Pathophysiology of fecal incontinence in obese patients: A prospective case‐matched study of 201 patients

Brochard, Charlène; Venara, Aurélien; Bodere, Anaïs; Ropert, Alain; Bouguen, Guillaume; Siproudhis, L.

doi:10.1111/nmo.13051

Cited by 22 publications

(26 citation statements)

References 28 publications

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“…Similar to women with FI, the rectal threshold volume for discomfort was correlated with BMI in healthy women; the BET was also correlated with BMI in this study. However, the BMI was not associated with these parameters in men, either due to a type II error or because among men, the distribution of BMI values was tighter.…”

Section: Discussionsupporting

confidence: 70%

“…Whether this represents an inability to simulate defecation in an artificial environment or asymptomatic pelvic floor dysfunction is unclear. While increased BMI and bariatric surgery are risk factors for FI, the effect of increased BMI on rectoanal pressures in asymptomatic healthy people is unknown. Hence, the objectives of this study were to define normal values for rectoanal pressures measured with HRM in men and women, to evaluate the relationship between rectoanal pressures with age and BMI in asymptomatic people, and to compare rectoanal pressures in asymptomatic people with a normal and prolonged BET.…”

Section: Introductionmentioning

confidence: 99%

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Anorectal pressures measured with high‐resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction

Oblizajek

Gandhi

Sharma

et al. 2019

Neurogastroenterology Motil

112

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Background: High-resolution manometry (HRM) is used to measure rectoanal pressures in defecatory disorders and fecal incontinence. This study sought to define normal values for rectoanal HRM, ascertain the effects of age and BMI on rectoanal pressures, and compare pressures in asymptomatic women with normal and prolonged balloon expulsion time (BET). Methods:High-resolution manometry pressures and BET were measured in 163 asymptomatic healthy participants. Women (96) and men (47) with normal BET were used to estimate normal values and the effects of age/BMI on pressures using a Medtronic 4.2-mm-diameter rectoanal catheter.Key Results: Age is associated with lower resting pressure, higher rectal pressure during evacuation, and a higher rectoanal gradient during evacuation in women and men. In women, the BET is also inversely correlated with age while the BMI is correlated with a higher threshold volume for discomfort and a longer BET. The anal squeeze pressure increment, squeeze duration, and HPZ length are higher in men than women. The rectoanal gradient during evacuation is also lower (ie, more negative) in asymptomatic women with an abnormal than a normal BET. Conclusions & Inferences:These findings provide an expanded database of normal values for anorectal HRM in men and women. Age and sex affect anal resting and squeeze pressures, respectively; rectal pressure during evacuation is also higher in older people. Less than 15% of asymptomatic people have BET >60 seconds, which is associated with manometry features of impaired evacuation. K E Y W O R D Sanorectal manometry, balloon expulsion test, constipation, defecatory disorders, pelvic floor dysfunction

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Anorectal pressures measured with high‐resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction

Oblizajek

Gandhi

Sharma

et al. 2019

Neurogastroenterology Motil

112

View full text Add to dashboard Cite

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“…In neurological patients, the objective is to obtain normal or hard stools because soft or liquid stools are not easily retained in the presence of neurological sphincter deficiency. Normalization of stool consistency is also needed to correct FI in many other etiologies . Finally, patients with SB are sometimes compared to those with anorectal malformation because both are congenital disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Normalization of stool consistency is also needed to correct FI in many other etiologies. 13,21 Finally, patients with SB are sometimes compared to those with anorectal malformation because both are congenital disorders. A study 22 evaluating the management of digestive disorders in patients with anorectal malformation showed that large enemas improved constipation but could worsen incontinence because the stool was too liquid.…”

Section: Discussionmentioning

confidence: 99%

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Brochard

Peyronnet

Hascoët

et al. 2018

Neurourology and Urodynamics

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Aims Spina Bifida (SB) is a rare congenital condition that frequently impairs the neurological control of both fecal continence and defecation. Several therapeutic strategies have been proposed but impact assessment is lacking. Our objectives were to quantify the symptomatic improvement and to determine the optimal strategy in this rare condition where randomized controlled trials are difficult to conduct. Methods Data were extracted from a prospective database. The present analysis focused on patients having undergone at least two gastroenterological assessments. A standardized therapeutic approach was used from the first visit. Improvement was quantified by the variation of quantified symptomatic scores. Results The data of of 57 adults with SB (gender F/M: 30/27 [52.6/47.4%]; mean age: 33.8 [18.5] years) were extracted. After a mean follow‐up of 46 months, 23/57 patients (40.4%) had at least improvement of one point of the Cleveland Clinic Incontinence score (CCIS); 13/57 (22.8%) reported a significant improvement of continence (delta score >50%). Five of the twelve patients (41.6%) with CCIS < 5 at baseline became incontinent over time. The neurological level was not associated with a worse continence outcome. Work on stool consistency and transanal irrigation were the most useful strategies in those with significant improvement of continence. Conclusions Using conventional strategies, a benefit on fecal continence occurs in only one out of five patients suffering from Spina Bifida and continent patients at baseline can develop fecal incontinence over time. A strategy targeting improved control of defecation (transanal irrigation) and a standardization of follow‐up protocol might be beneficial.

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“…Assessment of constipation was performed using the validated Knowles–Eccersley–Scott [constipation] Symptom (KESS) score . Quality of life was quantified using a validated scale for gastrointestinal complaints (Gastrointestinal Quality of Life Index, GIQLI) as previously published in studies of faecal incontinence cohorts .…”

Section: Methodsmentioning

confidence: 99%

Chronic pelvic pain and rectal prolapse invite consideration of enterocele

et al. 2019

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Aim Data on the pathogenesis and symptoms of enterocele are limited. The objectives of this study were to determine the clinical phenotype of patients with enterocele, to highlight the main functional and/or anatomical associations and to improve the accuracy of the preoperative assessment of pelvic floor disorders. Method A total of 588 patients who were referred to a tertiary unit for an anorectal complaint completed a self‐administered questionnaire and underwent physical examination, anorectal manometry and defaecography. Using defaecography, enterocele was defined as a radiological hernia of the small bowel into an enlarged rectovaginal space. One hundred and thirty‐five patients with enterocele were age‐ and gender‐matched with 270 patients without enterocele. Factors associated with enterocele were assessed using univariate and multivariate analysis models. Results Patients with enterocele were less frequently obese than patients without enterocele (8/135 vs 36/270; P = 0.02) and more frequently had a past history of pelvic surgery (51/135 vs 75/270; P = 0.04). They complained more frequently of pelvic pain on bearing down (29/135 vs 24/270; P = 0.003), anal procidentia (37/135 vs 46/270; P = 0.01) and more frequently had irritable bowel syndrome (83/135 vs 131/270; P = 0.01) and severe constipation according to the Kess score (104/135 vs 182/270; P = 0.04). Anorectal function was comparable between the two groups. Patients with enterocele had more frequent rectoceles and overt rectal prolapses than patients without enterocele. Conclusions Enterocele should be investigated in patients with chronic pelvic pain, overt rectal prolapse and/or a past history of pelvic surgery.

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Pathophysiology of fecal incontinence in obese patients: A prospective case‐matched study of 201 patients

Abstract: Obese patients with FI had a comparable severity of FI to that of non-obese patients with FI. Regarding obesity in patients with FI, physicians should focus on stool consistency.

Cited by 22 publications

References 28 publications

Anorectal pressures measured with high‐resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction

Anorectal pressures measured with high‐resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction

Defecation disorders in Spina Bifida: Realistic goals and best therapeutic approaches

Chronic pelvic pain and rectal prolapse invite consideration of enterocele

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