (AI) was associated with reduced anal canal resting pressure and an increased risk of minor faecal ncontinence.38 Chun et al. demonstrated the same results in their study on 28 males engaging in AI. On further examination with EAUS, they reported thinner anal sphincters in anoreceptive group, albeit not statistically significant, but no disruption of the IAS or EAS was seen. There were no complaints of faecal incontinence by the study subjects.39 In contrast to passive AI, unwanted anal penetration was found to be associated with structural internal anal sphincter damage in all the 7 patients who were studied by Engel et al.40

The above source appears to be suitable to include (not so old, review paper). There has been a lot argument about how it should be used in this article (see section #IAS_damage_from_unwanted_anal_penetration above for background). Essential argument boils down to:

• Is the entirety of this section directly related to fecal incontinence? (especially the last sentence about Engel et al). In my opinion yes, for the reasons below, but other editors feel it does not directly refer to FI because of the "In contrast to passive AI" wording. Note however passive AI / FI is a subtype of FI, there are other types like urge FI, etc.

1. The authors divide all pathology of IAS into high pressure and low pressure
2. They state low pressure pathology manifests as incontinence
3. They discuss this section, including reference of Engel, in the low pressure pathology section. Meaning that it is a low pressure pathology which manifests as incontinence.
4. There is also a table which lists trauma from anal penetration as an example of low pressure pathology
5. In the "high pressure" section, they state: "Low pressure in the anal canal due to the above mentioned pathological disorders usually leads to FI. "The above mentioned pathological disorders" includes the section in question.
6. The source the authors are referring to is called "Unwanted anal penetration as a physical cause of faecal incontinence" https://pubmed.ncbi.nlm.nih.gov/7866814/ (note in the full text authors mistakenly cite a different paper by the same authors published in the same year, I corrected the error here). --Moribundum (talk) 10:23, 31 January 2025 (UTC)

Further, other questions are:

• All of these 3 cited primary sources are not ideal (although the secondary source does not make this critique). They are from the early 90s. In those years poorly treated HIV/AIDS tended to be over-represented in groups of homosexual men in research papers. A late feature of HIV/AIDS is muscle wasting, which very likely would affect the prevalence and severity of FI in that group. So when a paper from that period talks about a group of homosexual men, that group might not represent all homosexual men in the modern context. Also, the number of participants is small. On the other hand, we do not have better research to replace these studies... it seems to be all that is available.
• If content based on Engel is included, should it be in the "trauma" section or in the "anal sex" section? In my opinion, strictly speaking any anal sex would potentially be linked to FI because via mechanisms which could broadly be described as "trauma". See also the 2024 review which highlighted that pain during anal sex is v common. Pain usually means some degree of trauma is occurring. I think in terms of causes of FI, anal sex is a type of trauma, which we are rightly discussing in its own section. Therefore the content based on Engel should go in the "anal sex" section, with qualifier that we are talking about "unwanted anal penetration" at that point. Moribundum (talk) 10:35, 31 January 2025 (UTC)

If content based on Engel is included, should it be in the "trauma" section or in the "anal sex" section?, you could make this a lot easier and find other secondary sources citing Engel, example [4]. Note that source also includes anal rape under the "trauma" section, so that's two secondary sources now that list nonconsensual anal penetration under trauma. Zenomonoz (talk) 10:56, 31 January 2025 (UTC)

So when a paper from that period talks about a group of homosexual men, that group might not represent all homosexual men in the modern context, yes but Garros et al. are doing internet surveys on dating/sex apps. That is not representative sampling either. I don't think this really matters that much. Zenomonoz (talk) 11:01, 31 January 2025 (UTC)

Internet surveys are v different level of evidence yes agree. Sure they have many more participants, but rely on patient self reporting. No clinical examination or testing. I meant to say no other clinical / physiological research is available apart from those studies from the 90s.

I'll look at the textbook. I already checked pubmed for suitable articles which cite Engel, couldn't find. Moribundum (talk) 12:37, 31 January 2025 (UTC)

Can't get full textbook on libgen. Google preview doesn't cover full book. I can see Engel is cited in the FI chapter, that's all. It might be useful, but can't assess Moribundum (talk) 13:00, 31 January 2025 (UTC)

Moribundum, as WhatamIdoing has expanded on below, it seems it would be unnecessary to refer specifically to the 7 cases per WP:MEDSAY. The secondary sources state that nonconsensual anal penetration can result in fecal incontinence, that's probably all that needs to be said. This seems to be my original point. Zenomonoz (talk) 19:44, 31 January 2025 (UTC)

Two things:

First, I see that most of this is focused on males who have sex with males. My impression is that it's important to differentiate between male and female (as defined by anatomical sex). Log in to https://wikipedialibrary.wmflabs.org/ (if you can) and look at this peer-reviewed summary: https://www-bmj-com.wikipedialibrary.idm.oclc.org/content/378/bmj.o1975 If you can't get access, then here's a relevant quotation:

"Increased rates of faecal incontinence and anal sphincter injury have been reported in women who have anal intercourse.12 Women are at a higher risk of incontinence than men because of their different anatomy and the effects of hormones, pregnancy, and childbirth on the pelvic floor. Women have less robust anal sphincters and lower anal canal pressures than men,13 and damage caused by anal penetration is therefore more consequential."

Second, Wikipedia articles should comply with the advice in WP:MEDSAY. We want to avoid things like "In a clinical study of 28 anoreceptive homosexual males, Chun et al. found..." whenever we can. WhatamIdoing (talk) 18:24, 31 January 2025 (UTC)

Good find, but yes no access. Maybe you would be able to past a cite journal text here? We already mention that females have higher risk during this activity but this goes into more detail and is definitely worth including. The reasons for higher risk for females engaging in anal sex are exactly as I guessed.

Re medsay, it seems if the secondary source talks about the studies themselves, it is OK to refer to the studies in such a way? Agree Harvard citation style is rarely appropriate. But if all we have is small, old clinical studies, imo it is worth mentioning the date and the size of the study in a neutral and v brief way. Moribundum (talk) 19:18, 31 January 2025 (UTC)

If all we have is old studies, then they shouldn't be in the article at all per WP:MEDDATE. "A couple of decades ago, a small study found that the joopleberry shrub is a mauvy shade of pinky russet" is not an improvement over either nothing, or whatever summary the secondary source gives (perhaps "the joopleberry shrub may be a mauvy shade of pinky russet"). If the secondary source isn't actually summarizing this study (e.g., perhaps it was added as a supporting detail or example for a larger point), then an encyclopedia article shouldn't be including it. WhatamIdoing (talk) 02:52, 1 February 2025 (UTC)

here's a relevant quotation – I don't know that the this brief editorial is suitable here after reading it. If there are other sources also discussing female/male differences, it would be suitable. BMJ editorials are essentially opinion pieces.

Also see the responses from others: E.g. Merli: "Limited evidence is available on the likelihood of sphincter injury severe enough to cause faecal incontinence after consenting anal intercourses... According to Gana and Hunt, because of anatomic and functional anorectal differences, women are more prone than men to develop faecal incontinence as a consequence of anal sex [1]. However, in the National Health and Nutrition Examination Survey, the effect of receptive anal intercourse was significantly larger in men than in women, as faecal incontinence rates in those reporting versus not reporting anal intercourse were 11.6% and 5.3% in men, and 9.9% and 7.4% in women.

And Waters: Evidence that anal sex is more ‘dangerous’ in women is lacking.

I think if there are other secondary sources discussing men/women and anatomical differences in anal sex, they would be preferable. Zenomonoz (talk) 19:57, 31 January 2025 (UTC)

Still haven't been able to see it but if that source is in need expert opinion, maybe Chen 2024 is the best source available (and v modern) Moribundum (talk) 21:35, 31 January 2025 (UTC)

Here's the citation:

Gana, Tabitha; Hunt, Lesley M (2022-08-11). "Young women and anal sex". BMJ: o1975. doi:10.1136/bmj.o1975. ISSN 1756-1833. PMID 35953092.

This is an editorial because it is advocating for a semi-political course of action (namely, that the NHS should provide more information and training, so that doctors won't shy away from asking female patients about whether anal sex is part of their experiences). That is certainly an opinion, but it is also labeled as being externally peer reviewed, which means that the non-opinionated parts have been checked like any other article.

I don't think that non-peer-reviewed letters to the editor should be relied upon. Also, I notice that Merli et al. gives a lot of advice that "may" help (citing no sources, because there are no studies to back up their advice) and that the authors corrected several misinterpretations (e.g., raw numbers vs after controlling for variables) by the letter writers. WhatamIdoing (talk) 03:26, 1 February 2025 (UTC)

References

Source on non-surgical treatment

Here is a chapter may be useful on this article: access here. Zenomonoz (talk) 03:07, 1 February 2025 (UTC)

I suppose it's technically on anal incontinence, but there is a lot of overlap. Plus AI redirects here. Zenomonoz (talk) 05:26, 1 February 2025 (UTC)

Some sources treat "anal incontinence" as a 100% synonym of fecal incontinence but just use it instead out of preference.

Other sources, as this one, state that AI (incontinence to gas + solid) is distinct from FI (solid / liquid), with the former allegedly being more severe. In contradiction to this, some sources refer to flatus incontinence (gas only) and state that is is less severe form of incontinence, or occasionally, that this does not even meet the definition of incontinence.

However, overall most sources use the term FI to describe any type (passive, urge) or degree of incontinence (partial, full, gas, liquid, solid) and avoid using the term AI. Therefore that's generally what we went for in the article. Moribundum (talk) 11:12, 1 February 2025 (UTC)

References

Anal sex rewrite

Although Moribundum proposed a rather large paragraph of text on anal sex above, I have rewritten the area as follows:

“ Receptive anal sex safe in most cases, however, in certain cases anal intercourse may cause fecal incontinence. Risk factors include inadequate lubrication, emotional discomfort, frequency, and practices such as anal fisting, psychoactive drug use and BDSM. Penis size may also be a factor. Females have lower anal canal pressures and less robust sphincters than males, which may make them more susceptible to incontinence, particularly if coercion is involved. ”

I think there was too much detail in the earlier section proposed by Moribundum, given WP:MEDSAY. Of course, it would have been ideal if secondary sources had discussed that incidents of fecal incontinence may, in many cases, be a temporary side effect (as discussed by Garros et al.) but eventually this will be better established in the research.

Also, if Moribundum thinks we should mention reducing frequency of anal sex as treatment, (mentioned in the Chen review) we could probably add that too. This would probably provide a little more info about incontinence as a long term vs short term side effect.

Pinging WhatamIdoing and IntentionallyDense for feedback as they were in the discussion above.

Zenomonoz (talk) 21:32, 1 February 2025 (UTC)

There were a few more risk factors identified.. age, frequency of anal sex. Also some correlations were more significant than others.

No need to say intercourse imo. Use the academic term at the beginning, after that just use the term readers will be more familiar with.

It would be good to include mechanism. How does anal sex cause FI?

I still think including at least some exact figures would be good. Medsay does not prohibit that.

Chen seems to be the best and most modern review available, so their recommendation would be worth including imo.

Regarding females, Did source say lower pressure or lower resting pressure in anal canal? It's relevant because reduced squeeze pressure (more connectedto external sphincter) causes urge FI and reduced resting pressure (more connected to internal sphincter) causes passive FI.

Also re length of this section, I don't think a slightly longer section would be a problem. Let this section be a little more developed than some other sections in causes... there is no deadline, the other sections will sooner or later catch up. Readers are clearly interested in this aspect (see comments in the history of this talk page), and as I said before if the section provides full coverage then there will be less chance of primary or otherwise unsuitable sources being added in future Moribundum (talk) 22:13, 1 February 2025 (UTC)

I did include "frequency". Copying too much text like "frequency of anal sex" can become a WP:COPYVIO problem. Can add age in, but that seems tangential (it's a risk factor for incontinence anyway)

I still think including at least some exact figures would be good – I'm going to say probably not, because it falls into the trap of you covering every single study on this topic, as WP:MEDSAY warns against.

Did source say lower pressure or lower resting pressure in anal canal? It's relevant because reduced squeeze pressure (more connectedto external sphincter) causes urge FI and reduced resting pressure (more connected to internal sphincter) causes passive FI – the source is here, it says lower anal canal pressure.

Readers are clearly interested in this aspect (see comments in the history of this talk page) – reader interest is irrelevant. What matters is coverage in medical sources. This topic is hardly covered in tertiary or secondary sources to begin with. Zenomonoz (talk) 22:26, 1 February 2025 (UTC)

I unfortunately do not have the time to do a deep dive on this topic right now, however this seems like it may also be a bit of a WP:WEIGHT issue. I’m going to preface this by saying, weight isn’t always determined by sources, however if there is little sources on a topic or a topic is not well discussed in sources, it’s worth considering that that might be due to the fact that the topic is not as significant as other topics. IntentionallyDense ^(Contribs) 22:50, 1 February 2025 (UTC)

References