Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with fecal incontinence (especially women who sustained injury from forceps delivery that now manifests as fecal incontinence in advanced age), what permanent, reliable and effective treatments are available to return this population back to a normal life and free them from the social isolation the condition creates?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women of advanced age with a history of forceps delivery during childbearing years which caused permanent damage to the anal sphincter.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Permanent effective intervention. Presently, there are no effective treatments. Biofeedback is not effective and does not consider the emotional toll upon the patient.

Describe any health-related risks, side effects, or harms that you are concerned about.

Fecal incontinence is highly embarrassing and socially isolating condition for women of advanced age. The treatment must consider the psychological effect on the patient

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

no

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Functional limitations and disability

AHRQ Priority Populations

• Women

Federal Health Care Program

• Medicare

Importance

Describe why this topic is important.

No significant research is being done and the condition is probably grossly under reported due to the social/psychological impact of the condition upon the effected population.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Extremely limited clinical options to treat this condition.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Few doctors/clinicians have any deep understanding or knowledge of effective treatments. They have no real options available to them to treat patients with this condition.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

With effective treatment, this group will be less isolated and able to return to normal activities.

Describe the timeframe in which an answer to your question is needed.

As soon as possible.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

This is likely a grossly under reported condition since it affects an older female population that is less inclined to seek help or speak freely of the condition. Instead, they tend to become socially isolated and depression from this isolation is a significant problem.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

With effective treatment, this group will be less isolated and able to return to normal activities.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program