Overt rectal prolapse and fecal incontinence.
OBJECTIVE
Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing on both past history, anal physiology, and imaging.


METHODS
Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 +/- 19.5 years) as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic regression analyses were performed.


RESULTS
The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds ratio (OR), 4.51 (1.49-13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68-48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with the continent group (60 vs. 6.2 percent; P = 0.0018).


CONCLUSIONS
In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed.
Gastroenterology Unit, Rennes University Hospital, Rennes, France. laurent.siproudhis@chu-rennes.fr
Laurent
L
Siproudhis
Marianne
M
Eléouet
Agathe
A
Rousselle
Mounia
M
El Alaoui
Alain
A
Ropert
Jean-François
JF
Bretagne
D000367:Age Factors; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D019160:Endosonography; D005242:Fecal Incontinence / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012005:Rectal Prolapse / Q000150:complications*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index