A Neurogenic Factor in Faecal Incontinence in the Elderly

Abstract

Idiopathic faecal incontinence in middle-aged people has been found to be commonly associated with neurogenic damage to the anal sphincter musculature. Because neurogenic atrophy of skeletal muscle is a common feature of ageing, we have investigated the possibility that faecal incontinence in elderly people might be due to age-related denervation of the anal sphincter musculature. The technique of single fibre electromyography was used to measure the motor unit fibre density in the external and sphincter muscle in ten patients aged 78 to 99 years. Those patients whose continence was impaired had a markedly increased fibre density. Our findings suggest that neurogenic damage to the anal sphincter musculature may so reduce its functional reserve in elderly people that incontinence occurs when other factors, such as looseness of stool or depression of cerebral function, co-exist.

Urinary Incontinence and the Psychopathology of the Elderly with Cognitive Failure

“…Castleden et al [7] have reported no correlation between mental test scores and urodynamic measurements in patients with unstable bladders and concluded that in most elderly patients urinary incontinence is not associated with cerebral disease. These nega tive results, however, might be explained by the relative insensitivity of the cognitive scale utilized and by the type of population sampled by these workers [14], In addition, there is the finding that incontinence may fol low age-related neurogenic damage to the sphincters [13]. For example, with regards to faecal incontinence, increased motor unit fibre density (believed to reflect increased sprouting of undamaged axons) has been re ported [13].…”

“…These nega tive results, however, might be explained by the relative insensitivity of the cognitive scale utilized and by the type of population sampled by these workers [14], In addition, there is the finding that incontinence may fol low age-related neurogenic damage to the sphincters [13]. For example, with regards to faecal incontinence, increased motor unit fibre density (believed to reflect increased sprouting of undamaged axons) has been re ported [13].…”

Aging and spinal cord injury

“…2 Sluggish colonic movement, ano-rectal dysfunction and increased incidence of incontinence tend to increase with age. 26,27 Gall bladder disease increases with age in SCI as in the general population. A chronic spinal cord injury above T10, however, is thought to be an added independent risk factor.…”

Morphology and neuropathology of the pelvic floor in patients with stress incontinence

“…This suggests that the changing hormonal environment at this time may be a relevant factor leading to susceptibility to stress incontinence. There appears to be no trend to linear increase with advancing age, but an abrupt increase around the time of the menopause, and elderly patients with fecal incontinence show abnormalities which are multifactorial in nature and include pelvic floor denervation [22,25].…”