I'm interested in taking the CWCA exam, but a friend of mine mentioned that the WCC is better. What is the difference between the two?
The Anal Bag: A Modern Approach to Fecal Incontinence Management
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Fecal incontinence is an expensive and potentially dangerous pathologic condition, with severe consequences in terms of contamination, infection, and impending risk of skin ulceration, especially in long-term bedridden patients. Prevalence studies of fecal incontinence in the general population are rare.1,2 Among younger age groups (<65 years), the prevalence of fecal incontinence has been estimated at 0.7%3 and 0.9%.4 In people 60 years or older, prevalence estimates are higher, ranging between 3.1% and 8.2%, but the sample sizes are not large enough to draw firm conclusions regarding occurrence rates.5-8 Fecal incontinence has been related to advancing age; institutionalized persons >85 years have been found to be at risk.9
Perry and colleagues10 conducted a cross-sectional postal survey of 15,904 randomly selected adults age 40 years or older (excluding residents of nursing and residential homes) from the Leicestershire Health Authority patient register. Participants were asked to complete a confidential health questionnaire in which major fecal incontinence was defined as clothes soiling several times a month or more. From a sample of 10,116 respondents, 1.4% reported major fecal incontinence and 0.7% experienced major fecal incontinence with bowel symptoms that had an impact on quality of life. This condition was more prevalent and more severe in older people with no significant difference between men and women.
Recently, studies have suggested that females are at greater risk of fecal incontinence, primarily related to childbirth11-13; however, supportive data are inconclusive. General population surveys have either assessed the prevalence of anal incontinence (incontinence of solid or liquid stool or flatulence) or fecal incontinence (incontinence of solid or liquid stools only). Nelson and colleagues3 found that female gender was an independent risk factor for anal incontinence; whereas, Thomas and colleagues4 found a preponderance of fecal incontinence in men as opposed to women age 15 to 64 years. According to Johanson and Lafferty,14 2.2% of pluriparous women experience fecal incontinence due to obstetric stress-related sphincter weakening. The rate rises to 7% in healthy people over 65 years old.15 Tobin and Brocklehurst16 note that 23% of post-stroke patients have fecal incontinence, with incidence increasing throughout follow-up. Thomas4 and Lahr17 found a fecal incontinence prevalence rate of 25% in institutionalized patients; the rate reached 33% when extended to elderly retired people at home or in hospitals.
When anal sphincter dysfunction evolves into chronic disease, it usually is investigated with modern techniques such as anorectal manometry, endosonography, endo-anal magnetic resonance imaging (MRI), and defecography and classified in two main categories: passive and urgent.18
Passive fecal incontinence refers to internal sphincter dysfunction and reduced maximum resting anal pressure where the person is unaware of stool discharge. Urgent fecal incontinence is a loss of efficient voluntary external sphincter contraction or an increased ejection bowel pressure, with conscious fecal loss perception.
References:
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2. Enck P, Bielefeldt K, Rathmann W, Purrmann J, Tschope D, Erckenbrecht JF. Epidemiology of fecal incontinence in selected patient groups. Int J Colorectal Dis. 1991;6(3):143–146.
3. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA. 1995;274(7):559–561.
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