Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction

Gee, A. S.; Durdey, P.

doi:10.1002/bjs.1800820910

Cited by 57 publications

(24 citation statements)

References 11 publications

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“…In accordance with previous studies we found a significant negative relation between internal anal sphincter lesions and resting pressure [56,57], and a significant negative association between external anal sphincter lesions and maximal squeeze pressure [26,27,56,58,59]. The levator ani consists of different muscle components, of which the puborectal muscle is closely aligned to the deep part of the external anal sphincter and forms the upper outer part of the anal sphincter.…”

Section: Discussionsupporting

confidence: 91%

Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence

et al. 2008

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To evaluate the frequency and spectrum of lesions of different pelvic floor muscles at endoanal MRI in women with severe faecal incontinence and to study their relation with incontinence severity and manometric findings. In 105 women MRI examinations were evaluated for internal anal sphincter (IAS), external anal sphincter (EAS), puborectal muscle (PM) and levator ani (LA) lesions. The relative contribution of lesions to differences in incontinence severity and manometric findings was studied. IAS (n = 59) and EAS (n = 61) defects were more common than PM (n = 23) and LA (n = 26) defects. PM and LA defects presented mainly with IAS and/or EAS defects (isolated n = 2 and n = 3). EAS atrophy (n = 73) was more common than IAS (n = 19), PM (n = 16) and LA (n = 9) atrophy and presented mainly isolated. PM and LA atrophy presented primarily with EAS atrophy (isolated n = 3 and n = 1). Patients with IAS and EAS lesions had a lower resting and squeeze pressure, respectively; no other associations were found. PM and LA lesions are relatively common in patients with severe faecal incontinence, but the majority of lesions are found in women who also have IAS and/or EAS lesions. Only an association between anal sphincter lesions and manometry was observed.

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Section: Discussionsupporting

confidence: 91%

Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence

et al. 2008

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“…Nearly all patients with UFI were noted to have abnormal EAS function, irrespective of rectal sensory thresholds, supporting the observation that EAS dysfunction is the major pathophysiological factor in this condition. [5][6][7] In contrast, 50% of patients with RH had evidence of IAS disruption, three times higher than in patients with NS. Although the proportions of patients with a functionally poor IAS (as reflected by reduced anal resting tone) were similar between groups, recording solely maximum resting tone does not reflect ''global'' IAS function.…”

Section: Rectal Sensation and Anal Sphincter Functionmentioning

confidence: 89%

“…4 External anal sphincter (EAS) dysfunction, either secondary to compromised structural integrity, neurological injury, or a combination of both, is recognised as the major cause of UFI. [5][6][7] Nevertheless, patients with an anatomically intact and normal functioning EAS also experience episodes of UFI, 8 indicating that other pathophysiological mechanisms may contribute to symptoms. It is known that alterations in suprasphincteric mechanisms influence continence 9 but their precise role in UFI remains undetermined.…”

mentioning

confidence: 99%

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Chan

2005

Gut

100

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Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence-namely, those with rectal hypersensitivity-who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.

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“…In prospective studies, nearly 35% of primiparous women (normal ante partum) showed evidence of sphincter disruption following vaginal delivery (26)(27)(28). Other important risk factors include forceps delivery, prolonged second stage of labor, large birth weight, and occipito-posterior presentation (29)(30)(31). Perineal tears, even when carefully repaired, can be associated with incontinence, and patients may either present immediately or several years following delivery (27).…”

Section: Pathogenic Mechanisms and Etiologymentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction

Cited by 57 publications

References 11 publications

Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence

Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

Diagnosis and Management of Fecal Incontinence

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