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Am J Gastroenterol. 2016 Feb;111(2):269-74. doi: 10.1038/ajg.2015.419. Epub 2016 Jan 12.

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

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Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA.
Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA.
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.
Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA.
Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia, USA.



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


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.


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).


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

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Conflict of interest statement

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. Potential competing interests: None.

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