Importance of extrasphincteric mechanisms in the pathophysiology of faecal incontinence in adults with a history of anorectal anomaly

Athanasakos, Eleni; Ward, Harry C.; Williams, Norman S.; Scott, S. M.

doi:10.1002/bjs.6327

Cited by 17 publications

(9 citation statements)

References 44 publications

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“…In conclusion, although many authors [24,25] state that patients with imperforate anus have significant disruption of IAS and EAS, these injuries were investigated in few cases. Anorectal manometry and 3D-EAUS are validated, highly sensitive, and specific examinations for defining injuries to the anal sphincter complex.…”

Section: Discussionmentioning

confidence: 94%

Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries

Caldaro

Romeo

Angelis

et al. 2012

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 94%

Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries

Caldaro

Romeo

Angelis

et al. 2012

Journal of Pediatric Surgery

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“…The coexistence of constipation and incontinence is recognized as being much higher in association with specific clinical pathologies, including spinal cord injury [93], and congenital anorectal anomaly [94]. However, a detailed description of these conditions is beyond the scope of this review.…”

Section: Coexistent Constipation and Fecal Incontinence In Adultsmentioning

confidence: 99%

Coexistence of constipation and incontinence in children and adults

Nurko

Scott

2011

Best Practice & Research Clinical Gastroenterology

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The coexistence of constipation and fecal incontinence has long been recognized in pediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behavior problems. The treatment of underlying constipation usually results in improvement in incontinence. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.

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“…Although the sphincter dysfunction is considered the most important factor in AI, sensitivity and rectal adaptation plays a role in it (24). The response of EAS to the rectal distension is crucial to maintain the continence and is closely related to the sensorial function and rectal compliance (21).…”

Section: Discussionmentioning

confidence: 99%

“…The duration of the sustained squeeze pressure must be considered as the time interval in which the pressure stays > 50% of the maximal pressure (10). The normal values vary in the different studies being indicated with the stationary technique values from 32 seconds (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) in males and 24 seconds (20)(21)(22)(23)(24)(25)(26)(27)(28) in females (7).…”

Section: Introductionmentioning

confidence: 99%

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

Ríos

Juan²,

Garcı́a

et al. 2010

Rev. esp. enferm. dig.

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Introduction: There exits a great variability in the manometric findings between patients with anal incontinence (AI) and healthy subjects. The correlation between the pressures of the anal canal and the AI is not exact by the wide rank of normal values.Objectives: Prospective study to evaluate differences in the pressures of the anal canal and in rectal sensitivity in patients with AI, chronic constipation (CC) and healthy subjects.Material and methods: Ninety four patients with AI, 36 patients with CC and 15 healthy subjects were included. The following data were obtained: age, sex, resting pressure, anal canal length (ACL), squeeze maximum pressure (SMP), squeeze pressure duration (SPD), first sensation, urge and maximum tolerated volume (MTV). Statistical study: test of Kruskal-Wallis, test of Mann-Whitney, and multinomial logistic regression test.Results: There were significant differences in the resting pressure (p < 0.001), the ACL (p < 0.001) and the SMP (p < 0.01) in the group of AI with respect to the other two groups. The volume for the first sensation was significantly lower in the healthy subjects than that in the other two groups (p < 0.05). The urge volume and the MVT were smaller in the group with AI with respect to the other groups (p < 0.001). In multivariate analysis the age, the resting pressure and the volume for the first sensation and urge increase the relative risk for AI.Conclusions: The greater age, the decrease in anal canal resting pressure and the alteration of rectal sensation increase the risk for AI.Key words: Incontinencia fecal. Manometría ano-rectal. Presiones del canal anal. Sensibilidad rectal. RESUMENIntroducción: Existe gran variabilidad en los hallazgos manométricos entre pacientes con incontinencia anal (IA) y sujetos sanos. La correlación entre las presiones del canal anal y la IA no es exacta por el amplio rango de valores normales.Objetivos: Estudio prospectivo para evaluar diferencias en las presiones del canal anal y en la sensibilidad rectal en pacientes con IA, estreñimiento crónico (EC) y sujetos sanos.Material y métodos: Noventa y cuatro pacientes con IA, 36 pacientes con EC y 15 sujetos sanos. Se obtuvieron: edad, sexo, presión de reposo, longitud del canal anal (LCA), presión de máxi-ma contracción voluntaria (PMCV), duración de la contracción voluntaria, primera sensación, sensación de urgencia y máximo volumen tolerado (MVT). Estudio estadístico: test de Kruskal-Wallis, test de Mann-Whitney, regresión logística multinomial.Resultados: Se encontraron diferencias significativas en la edad (p < 0,001), la presión de reposo (p < 0,001), la LCA (p < 0,001) y la PMCV (p < 0,01) en el grupo de IA con respecto a los otros dos grupos. El volumen para la primera sensación fue significativamente más bajo en los sujetos sanos que en los otros dos grupos (p < 0,05). El volumen de urgencia y el MVT fueron menores en el grupo con IA con respecto a los otros dos grupos (p < 0,001). En el análisis multivariante la edad, la presión de reposo y el volumen de la primera sensació...

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Importance of extrasphincteric mechanisms in the pathophysiology of faecal incontinence in adults with a history of anorectal anomaly

Abstract: Faecal incontinence in adult patients with ARA is related to various pathophysiologies. Structural integrity of the anal sphincters is a major factor, but extrasphincteric mechanisms, notably rectal sensory function, may be as important.

Cited by 17 publications

References 44 publications

Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries

Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries

Coexistence of constipation and incontinence in children and adults

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

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