title: Rectal tone and compliance affected in patients with fecal incontinence after fistulotomy.
abstract: OBJECTIVE
  To investigate the anal sphincter and rectal factors that may be involved in fecal incontinence that develops following fistulotomy (FIAF).
  
  
  METHODS
  Eleven patients with FIAF were compared with 11 patients with idiopathic fecal incontinence and with 11 asymptomatic healthy subjects (HS). All of the study participants underwent anorectal manometry and a barostat study (rectal sensitivity, tone, compliance and capacity). The mean time since surgery was 28 ± 26 mo. The postoperative continence score was 14 ± 2.5 (95%CI: 12.4-15.5, St Mark's fecal incontinence grading system).
  
  
  RESULTS
  Compared with the HS, the FIAF patients showed increased rectal tone (42.63 ± 27.69 vs 103.5 ± 51.13, P = 0.002) and less rectal compliance (4.95 ± 3.43 vs 11.77 ± 6.9, P = 0.009). No significant differences were found between the FIAF patients and the HS with respect to the rectal capacity; thresholds for the non-noxious stimuli of first sensation, gas sensation and urge-to-defecate sensation or the noxious stimulus of pain; anal resting pressure or squeeze pressure; or the frequency or percentage of relaxation of the rectoanal inhibitory reflex. No significant differences were found between the FIAF patients and the patients with idiopathic fecal incontinence.
  
  
  CONCLUSIONS
  In patients with FIAF, normal motor anal sphincter function and rectal sensitivity are preserved, but rectal tone and compliance are impaired. The results suggest that FIAF is not due to alterations in rectal sensitivity and that the rectum is more involved than the anal sphincters in the genesis of FIAF.
authors: Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico.
authors: Richard Alexander
authors: RA
authors: Awad
authors: Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico.
authors: Santiago
authors: S
authors: Camacho
authors: Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico.
authors: Francisco
authors: F
authors: Flores
authors: Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico.
authors: Evelyn
authors: E
authors: Altamirano
authors: Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico.
authors: Mario Antonio
authors: MA
authors: García
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation*; D016022:Case-Control Studies; D003187:Compliance; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D040542:Mechanotransduction, Cellular; D008875:Middle Aged; D011312:Pressure; D012003:Rectal Fistula / Q000601:surgery*; D012007:Rectum / Q000294:innervation*; D012307:Risk Factors; D012684:Sensory Thresholds; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anorectal surgery; Barostat; Fecal incontinence; Fistulotomy; Visceral sensitivity