Hogeschool van Amsterdam

Urban Vitality

Clinical Presentation of Fecal Incontinence and Anorectal Function: What Is the Relationship

OBJECTIVES: Fecal incontinence is classified into various types passive, urge, and combined. Its clinical presentation is thought to be related to the underlying physiological or anatomical abnormality. The aim of the present study was to evaluate the associations between the frequency of clinical symptoms and anatomic and functional characteristics of the anorectum of patients with severe fecal incontinence

METHODS:

Associations were explored in a consecutive series of 162 patients (91|[percnt]| women, mean age 59 |[lsqb]|SD |[plusmn]| 12|[rsqb]| yr) with a mean Vaizey incontinence score of 18 (SD |[plusmn]| 3).

RESULTS:

Urge incontinence was reported as “daily” by 55|[percnt]|, “often” by 27|[percnt]|, and “sometimes” by 7|[percnt]| of all patients. No significant associations were observed between the frequency of urge incontinence and either manometric data, anal mucosal sensitivity testing, or defects of internal anal sphincter (IAS) or external anal sphincter (EAS). A significant relation was observed between the frequency of urge incontinence and maximal tolerable volume (P |[equals]| 0.03) and atrophy of the EAS (P |[equals]| 0.05). Passive incontinence was reported as “daily” by 14|[percnt]|, “often” by 30|[percnt]|, and “sometimes” by 14|[percnt]| of all patients. Resting and maximal squeeze pressure were both associated.

CONCLUSION:

Most patients reported combined incontinence (59|[percnt]|) and underlying pathophysiologic abnormalities were identified. The hypothesized associations between urge and passive incontinence and functional and anatomical impairment of the anorectum are less clear-cut than previously assumed. Patients presenting with fecal incontinence should undergo physiologic investigation.

Referentie Dobben,A.C., Terra,M.P., Deutekom, M., Gerhards,M.F., Bijnen,A.B., Felt-Bersma,R.J., Janssen,L.W., Bossuyt,P.M., and Stoker,J. (2007): Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int.J.Colorectal Dis., 22:783-790.
Gepubliceerd door  Kenniscentrum Bewegen, Sport en Voeding 1 februari 2007