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Prospective study of the diagnostic evaluation of faecal incontinence and leakage in male patients
Author(s) -
Titi M.,
Jenkins J. T.,
Urie A.,
Molloy R. G.
Publication year - 2007
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.1463-1318.2006.01196.x
Subject(s) - medicine , fecal incontinence , interquartile range , anorectal manometry , sphincter , prospective cohort study , external anal sphincter , defecation , anal sphincter , endoanal ultrasound , urology , anal canal , surgery , rectum
Objective Male faecal incontinence (FI) has received little attention. No consistent pathophysiological abnormality has been identified in those studies that have specifically assessed male patients with FI or faecal leakage (FL). This study was designed to re‐examine the different theories relating to the pathophysiology of male incontinence and to assess if manometric and ultrasound assessment yields clinically relevant information that directs patient care. Method This was a prospective study of all men referred to a Coloproctology clinic with incontinence. The Wexner Incontinence score was used to assess severity of symptoms. Specific investigations included anal manometry, rectal sensation and endo‐anal ultrasound (EAUS). Results were compared with a group of 20 normal male controls. Results A total of 59 symptomatic male patients were investigated (36 FI, 23 FL). FL and control groups had similar maximum resting (MRP) and maximum squeeze pressure (MSP). The incontinence group had a significantly lower MRP & MSP compared with controls [MRP: FI 58 (42–75.5) vs control 85 (72–104)] ( P < 0.0001), [MSP: FI 167 (125–215) vs control 248 (192–302)] ( P < 0.0001). There was no significant difference in rectal sensation between the groups and the defecation index was also similar. EAUS detected only one external anal sphincter defect amongst the 23 male patients with FL. One external sphincter defect and three internal sphincter defects were identified amongst the 36 patients with incontinence. Of these five patients with sphincter defects, four had previously undergone anorectal surgery. [Results expressed as median (interquartile range): manometry expressed as mmHg]. Conclusion Male patients presenting with faecal incontinence frequently show impaired sphincter function which may be associated with sphincter defects. In contrast, those presenting predominantly with FL have no morphological or physiological changes that might account for their symptoms. Investigating such patients with anorectal physiology and EAUS is usually unhelpful and can be omitted.