Selecting patients with faecal incontinence for anal sphincter surgery: the influence of irritable bowel syndrome

Abstract

Aim: This was a prospective study to determine the prevalence of irritable bowel syndrome (IBS) in patients with faecal incontinence and to investigate the association of IBS positivity with sphincter dysfunction.

Method: Patients with faecal incontinence were referred for physiological assessment and further management. Those with an acute obstetric injury, rectal prolapse or previous anorectal surgery were excluded. One hundred and seventy-seven women were studied. Symptom questionnaires were used prospectively to identify IBS positivity using Rome 11 criteria and the Cleveland Clinic incontinence score.

Results: The prevalence of IBS was 44%. IBS patients had higher incontinence scores than non-IBS patients (11.0 vs 9.0, P < 0.01). A normal or high maximum resting anal pressure in an incontinent woman increased the chance of her having IBS by a factor of 2.6.

Conclusion: The prevalence of IBS positivity in patients presenting with faecal incontinence was high. A normal or high anal resting pressure and a high incontinence score should raise the suspicion of IBS.