Anal physiology testing in fecal incontinence: is it of any value?
BACKGROUND
The prognostic value of postoperative manometry in fecal incontinence is still controversial. The aims of this study were to establish if Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL) scores correlate with anal manometry and endoanal ultrasound findings and to define if there is any prognostic value in performing anal manometry after patients are surgically treated for fecal incontinence.


METHODS
Fifty-three patients, all women, were identified. All patients underwent a surgical procedure and were analyzed pre- and postoperatively. Fecal incontinence was assessed using the FISI and FIQL. Patients who did not have these score were excluded. Manometry and ultrasound findings before treatment and manometry findings after treatment were compared with surgical patient's incontinence scores. Anal canal length was noted, and its association with the pre- and postoperative manometry finding and incontinence scores were compared.


RESULTS
No correlation of pre- and postoperative resting and squeeze pressures with incontinence scores was found. Ultrasound findings had no correlation with manometry results and incontinence scores. Anal canal length correlated with both pre- and postoperative manometry findings but not with incontinence scores.


CONCLUSIONS
Preoperative anal manometry and endoanal ultrasound help in guiding treatment options in patients with fecal incontinence. A decrease in FISI and increase in FIQL scores after a sphincter repair quantifies improvement after incontinence surgery, while changes in anal manometry pressures readings do not.
Zutshi
Massarat
M
Department of Colorectal Surgery, A-30 Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. zutshim@ccf.org
Salcedo
Levilester
L
Hammel
Jeffrey
J
Hull
Tracy
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology*; D019992:Databases as Topic; D013505:Digestive System Surgical Procedures; D019160:Endosonography; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011312:Pressure; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome