title: Male faecal incontinence presents as two separate entities with implications for management.
abstract: OBJECTIVE
  In contrast to females, male faecal incontinence has received little attention. We investigate its pattern and management at a large UK teaching hospital.
  
  
  METHODS
  Men presenting with faecal incontinence between January 2006 and December 2008 were identified from a gastrointestinal physiology database and classified into faecal leakage or faecal incontinence on the basis of symptomatology. Demographics, Cleveland Clinic incontinence score (CCIS), aetiological factors, investigations and treatments were collected by case note review and compared to clinical outcomes.
  
  
  RESULTS
  Forty-three symptomatic patients were identified with faecal incontinence, in which 33 were classified as having faecal leakage (FL) and ten as faecal incontinence (FI). The mean CCIS was 10.7 (range, 4-14) and 14.2 (8-20) for FL and FI, respectively. The FL group had normal anal sphincter pressures, whilst the FI group had significantly lower mean resting pressure, 45 mmHg (8-90 mmHg), and mean squeeze pressure, 62.1 mmHg (18-110 mmHg). Thirteen out of 33 patients in the FL group and seven out of ten in the FI group had undergone previous anorectal surgery and had demonstrable sphincter defects whilst in the remainder, no definite aetiological factor could be identified. All patients in the FL group improved with lifestyle changes (28/33) or biofeedback (5/33). Six patients in the FI group required surgical intervention (3/6, collagen injection; 1/6, graciloplasty; 1/6, sacral nerve stimulation; 1/6, rectopexy).
  
  
  CONCLUSIONS
  Patients presenting with FL characteristically have normal anorectal physiology and respond to non-operative measures, as compared to patients with FI who tend to have weakened anal sphincters, previous history of anorectal surgery, and more often require surgical intervention.
authors.affiliation: The John Goligher Colorectal Unit, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Muhammad Saeed
authors.initials: MS
authors.lastname: Qureshi
authors.forename: Milind M
authors.initials: MM
authors.lastname: Rao
authors.forename: Kishore K
authors.initials: KK
authors.lastname: Sasapu
authors.forename: John
authors.initials: J
authors.lastname: Casey
authors.forename: Mehr-Un-Nisa
authors.initials: MU
authors.lastname: Qureshi
authors.forename: Umar
authors.initials: U
authors.lastname: Sadat
authors.forename: David
authors.initials: D
authors.lastname: Hick
authors.forename: Simon
authors.initials: S
authors.lastname: Ambrose
authors.forename: David G
authors.initials: DG
authors.lastname: Jayne
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography