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Evacuation proctography – should it be part of the assessment of all patients with faecal incontinence?
Author(s) -
Dench J. E.,
Gooneratne M.,
Hickey F.,
Williams N. S.,
Lunniss P. J.,
Scott M.
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01102_6.x
Subject(s) - medicine , incidence (geometry) , dyssynergia , retrospective cohort study , intussusception (medical disorder) , surgery , sphincter , physics , optics
Evacuation Proctography (EP) is rarely incorporated into the assessment of patients with faecal incontinence (FI). Continence‐restoring surgery (e.g. sphincteroplasty, ESGN) may result in the worsening or unmasking of a pre‐existing rectal evacuatory disorder (RED), or precipitate a new‐onset RED. This study compared the incidence of RED, diagnosed on EP, between patients with FI, with or without symptoms of RED. Method: A retrospective study of 250 patients with FI (mean age 53 years; range 21–83 years, F = 213), +/ symptoms of RED, referred for comprehensive physiological investigation. Proctographic diagnoses were classified as: normal; functional i.e. no clear anatomical cause (e.g. pelvic floor dyssynergia); mechanical (e.g. rectocoele, intussusception; deemed to obstruct evacuation) or mechanical and functional . Results: Seventy‐three patients (29%) had isolated FI; the remaining 177 (71%) had FI combined with symptoms of RED. Table Proctographic results.Diagnosis FI (%) FI & RED (%)Normal 22 (30) 36 (20) Abnormal Mechanical 33 (45) 99 (56) Functional 16 (22) 24 (14) Mechanical & Functional 2 (3) 18 (10)Normal vs abnormal: P = 0.10, 2 , df = 1.Conclusion: There is no significant difference in the incidence of proctographic abnormalities between those patients who do, and those who do not volunteer symptoms of RED. Seventy percent of patients with FI, who deny symptoms of RED, have evidence of abnormal evacuation on proctography. Within the limitations of a retrospective study, these data suggest that proctography should be routinely performed in patients with FI.