Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment

Abstract

ObjectiveAnorectal function tests are often performed in patients with faecal incontinence who have failed conservative treatment. This study was aimed to establish the additive value of performing anorectal function tests in these patients in selecting them for surgery.Patients and methodsBetween 2003 and 2009, all referred patients with faecal incontinence were assessed by a questionnaire, anorectal manometry and anal endosonography. Patients with diarrhea, inflammatory bowel disease, pouches or rectal carcinoma were excluded.ResultsIn total, 218 patients were evaluated. Of these, 107 (49%) patients had no sphincter defects, 71 (33%) had small defects and 40 (18%) had large defects. Anorectal manometry could not differentiate between patients with and without sphincter defects. Patients with sphincter defects were only found to have a significantly shorter sphincter length and reduced rectal capacity compared to patients without sphincter defects. Forty-three patients (20%) had a normal anal pressures ≥40 mmHg. Seventeen patients (8%) had also a dyssynergic pelvic floor both on clinical examination and anorectal manometry. Fifteen patients (7%) had a reduced rectal capacity between 65 and 100 ml. There was no difference in anal pressures or the presence of sphincter defects in these patients compared to patients with a rectal capacity >150 ml. There was no correlation between anorectal manometry, endosonography and faecal incontinence severity scores.ConclusionIn patients with faecal incontinence who have failed conservative treatment, only anal endosonography can reveal sphincter defects. Anorectal manometry should be reserved for patients eligible for surgery to exclude those with suspected dyssynergic floor or reduced rectal capacity.

Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: A systematic review

“…In contrast to the beneficial effects of PFMT on the patientreported measures of bowel function, all studies except one retrospective study reported no significant changes in manometric measures following interventions. 32,33,36,37,39 The inconsistent findings between patient-reported measures and objective manometric measures of bowel function were consistent with previous studies, which demonstrated no correlation between anorectal manometry and severity of fecal incontinence 41,42 or patients' perception of relief. 43 This may be due to the multifactorial etiology of bowel dysfunction or insufficient intensity of PFMT to achieve a physiological effect.…”

Increased yield pressure in the anal canal during sacral nerve stimulation: a pilot study with the functional lumen imaging probe

“…28 In the upper GI tract there is only poor correlation between pressure determined by manometry and the competence of sphincters. [29][30][31] In the present study, we confirmed that the distensibility properties of the anal canal differ significantly along its longitudinal axis with the middle part being most resistant to distension. Thus, anal sphincter competence may be described by pressure/CSA relationships as a distensibility index calculated for the narrowest point in the sphincter.…”

“…Furthermore, inter‐individual variation is very large with manometry causing substantial overlap between healthy subjects and patients with FI . In the upper GI tract there is only poor correlation between pressure determined by manometry and the competence of sphincters …”

ACR Appropriateness Criteria Pelvic Floor Dysfunction

“…Endoanal ultrasound is the primary imaging method for evaluating the internal and external anal sphincters, and it adds value to clinical examination and manometry in patients with fecal incontinence [6,49,50]. It has a high correlation with surgical and histologic findings [51,52].…”