Evaluating Patients with Anorectal Incontinence

Abstract

Fecal incontinence is a devastating disability, and although this condition is widely accepted as a problem in the elderly, it is now becoming apparent that much younger age groups are also frequently affected. Thorough assessment of anorectal incontinence is very important to choosing the most appropriate treatment. Careful history-taking and physical examination can identify the cause of most cases of incontinence and are essential in every patient. Several incontinence scoring systems have been proposed to provide an objective measure of a subject's degree of fecal incontinence, but only one acknowledges the important contribution of the severity of symptoms to quality of life. The investigations used to evaluate anorectal physiology include anorectal manometry, anal endosonography, nerve stimulation techniques, electromyography, defecography, endoluminal magnetic resonance imaging, the saline continence test, and the balloon-retaining test. Although all of these tests are important, the most useful for patients with incontinence are anal manometry, anal endosonography, and the pudendal nerve terminal motor latency test, because they can identify anatomic or physiologic abnormalities for which there may be effective treatments.

Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects

“…De O'Campo et al (9) obtained average values for the first sensation of 18 ± 8 ml, desire to defecate 111 ± 56 ml, and MTV 188 ± 53 ml. Other groups obtained the first sensation with 20-40 ml, urge sensation with 80-200 ml and MTV with 110-480 ml (11). Also rectal sensitivity values differ according to sex, that the urge sensation oscillates between 60-160 ml in women and 70-190 in men and MTV in 90-270 ml in women and 140-270 ml in men (12).…”

Executive summary: The International Consultation on incontinence 2008—committee on: “Dynamic Testing”; for Urinary or fecal incontinence. Part 3: Anorectal physiology studies

“…The ICI-CDT has found some evidence that different patient groups have different abilities to retain saline or a fluid-filled balloon in the rectum but although continent individuals have better retention than patients with FI there is considerable overlap between the two groups, and the reproducibility of SCT remains unknown. 22 A small study has shown that SCT helped to predict the return to continence of some patient groups postoperatively. 23 The ICI-CDT expresses the opinion that SCT has very limited clinical value and its use should be restricted to research.…”

“…The ICI-CDT concluded that the most useful tests for patients with FI are AM, anal endosonography (not discussed here), and the PNTML test, because they can identify anatomical or physiological abnormalities for which there may be effective treatments. 35 The ICI-CDT has on the basis of some, not systematic expert reviews, 36,37 acknowledged that tests for which there is (at least ''some'') consensus regarding their clinical utility in the assessment of patients with FI, include the points mentioned in Table I.…”

Vektorvolumenmanometrie in der Diagnostik des Descending-Perineum-Syndroms

“…Nach Kouraklis & Andromanakos ist aufgrund der apparativ-technischen Vielfalt die Ermittlung abteilungsspezifischer Normalwerte zur Interpretation der Befunde sinnvoll [13]. Die eigenen Normalwerte entsprechen den von Jorge & Wexner [11] publizierten.…”