Combining the strength–duration curve of the external anal sphincter with manometry for the assessment of faecal incontinence

Abstract

The strength-duration curve, when used in conjunction with anorectal manometry, may have a role in the investigation of faecal incontinence.

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

“…However, only Thekkinkattil et al [7] had a comparable high number of controls and FI patients, which seems mandatory due to the known influence of sex and age on the ARM parameter [5]. Notwithstanding, we can confirm that MRP and MSP are significantly lower in FI than in continent people [3,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. Thus, the ARM pressure parameters seem to be appropriate to quantify the sphincter function in FI patients.…”

“…The data ranges from 0% [31] to 92% [40] for MRP, from 14% [9,21] to 100% [41] for MSP, from 0% [39] to 47% [9] for perception threshold, and from 0% [36,39] to 47.5% [24] for urge threshold. The main reason for these enormous data ranges seems to be the low number of patients and/or controls in these studies.…”

“…This is in agreement with the literature. The reported sensitivities range between 50 and 81% for MRP, 46 and 73% for MSP, and 43 and 67% for the sensory thresholds, while the ranges for specificity spans from 59 to 98% for MRP, from 67 to 100% for MSP, and from 33 to 93% for perception and urge [9,12,14,21,30,34,47]. For comparison of the absolute values, it has to be kept in mind that all the studies presented involved far fewer patients and controls than the present study.…”

Strength-Duration Testing of the External Anal Sphincter in Females with Anorectal Dysfunction

“…I n a recent study Monk et al (1998) reconsidered the strength-duration test. 1 This is a measure of muscle denervation and involves placing an electrode on the skin overlying the muscle.…”

Anal Canal Vector Volume Manometry

“…1 The ability of manometry to discriminate between patients with fecal incontinence and healthy age-and sex-matched controls is uncertain. Although both resting pressures and maximal squeeze pressures are significantly lower in patients with incontinence than in matched controls, [2][3][4] there is considerable overlap between pressures recorded in these groups. 5,6 As such, manometry is only one component of the assessment of the patient with fecal incontinence, and often a minor part compared with anal endosonography (AES).…”