Clinical presentation of fecal incontinence and anorectal function: what is the relationship?
OBJECTIVE
Fecal incontinence is classified into various types: passive, urge, and combined. Its clinical presentation is thought to be related to the underlying physiological or anatomical abnormality. The aim of the present study was to evaluate the associations between the frequency of clinical symptoms and anatomic and functional characteristics of the anorectum of patients with severe fecal incontinence.


METHODS
Associations were explored in a consecutive series of 162 patients (91% women, mean age 59 [SD +/- 12] yr) with a mean Vaizey incontinence score of 18 (SD +/- 3).


RESULTS
Urge incontinence was reported as "daily" by 55%, "often" by 27%, and "sometimes" by 7% of all patients. No significant associations were observed between the frequency of urge incontinence and either manometric data, anal mucosal sensitivity testing, or defects of internal anal sphincter (IAS) or external anal sphincter (EAS). A significant relation was observed between the frequency of urge incontinence and maximal tolerable volume (P= 0.03) and atrophy of the EAS (P= 0.05). Passive incontinence was reported as "daily" by 14%, "often" by 30%, and "sometimes" by 14% of all patients. Resting and maximal squeeze pressure were both associated (P < 0.001) with the frequency of passive incontinence. No relationship could be detected between clinical presentation and rectal sensation, anal mucosal sensitivity, defects, or atrophy of IAS or EAS.


CONCLUSIONS
Most patients reported combined incontinence (59%) and underlying pathophysiologic abnormalities were identified. The hypothesized associations between urge and passive incontinence and functional and anatomical impairment of the anorectum are less clear-cut than previously assumed. Patients presenting with fecal incontinence should undergo physiologic investigation.
Deutekom
Marije
M
Department of Clinical Epidemiology and Biostatistics, Zaans Medical Center, Zaandam, The Netherlands.
Dobben
Annette C
AC
Terra
Maaike P
MP
Engel
Alexander F
AF
Stoker
Jaap
J
Bossuyt
Patrick M M
PM
Boeckxstaens
Guy E E
GE
D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000503:physiopathology*; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011379:Prognosis; D012007:Rectum / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology; D012720:Severity of Illness Index