Clinical, urodynamic, and manometric findings in women with combined fecal and urinary incontinence

Lacima, Gloria; Espuña, Montserrat; Pera, Miguél; Puig-Clota, Montserrat; Quintó, Llorenç; García‐Valdecasas, Juan Carlos

doi:10.1002/nau.10025

Cited by 30 publications

(30 citation statements)

References 32 publications

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“…Women with double incontinence have been shown to have lower anal resting and squeeze pressures on manometry, and a greater anorectal angle on proctography, than women with faecal incontinence alone [66]. This has not been confirmed by other studies [63].…”

Section: Investigationmentioning

confidence: 82%

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Combined urinary and faecal incontinence

2005

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Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9-19% (urinary) and 5-10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.

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Section: Investigationmentioning

confidence: 82%

“…While some authors found an association between urinary and faecal urgency [61, 64,65], others reported stress incontinence in 80% of women with FI [63]. The odds ratio of developing FI in women with UI was 4.6 [48].…”

Section: Prevalence Of Fi In Women With Uimentioning

confidence: 99%

Combined urinary and faecal incontinence

2005

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“…Due to our huge data cohort, the results of the present study (MRP 59.0%, MSP 59.2%, BVP 27.6%, BVU 36.5%) provide appropriate estimates about the amount of pathological results of ARM which can be expected in patients with FI. Irrespective of the reported amount of pathological results, all datasets show uniformly that pathological pressure values are seen more often in FI patients than pathological results of the sensory parameters [4,12,39,40,42]. The percentage of pathologic pressure parameters rose steadily with increasing severity of FI in our patients (data not shown), while nearly equal percentages of pathologic sensory parameters were seen in all FI grades (except for BVU in grade III FI patients).…”

Section: Discussionmentioning

confidence: 97%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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Background/Aim: Patients with fecal incontinence (FI) have lower anal resting (MRP) and squeeze (MSP) pressure and an impaired sensitivity compared to healthy people. However, whether anorectal manometry (ARM) can separate precisely between health and disease is discussed controversially. The aim was to evaluate the accuracy of ARM in a huge cohort of patients and controls. Methods: ARM was obtained in 144 controls and in 559 FI patients. MRP, MSP, and balloon volume at first perception (BVP) and urge sensation (BVU) were determined. Receiver operating curve analysis was used to determine optimal cut-offs and sensitivity, specificity and accuracy calculated. Results: FI patients showed lower MRP, MSP, BVU (p < 0.001) and a higher BVP (p = 0.007). Deterioration of the ARM parameter increased with FI severity. ARM demonstrated an excellent sensitivity (91.4%) and accuracy (85.8%), but only a moderate specificity (62.5%). The sensitivity of ARM rose with FI severity. The pressure data showed higher sensitivity and accuracy than the sensory data despite comparable specificity. Conclusions: Sensitivity and accuracy of single ARM parameters is only moderate for the pressure data and poor for the sensory data. In contrast, ARM demonstrated an excellent sensitivity, a moderate specificity, and a convincing accuracy justifying its use in clinical routine.

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“…Although UI often coexists with genital prolapse and anal incontinence, 28 it is likely that the pathogenesis resulting in RP differs from that of stress UI, and even more likely from that of urge UI. This assumption is supported by the fact that stress UI did not share any of the risk factors predisposing for RP (Table 3) and that age at onset of stress UI did not differ significantly between the study and control groups.…”

Section: Discussionmentioning

confidence: 99%