Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Jul;27(7):931-7.
doi: 10.1007/s00384-012-1415-9. Epub 2012 Feb 18.

Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment

T J Lam  1 , C J J Mulder, R J F Felt-Bersma
Affiliations

Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment

T J Lam et al. Int J Colorectal Dis. 2012 Jul.

Abstract

Objective: Anorectal function tests are often performed in patients with faecal incontinence who have failed conservative treatment. This study was aimed to establish the additive value of performing anorectal function tests in these patients in selecting them for surgery.

Patients and methods: Between 2003 and 2009, all referred patients with faecal incontinence were assessed by a questionnaire, anorectal manometry and anal endosonography. Patients with diarrhea, inflammatory bowel disease, pouches or rectal carcinoma were excluded.

Results: In total, 218 patients were evaluated. Of these, 107 (49%) patients had no sphincter defects, 71 (33%) had small defects and 40 (18%) had large defects. Anorectal manometry could not differentiate between patients with and without sphincter defects. Patients with sphincter defects were only found to have a significantly shorter sphincter length and reduced rectal capacity compared to patients without sphincter defects. Forty-three patients (20%) had a normal anal pressures ≥ 40 mmHg. Seventeen patients (8%) had also a dyssynergic pelvic floor both on clinical examination and anorectal manometry. Fifteen patients (7%) had a reduced rectal capacity between 65 and 100 ml. There was no difference in anal pressures or the presence of sphincter defects in these patients compared to patients with a rectal capacity >150 ml. There was no correlation between anorectal manometry, endosonography and faecal incontinence severity scores.

Conclusion: In patients with faecal incontinence who have failed conservative treatment, only anal endosonography can reveal sphincter defects. Anorectal manometry should be reserved for patients eligible for surgery to exclude those with suspected dyssynergic floor or reduced rectal capacity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart of evaluation of patients with faecal incontinence
See this image and copyright information in PMC

References

    1. Bartolo DC, Paterson HM. Anal incontinence. Best Pract Res Clin Gastroenterol. 2009;23(4):505–515. doi: 10.1016/j.bpg.2009.06.001. - DOI - PubMed
    1. Bharucha AE, Wald AM. Anorectal disorders. Am J Gastroenterol. 2010;105(4):786–794. doi: 10.1038/ajg.2010.70. - DOI - PMC - PubMed
    1. Heymen S, Scarlett Y, Jones K, et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009;52(10):1730–1737. doi: 10.1007/DCR.0b013e3181b55455. - DOI - PMC - PubMed
    1. Ozturk R, Niazi S, Stessman M, Rao SS. Long-term outcome and objective changes of anorectal function after biofeedback therapy for faecal incontinence. Aliment Pharmacol Ther. 2004;20(6):667–674. doi: 10.1111/j.1365-2036.2004.02125.x. - DOI - PubMed
    1. Bliss DZ, Jung HJ, Savik K, et al. Supplementation with dietary fiber improves fecal incontinence. Nurs Res. 2001;50(4):203–213. doi: 10.1097/00006199-200107000-00004. - DOI - PubMed

LinkOut - more resources