Post-surgical fecal incontinence

Abstract

The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρ 73; IAS: ρ = 81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.

Is pelvic floor muscle contractility an important factor in anal incontinence?

“…The association of AI with hysterectomy detected in this study is interesting and has been reported previously 38,39 . However, the pathophysiological processes leading to AI after hysterectomy remain unclear.…”

Assessment and Treatment of Obstructed Defecation Syndrome

“…An Italian study on patients who underwent STARR reported increased predominantly incidence of urge type of incontinence. Maximum tolerated rectal volume capacity was impaired according to anorectal manometry [31]. The European Stapled Transanal Rectal Resection Registry reports urgency in about 20% of operated patients.…”

Comprehensive Clinical Approach to Fecal Incontinence

“…FI in men was more associated with constipation and previous colon and anorectal surgery compared to women [34]. Anorectal surgery, including hemorrhoidectomy, lateral internal sphincterotomy, and fistulectomy, may affect the anal sphincter and vascular cushion, thus leading to FI [15,35].…”