Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of 'idiopathic' faecal incontinence.

Sun, Wei; Donnelly, T. C.; Read, N W

doi:10.1136/gut.33.6.807

Cited by 157 publications

(101 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, the cause of fecal incontinence is often multifactorial (23)(24)(25). In a prospective study, 80% of patients had more than one pathogenic abnormality (23).…”

Section: Pathogenic Mechanisms and Etiologymentioning

confidence: 99%

“…The duration of the sustained squeeze pressure provides an index of sphincter muscle fatigue. The ability of the external anal sphincter to contract in a reflex manner can also be assessed during abrupt increases of intraabdominal pressure such as when coughing (25,63,68,69). This reflex response causes the anal sphincter pressure to rise above that of the rectal pressure to preserve continence.…”

Section: Anorectal Manometry and Sensory Testingmentioning

confidence: 99%

“…By distending a balloon in the rectum with incremental volumes, it is possible to assess the thresholds for first perception, a first desire or an urgent desire to defecate (25,52,63,68,69). A higher threshold for sensory perception suggests impaired rectal sensation (23,25,41,52,71). Also, the balloon volume required for partial or complete inhibition of anal sphincter tone can be assessed.…”

Section: Sensory Testingmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

View full text Add to dashboard Cite

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...

show abstract

“…Thus, the cause of fecal incontinence is often multifactorial (23)(24)(25). In a prospective study, 80% of patients had more than one pathogenic abnormality (23).…”

Section: Pathogenic Mechanisms and Etiologymentioning

confidence: 99%

Section: Anorectal Manometry and Sensory Testingmentioning

confidence: 99%

Section: Sensory Testingmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

286

295

View full text Add to dashboard Cite

show abstract

“…Fecal incontinence is regarded as a multifactorial condition as it is not usually associated with just one pathogenic abnormality. 17 Evaluation of the health impact is a clinical challenge, as proper assessment of patients needs to take into account the pathophysiology, pathogenesis, clinical severity, and quality of life (QoL) dimensions. Pathophysiological evaluation aims to determine the functional and structural elements implicated in fecal incontinence.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life Differences in Female and Male Patients with Fecal Incontinence

Mundet

Ribas

Arco

et al. 2015

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Background/AimsTo explore and compare quality of life (QoL) differences in female and male patients with fecal incontinence. MethodsNinety-one patients with fecal incontinence (60 women, mean (SD) age 64.13 (9.72) years; 31 men, mean (SD) age 63.61 (13.33) years) were assessed for pathophysiology (anorectal manometry and ultrasound), clinical severity (Wexner and Vaizey scales), QoL (Fecal Incontinence Quality of Life Score [FIQL]) and health status (EQ-5D). ResultsExternal and internal anal sphincter impairment rates were 96.5% and 70.2%, respectively, in women, compared to 30% and 43.3% respectively in men (P < 0.05). Clinical severity was similar in both sexes, with mean (SD) Wexner scores of 10.95 (4.35) for women and 9.81 (4.30) for men, and mean (SD) Vaizey scores of 13.27 (4.66) for women and 11.90 (5.22) for men. Scores for women were significantly lower for all FIQL depression and coping subscales (P < 0.001) and the EQ-5D depression subscale (P < 0.01). EQ-5D index was 0.687 (0.20) for women and 0.835 (0.15) for men (P < 0.001). QoL was negatively affected by female gender (-1.336), anxiety/depression (-1.324) and clinical severity (-0.302), whereas age had a positive impact (0.055 per year) (P < 0.01). ConclusionsThe pathophysiology of fecal incontinence differed between the sexes. For similar severity scores, impact on QoL was higher in women. Gender had the highest impact on QoL compared to other factors. QoL measurements should be part of assessment and treatment protocols.

show abstract

“…14 Evaluation of rectal sensory function in patients with UFI has demonstrated that up to ,50% of patients have evidence of rectal hypersensitivity (RH) to simple volumetric balloon distension-that is, reduced sensory thresholds. 5 15 We have recently shown that in patients with UFI, RH is associated with increased bowel frequency, reduced ability to defer defecation, increased pad usage, and negative lifestyle effects. 5 Motor function of the colon and rectum is an integrated process involving myoelectrical and contractile activity, tone, compliance, wall tension, and stool transit.…”

mentioning

confidence: 99%

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

Chan

2005

Gut

100

View full text Add to dashboard Cite

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.

show abstract

Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of 'idiopathic' faecal incontinence.

Cited by 157 publications

References 23 publications

Diagnosis and Management of Fecal Incontinence

Diagnosis and Management of Fecal Incontinence

Quality of Life Differences in Female and Male Patients with Fecal Incontinence

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

Contact Info

Product

Resources

About