Colorectal 09

Abstract

Aims: Incontinence scores are used to quantify faecal incontinence and allow comparison between patients. Anorectal manometry is routinely used for the assessment of incontinence. Patients with mild incontinence often have normal results. We have reported the measurement of RPG in the assessment of incontinence. This study examined the role of this technique in patients with varying degrees of incontinence. Methods: Patients referred for anorectal investigations were recruited. Patients completed a Wexner incontinence score (WIS). Patients were grouped by incontinence score: continent (WIS 0, n = 37), mildly incontinent (WIS 1–7, n = 29), moderately incontinent (WIS 8–13, n = 34) and severely incontinent (WIS 14–20, n = 16). Patients underwent standard anorectal manometry. The following manometric measurements were recorded: maximum mean resting pressure (MMRP), maximum mean squeeze pressure (MMSP), vector volume (VV) and resting pressure gradient (RPG). The Mann–Whitney U‐test was used to analyse results. Results: A total of 116 patients were recruited into the study [92 females, 24 males: median age 51 (interquartile range 37–67) years]. Each measurement was compared between the continent group and: (a) all incontinent patients (b) moderately and severely incontinent patients and (c) mildly incontinent patients. Discussion: This study shows that RPG is an early indicator of faecal incontinence. Standard measurements of MMRP, VV and MMSP are often normal in patients with mild incontinence and only become significantly lower in patients with at least moderate symptoms. We recommend the routine use of RPG in the manometric assessment of faecal incontinence.