title: Fecal incontinence in men:  coexistent constipation and impact of rectal hyposensitivity.
abstract: BACKGROUND
  The pathophysiology of fecal incontinence in men is poorly established.
  
  
  OBJECTIVE
  The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence.
  
  
  METHODS
  This study was conducted at a tertiary referral center.
  
  
  METHODS
  Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire.
  
  
  METHODS
  Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated.
  
  
  METHODS
  : The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures.
  
  
  RESULTS
  One hundred sixty patients met the inclusion criteria, and 47% of these patients described concurrent constipation. Fifty-four patients (34%) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18%) had rectal sensory dysfunction, 26 (93%) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77%) in comparison with patients with normal rectal sensation (44%; p = 0.001), allied with decreased bowel frequency (19% vs 2%; p = 0.003) and a sense of difficulty evacuating stool (27% vs 8%; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35% vs 10%; p = 0.024) and incomplete rectal evacuation (<55% of barium neostool expelled, 50% vs 20%; p = 0.02).
  
  
  CONCLUSIONS
  : This study was limited by the retrospective analysis of prospectively collected data.
  
  
  CONCLUSIONS
  Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.
authors.affiliation: Academic Surgical Unit, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Burgell
authors.forename: Chetan
authors.initials: C
authors.lastname: Bhan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lunniss
authors.forename: S Mark
authors.initials: SM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015331:Cohort Studies; D003248:Constipation / Q000150:complications*; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D020886:Somatosensory Disorders / Q000150:complications*; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D055815:Young Adult