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Advancing the Treatment of Incontinence

Incontinence is a disorder that affects men and women of all ages, often with devastating personal and societal consequences. It can lead to social isolation, loss of employment, and institutionalization. The economic impact has been estimated at $16 to $26 billion annually in the U.S. Fecal incontinence is estimated to affect 2%-7% of adults while urinary incontinence occurs in a third of adults and is severe enough to interfere with the quality of life and work in 6%. In the IFFGD survey, IBS in the Real World, 25% of respondents with IBS reported loss of bowel control.

To address issues surrounding incontinence, IFFGD and the Office of Continuing Medical Education of the University of Wisconsin Medical School sponsored a meeting, Advancing the Treatment of Fecal & Urinary Incontinence Through Research: Trial Design, Outcome Measures, and Research Priorities, held November 3 - 5, 2002, at the Pfister Hotel, Milwaukee, Wisconsin.

This was a National Institutes of Health (NIH) supported interdisciplinary conference with international participation from over 180 gastroenterologists, urologists, colon and rectal surgeons, gynecologists, neurologists, geriatricians, pediatricians, nurses, psychologists, patient advocates, and representatives of the NIH. The purpose of the conference was to:

  • Summarize the state-of-the-science regarding epidemiology, pathophysiology, and available treatments for fecal and urinary incontinence;
  • Summarize available literature on outcome measures, predictors of successful treatment, and research design;
  • Identify the priorities for research from the perspective of each professional subspecialty concerned with the management of incontinence.

Over 40 faculty members presented on program topics that included:

  • Dimensions of the Problem: Prevalence and Impact
  • State-of-the-Art: Pathophysiology
  • Treatment Options for Fecal Incontinence
  • Treatment Options for Urinary Incontinence
  • Outcome Assessment
  • Predictors of Outcome in Treatment Trials
  • Priorities for Treatment Research from Different Professional Perspectives
  • Priorities for Treatment Research from Different Perspectives
  • Trial Design
  • General Discussion and Summation

Opening remarks at the meeting were presented by Nancy Norton, President of IFFGD and the driving force behind this symposium, and by William Whitehead, PhD, Chairman of the planning committee, which brought together a distinguished and diverse group of thought leaders and investigators for the conference. 

This conference is an outgrowth of the first IFFGD sponsored meeting held in Milwaukee in 1999, the Consensus Conference on Treatment Options for Fecal Incontinence. The aim of the first meeting was to draft a statement to summarize available treatment options that could be used by primary care physicians in the treatment of patients. The Consensus Report was published in the Diseases of the Colon & Rectum (Volume 44, Number 1, January, 2001). While the report has had an impact on clinical practice, issues raised in the first conference led to the current meeting.

The research base of current health care delivery for incontinence is relatively limited. While there are many treatments available--medical, behavioral, and surgical--few randomized trials in support of these treatments have been published. The reasons for this include the wide range of causes and contributing factors to incontinence, multiplicity and differences in patient populations by age and by gender, and technical issues in validating as well as measuring outcomes, all of which have complicated consistent study designs. However, recent advances in methodology make new research opportunities possible. Additionally, the implementation by the U.S. National Institutes of Health (NIH) of two research networks focusing on urinary incontinence and on pelvic floor disorders has contributed to expanding the knowledge of how to conduct valid studies.

The ultimate goal of this meeting is to develop requests for research applications (RFAs) on the part of the NIH to fund research on the treatment of incontinence. The high quality of presentations and the interest demonstrated by the presenters and participants will surely play a positive role in making that happen-to the benefit of patients and everyone affected by this disorder.

Information about publications from the meeting will be posted on this site. We wish to thank the following participants and supporters of this important meeting:

  • The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Office of Research on Women's Health, Office of the Director, National Institutes of Health (NIH)
  • The Simon Foundation for Continence
  • Solvay Pharmaceuticals, Inc.

Planning Committee

  • John B. Wyman, MD, Professor, Section of Gastroenterology, Dept of Medicine, Univ of Wisconsin Medical School, Madison
  • William E. Whitehead, PhD, Professor of Medicine and Co-Director, Univ of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill
  • Anne M. Weber, MD, MS, Assoc Professor of Obstetrics and Gynecology, Univ of Pittsburgh School of Medicine, Dept of Obstetrics, Gynecology & Reproductive Sciences
  • Arnold Wald, MD, Professor of Medicine, Univ of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology and Nutrition
  • John H. Pemberton, MD, Professor of Surgery and Consultant, Colon and Rectal Surgery, Mayo Graduate School of Medicine, Mayo Clinic and Mayo Foundation, Rochester
  • Nancy J. Norton, Founder and President of IFFGD
  • Frank A Hamilton, MD, MPH, Chief, Digestive Diseases Program, Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Diseases, NIH
  • Molly Dougherty, PhD, RN, Frances Hill Fox Professor of Nursing, Univ of North Carolina, Chapel Hill
  • Carlo DiLorenzo, MD, Professor of Pediatrics, University of Pittsburgh, and Director, Motility Center, Children's Hospital of Pittsburgh
  • Kathryn L. Burgio, PhD, Professor of Medicine, University of Alabama at Birmingham, and Assoc Director for Research, Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center

Faculty

  • Marc A. Benninga, MD, PhD, Pediatric Gastroenterologist, Academic Medical Centre, Amsterdam, The Netherlands
  • Adil E. Bharucha, MD, Assistant Professor of Medicine, Division of Gastroenterology and Heptology, Mayo Clinic, Rochester, Minnesota
  • Morton B. Brown, PhD, Professor of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
  • Linda Brubaker, MD, FACOG, FACS, Professor and Fellowship Director, Female Pelvic Medicine & Reconstructive Surgery, Departments of Obstetrics and Gynecology, and Urology, Loyola University Medical Center, Maywood, Illinois
  • Kathryn L. Burgio, PhD, Professor of Medicine, University of Alabama at Birmingham; and Associate Director for Research, Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
  • Toby C. Chai, MD, FACS, Assistant Professor, Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
  • Michael D. Crowell, PhD, FACG, Senior Director, Scient&c and Medical Affairs, Novartis Pharmaceuticals Corp.
  • John 0. L. DeLancey, MD, Norman F. Miller Professor of Gynecology, and Director of Pelvic Floor Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
  • Ghislain Devroede, MD, Professor of Surgery and Colorectal Surgeon, Cetre Hospitalier Universitaire, Fleurimont, Quebec, Canada
  • Carlo DiLorenzo, MD, Professor of Pediatrics, University of Pittsburgh; and Director, Motility Center; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
  • Molly Dougherty, PhD, RN, Frances Hill Fox Professor of Nursing, University of North Carolina, Chapel Hill, North Carolina
  • Douglas A. Drossman, MD, Professor of Medicine and Psychiatry, Division of Digestive Diseases, and Co Director, University of North Carolina Center for Functional GI and Motility Disorders, University of North Carolina School of Medicine, Chapel Hill, North Carolina
  • Clare J. Fowler, FRCP, Professor of Uro-Neurology, Institute of Neurology UCL, London; and Consultant at National Hospital for Neurology and Neurosurgery, Queen Square, London, England
  • Cheryle B. Gartley, President and Founder, The Simon Foundation for Continence, Wilmette, Illinois
  • Patricia S. Goode, MD, Associate Director for Geriatric Research, Education, and Clinical Center (GRECC) Clinical Programs, Birmingham Veterans Affairs Medical Center; Medical Director, UAB Continence Program, and Associate Professor of Medicine; University of Alabama at Birmingham, Birmingham, Alabama
  • Frank A. Hamilton, MD, MPH, Chief, Digestive Diseases Program, Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
  • Steve Heymen, MS, Director of Biofeedback Services; and Research Instructor, GI Division of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • Robert D. Madoff, MD, Clinical Professor of Surgery, Division of Colon and Rectal Surgery, University of Minnesota, St. Paul, Minnesota
  • Philip Miner; MD, Oklahoma Center for Digestive Medicine, Oklahoma City, Oklahoma
  • Bruce D. Naliboff, PhD, Professor of Medical Psychology, Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine and VA GLAHS, Los Angeles, California
  • Michelle J. Naughton, PhD, Associate Professor, Department of Public Health Sciences; Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • Richard Nelson, MD, Professor of Surgery, University of Illinois College of Medicine at Chicago; and Assistant Professor of Epidemiology and Biometry, University of Illinois School of Public Health
  • Christine Norton, PhD, MA, RN, Nurse Consultant (Bowel Control), St. Mark's Hospital, London; & Professor of Nursing, Kings College, London, England
  • Nancy J. Norton, Founder and President, IFFGD - International Foundation for Functional Gastrointestinal Disorders, Milwaukee, Wisconsin
  • Ingrid Nygaard, MD, Associate Professor, Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
  • Mary H. Palmer; PhD, RNC, FAAN, Helen W. and Thomas L Umphlet Distinguished Professor in Aging; and Associate Professor; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • John H. Pemberton, MD, Professor of Surgery, and Consultant, Colon and Rectal Surgery, Mayo Graduate School of Medicine, Mayo Clinic and Mayo Foundation, Rochester; Minnesota
  • Charlene Prather; MD, Associate Professor of Internal Medicine; and Director; Gastrointestinal Motility, Division of Gastroenterology and Hepatalogy, St. Louis University, St. Louis, Missouri
  • Satish SC Rao, MD, PhD, FRCP Professor of Medicine & Director; Neurogastroenterology & GI Motility, University af Iowa Health Cam, Iowa City, Iowa
  • Neil M. Resnick, MD, Professor of Medicine; Chief, Division of Geriatric Medicine; and Director; University of Pittsburgh Institute on Aging, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania
  • Todd H. Rockwood, PhD, Assistant Professor; Division of Health Services Research Policy and Administration, University of Minnesota, St. Paul, Minnesota
  • Yolanda V Scarlett, MD, Assistant Professor of Medicine, Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill, North Carolina
  • John F Schnelle, PhD, Professor; UCLA School of Medicine; Director; UCLA/Jewish Home Borun Center for Gerontological Research; and Research Scientist, VA-Geriatric Research, Education, and Clinical Center (GRECC), Sepulveda, California
  • Ami D. Sperber, MD, MSPH, Associate Professor of Medicine, Department of Gastroenterology, Soroka Medical Center; Beer-Sheva, Israel
  • Jeannette Tries, PhD, OTR, Director of Biofeedback Services at the University of Illinois, Chicago, Illinois, and Aurora Sinai Samaritan Medical Center and St. Joseph's Hospital, Milwaukee, Wisconsin; and President, Clinic for Neurophysiological Learning
  • Anthony Visco, MD, Assistant Professor; Deportment of Obstetrics and Gynecology, Division of Urogynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • Arnold Wald, MD, Professor of Medicine, University of Pittsburgh Medical Center; Division of Gastroenterology, Hepatalogy and Nutrition, Pittsburgh, Pennsylvania
  • Anne M. Weber, MD, MS, Associate Professor of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Women's Hospital, Pittsburgh, Pennsylvania
  • William E. Whitehead, PhD, Professor of Medicine and Co-Director; University of North Carolina Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Last modified on March 30, 2007 at 10:09:26 AM