A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence

Abstract

Anorectal physiology testing is useful in the evaluation of patients with fecal incontinence. Without the information obtained from physiologic testing, 11 percent of patients who may have benefited from surgery would not have been given this option, and 7 percent of patients could have potentially undergone unnecessary surgery. Transanal ultrasound is the study most likely to change a patient's management plan.

Early Functional Results of Biofeedback and Its Impact on Quality of Life of Patients With Anal Incontinence

“…It is also known that the clinical manifestations presented by patients with anal incontinence may not correlate with the results of tests performed. That is, patients with very severe symptoms may present tests with few or mild changes, whereas some patients may experience mild symptoms with quite altered tests (17) . This highlights the lack of clinical correlation of incontinence symptoms with the results of objective tests, which may be associated with psychological factors, or even social, impacting quite differently, the quality of life of patients.…”

Does Preoperative Anal Physiology Testing or Ultrasonography Predict Clinical Outcome With Sacral Neuromodulation for Fecal Incontinence?

“…However, other studies suggest that findings on physiology testing do not consistently correlate with severity of FI or prediction of outcome [14,15]. Endoanal ultrasonography may be a useful tool for identifying patients with complete sphincter disruption and allow the surgeon to choose between the options of sphincter repair or SNM.…”

“…Though the goals of these testing modalities are to correlate objective findings with selection for particular treatment modalities, data from these studies have not been consistently shown to correlate with the severity of FI or prediction of outcomes following treatment with traditional management algorithms [12][13][14][15][16]. The purpose of this study was to investigate whether anorectal physiology testing or transanal ultrasonography may predict patient response to treatment with SNM.…”

Management of Fecal Incontinence

“…[44][45][46] Anorectal testing can guide management particularly when surgical options are being considered. 47 Test results should be interpreted together with clinical features. The indications, modalities, and utility of testing will continue to evolve as newer therapeutic options become available.…”