History and examination in the assessment of patients with idiopathic fecal incontinence.
OBJECTIVE
This study was undertaken to identify those factors from the history and examination which might predict the pathophysiologic basis of idiopathic fecal incontinence.


METHODS
In a prospective study of 237 patients with idiopathic fecal incontinence (female to male, 7:1.7; mean age, 54.8 years; median history, 3 years), history, examination, and anorectal physiology studies findings have been analyzed using contingency table analysis.


RESULTS
In patients with idiopathic fecal incontinence, anorectal physiology studies have shown that a low maximum basal pressure (< 45 cm H2O) is predominantly attributable to internal and sphincter weakness, and low maximum squeezing pressure (< 76 cm H2O) is indicative of voluntary sphincter deficiency. In this study, a low maximum basal pressure is correlated with leakage, gaping of the anus on traction of the anal verge, and decreased resting tone on digital examination (all P < 0.05). A low maximum squeezing pressure is correlated with incontinence en route to the lavatory, urgency, both stress and urge incontinence of urine, reduced voluntary contraction in the external anal sphincter and puborectalis on digital examination, and a reduced or absent anorectal angle (all P < 0.05).


CONCLUSIONS
This study has shown that an informed history and digital examination can predict the manometric findings of specialist anorectal physiology studies.
Hill
J
J
Department of Gastroenterology, University Hospital of South Manchester, United Kingdom.
Corson
R J
RJ
Brandon
H
H
Redford
J
J
Faragher
E B
EB
Kiff
E S
ES
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008487:Medical History Taking; D008875:Middle Aged; D009119:Muscle Contraction; D009431:Neural Conduction; D010298:Parity; D010808:Physical Examination; D011312:Pressure; D011446:Prospective Studies; D012007:Rectum / Q000294:innervation / Q000503:physiopathology