Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence (original) (raw)
Related papers
International Journal of Colorectal Disease, 2006
Background Anal inspection and digital rectal examination are routinely performed in fecal incontinent patients but it is not clear to what extent they contribute to the diagnostic work-up. We examined if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonography. Methods A cohort of fecal incontinent patients (n=312, 90% females; mean age 59) prospectively underwent anal inspection and rectal examination. Findings were compared with results of anorectal function tests and endoanal ultrasonography. Results Absent, decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean (±SD) manometric findings: mean resting pressure 41.3 (±20), 43.8 (±20) and 61.6 (±23) Hg (p<0.001); incremental squeeze pressure 20.6 (±20), 38.4 (±31) and 62.4 (±34) Hg (p<0.001). External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects <90 degrees in 36% (37/103); for defects between 90-150 degrees in 61% (20/33); for defects between 150-270 degrees in 100% (6/6). Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures (p=0.04); patients with a gaping anus had lower resting pressures (p=0.013) at anorectal manometry. All other findings were not related to any anorectal function test or endoanal ultrasonography. Conclusions Anal inspection and digital rectal examination can give accurate information about internal and external anal sphincter function but are inaccurate for determining external anal sphincter defects <90 degrees. Therefore, a sufficient diagnostic work-up should comprise at least rectal examination, anal inspection and endoanal ultrasonography.
Evaluation of Anal Incontinence: Minimal Approach, Maximal Effectiveness
Clinics in Colon and Rectal Surgery, 2005
Anal incontinence is a symptom represented by the impaired ability to control the elimination of gas and stool, with an estimated incidence of 2.2 to 7.1% of the population. These numbers likely under-represent the true prevalence because physicians and patients are reluctant to discuss this problem. Evaluation of the patient with anal incontinence requires a fundamental knowledge of the etiologic factors. Careful history and physical examination is essential in every patient and can identify the cause of most cases of incontinence. Incontinence scoring systems are tools that provide objective data regarding the severity and quality of anal incontinence. Supplemental special tests for evaluating incontinence should be aimed at achieving three goals: (1) provide additional and confirmatory information regarding the diagnosis and cause of incontinence; (2) select appropriate treatment; and (3) predict treatment outcome. Numerous studies to evaluate anal incontinence exist; however, the most useful tests to achieve these goals are anal manometry, pudendal nerve terminal motor latency, and anal endosonography, because these studies can identify physiologic, neurologic, and anatomic abnormalities of the anorectum for which there may be effective treatments.
Annals of coloproctology, 2019
This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI). Methods: Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI. Results: Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery. Conclusion: PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.
The assessment of fecal incontinence in women 1 1 No competing interests declared
Journal of The American College of Surgeons, 2001
Fecal incontinence is a common problem in women after vaginal delivery. 1 Overt sphincter damage from a third or fourth degree tear occurs in approximately 0.6% to 3% of women undergoing vaginal delivery. Twenty-nine percent to 48% of these patients develop anal incontinence between 3 months and 3 years after primary sphincter repair. 2,5-7 Between 6.8% and 35% of primiparal and 12% and 44% of multiparal women have occult sphincter damage recognized on endoanal ultrasonography (EAUS) 7-10 . From one-third to two-thirds of women with such sphincter damage recognized on EAUS have bowel symptoms such as urgency or anal incontinenence. After vaginal delivery pudendal nerve conduction can also be impaired. 1,11 Prolonged pudendal nerve terminal motor latency (PNTML) is thought to occur in 42% of women who undergo vaginal delivery. 11 Subsequent recovery is noted in 60% of these patients within the first 2 months after delivery. Muscular and neurologic damage may also coexist. Indeed 60% of incontinent women who have sustained an obstetric injury to the external anal sphincter have prolonged PNTML. Both severity and the prevalence of fecal incontinence increase with age, suggesting that other factors may also be involved. A progressive denervation of the anal sphincter muscles may be responsible for the delayed onset of fecal incontinence. But no clear correlation can be demonstrated between the weakness of the external anal sphincter and PNTML 17,18 in elderly incontinent patients. These findings suggest that in this population a contribution to the weakness of external anal sphincter may be a decrease in the activity of the anterior horn cells in the spinal cord or the reduction in upper motor neurons caused by old age. The reduction in strength of the connective tissue fascia that occurs with the decline of estrogen production at menopause might weaken the pelvic floor and exacerbate any tendency to pudendal neuropathy caused by obstetric factors. This plethora of contributors mandates accurate assessment of anorectal and pelvic floor function in women with fecal incontinence to correctly identify the cause of the incontinence and to plan the most appropriate treatment.
The assessment of fecal incontinence in women
Journal of the American College of Surgeons, 2001
Fecal incontinence is a common problem in women after vaginal delivery. 1 Overt sphincter damage from a third or fourth degree tear occurs in approximately 0.6% to 3% of women undergoing vaginal delivery. Twenty-nine percent to 48% of these patients develop anal incontinence between 3 months and 3 years after primary sphincter repair. 2,5-7 Between 6.8% and 35% of primiparal and 12% and 44% of multiparal women have occult sphincter damage recognized on endoanal ultrasonography (EAUS) 7-10 . From one-third to two-thirds of women with such sphincter damage recognized on EAUS have bowel symptoms such as urgency or anal incontinenence. After vaginal delivery pudendal nerve conduction can also be impaired. 1,11 Prolonged pudendal nerve terminal motor latency (PNTML) is thought to occur in 42% of women who undergo vaginal delivery. 11 Subsequent recovery is noted in 60% of these patients within the first 2 months after delivery. Muscular and neurologic damage may also coexist. Indeed 60% of incontinent women who have sustained an obstetric injury to the external anal sphincter have prolonged PNTML. Both severity and the prevalence of fecal incontinence increase with age, suggesting that other factors may also be involved. A progressive denervation of the anal sphincter muscles may be responsible for the delayed onset of fecal incontinence. But no clear correlation can be demonstrated between the weakness of the external anal sphincter and PNTML 17,18 in elderly incontinent patients. These findings suggest that in this population a contribution to the weakness of external anal sphincter may be a decrease in the activity of the anterior horn cells in the spinal cord or the reduction in upper motor neurons caused by old age. The reduction in strength of the connective tissue fascia that occurs with the decline of estrogen production at menopause might weaken the pelvic floor and exacerbate any tendency to pudendal neuropathy caused by obstetric factors. This plethora of contributors mandates accurate assessment of anorectal and pelvic floor function in women with fecal incontinence to correctly identify the cause of the incontinence and to plan the most appropriate treatment.
Poor outcome of sphincter repair: an evacuation problem?
Techniques in Coloproctology, 2010
Introduction Colorectal transport in idiopathic fecal incontinence has scarcely been studied, and it remains to be investigated in patients with fecal incontinence and anal sphincter lesion. The aim of the present study was to compare colorectal transport during defecation in patients with idiopathic fecal incontinence and patients with fecal incontinence due to anal sphincter lesions with transport in healthy volunteers. Method Five women with idiopathic fecal incontinence (median age 72 years, range: 58-78 years) and five women with an obstetric sphincter lesion (median age 42 years, range: 28-63 years), four of whom had had previous anal sphincter repair, were compared with nine healthy female volunteers (median age 53 years, range 32-57 years). Colorectal scintigraphy was performed to assess colorectal emptying at defecation as well as segmental antegrade and retrograde transport during defecation. Segmental colorectal transit times were determined using radio-opaque markers. Results Median colorectal emptying time at defecation was significantly lower in the sphincter lesion group compared with the healthy volunteers (P = 0.009). At defecation, median antegrade transport time from the ascending colon was significantly lower in the sphincter lesion group than in the healthy group (P = 0.02). The median segmental transit time from the rectosigmoid colon was higher in the group with a sphincter lesion than in the healthy group (P = 0.05). There were no statistically significant differences between the group with idiopathic fecal incontinence and the healthy volunteers. Conclusion Patients with fecal incontinence due to sphincter lesions, but not those with idiopathic fecal incontinence, have reduced transport from the cecum/ ascending colon and from the rectosigmoid colon at defecation.
The British journal of surgery, 2014
Sacral nerve stimulation (SNS) is effective for some patients with faecal incontinence. Before insertion of a costly implant, percutaneous nerve evaluation (PNE) is undertaken to identify patients likely to report success from SNS. The aim of this study was to determine whether variables of anal sphincter function measured by anal acoustic reflectometry (AAR) could predict the outcome of PNE for faecal incontinence. Women with faecal incontinence undergoing PNE were recruited. AAR, followed by anal manometry, was performed on the day of surgery, immediately before PNE. The outcome of PNE was determined by bowel diary results and incontinence severity score. Patients with a successful PNE outcome were compared with those with an unsuccessful outcome; logistic regression analysis was used to identify any independent predictors of success. Fifty-two patients were recruited, of whom 32 (62 per cent) had a successful PNE outcome and 20 (38 per cent) an unsuccessful outcome. The AAR varia...
Electrodiagnostic evaluation of fecal incontinence
Muscle & Nerve, 1995
The aim of this study was to assess the utility of electrodiagnostic testing (EDT) for the evaluation of fecal incontinence (FI). Over a 5-year period, 225 patients (174 females) with FI were prospectively studied with anal manometry, anal ultrasonography, anal electromyography (AEMG), and pudendal nerve terminal motor latency (PNTML) assessment. The mean age was 60 (range 12-94) years. Causes of FI identified by clinical evaluation were obstetric injuries (454, rectal prolapse , iatrogenic or other trauma (42), neurologic disease , and idiopathic (72). EDT revealed abnormalities in 76% of patients. The incidence of pudendal neuropathy (PN) was 36% (bilateral 21%, unilateral 15%). Patients with PN were older than were those with normal PNTML (mean 71 vs. 63 years; P < 0.002). No relationship between squeeze pressure and PN could be demonstrated (P = 0.9). Reduced motor unit potential (MUP) recruitment on AEMG was present in 60% and was associated with decreased squeeze pressure ( P < 0.001) and increased MUP polyphasia (P < 0,001). Concurrence of AEMG and anal ultrasonographic findings was observed in 35 of 41 patients (84%). Defects were overlooked in one study but identified by the other on three occasions, each. Moreover, 8 of 22 patients with demonstrated sphincter defects had unsuspected PN or extensive sphincter injury on AEMG that precluded sphincter repair. In conclusion, EDT proved to be a valuable tool in the evaluation and subsequent treatment of patients with FI. 0