Abstract
Fecal incontinence is a consequence of functional disturbances in the mechanisms that regulate continence and defecation. In this chapter, we review the functional anatomy and physiology of the anorectum, pathogenic mechanisms, and diagnostic approaches for fecal incontinence.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
William PL, Warwick R (1980) Splanchnology. In: Grays Anatomy, 36th edn. Churchill Livingston London, pp 1356–1364
Matzel KE, Schmidt RA, Tanagho EA (1990) Neuroanatomy of the striated muscle anal continence mechanism. Implications for the use of neurostimulation. Dis Colon Rectum 33:666–673
William PL, Warwick R (1980) Neurology. In: Gray’s Anatomy, 36th edn. Churchill Livingston London, pp 1122–1136
Gunterberg B, Kewenter J, Peterson I et al (1976) Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 63:546–554
Frenckner B, Ihre T (1976) Influence of autonomic nerve on the internal anal sphincter in man. Gut 17:306–312
Fernandez Fraga X, Azpinoz F, Malagelada JR (2002) Significance of pelvic floor muscles in anal incontinence. Gastroenterology 123:1441–1450
Bassotti G, Crowell MD, Whitehead WE (1993) contractile activity of the human colon: lessons from 24 hour studies. Gut 34:129–133
Duthie HL, Bennett RC (1963) The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 4:179–182
Miller R, Bartolo DC, Cervero F et al (1988) Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 75:44–47
Duthie HL, Gaines FW (1960) Sensory nerve endings and sensation in the anal region of man. Br J Surg 47:585–595
Goligher JC, Huges ESR (1951) Sensibility of the rectum and colon. Its role in the mechanism of anal continence. Lancet 1:543–547
Rogers J (1992) Anal and rectal sensation. In: Henry MM, ed. Bailliere clinical gastroenterology. Bailliere Tindall London, pp 179–181
Sun WM, Donnelly TC, Read NW (1992) Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of ‘idiopathic’ faecal incontinence. Gut 33:807–813
Devroede G, Phillips S, Pemberton J, Shorter R (1991) Functions of the anorectum: defecation and anal continence: the large intestine physiology and disease. Raven New York, pp 115
Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic fecal incontinence. Gut 54:546–555
Rao SSC, Patel RS (1997) How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gastroenteric 92:469–475
Rao SSC (1999) Fecal incontinence. Clinical perspectives in gastroenterology 2:277–288
Samuelsson E, Ladfors L, Wennerholm UB et al (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931
Sultan AH, Kamm MA, Hudson CN et al (1993) Analsphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911
Engel AF, Kamm MA, Bartram CI et al (1995) Relationship of symptoms in fecal incontinence to specific sphincter abnormalities. Int J Colorectal Dis 10:152–155
Gee AS, Durdey P (1995) Urge incontinence of faeces is a maker of severe external anal sphincter dysfunction. Br J Surg 82:1179–1182
Hill J, Corson RJ, Brandon H et al (1994) History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum 37:473–477
Nyam DC, Pemberton JH (1999) Long term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis colon rectum 42:1306–1310
Rotholtz NA, Bun M et al (2005) Long-term assessment of fecal incontinence after lateral internal sphincterotomy. Tech Coloproctol 9(2):115–118
Del Pino A, Nelson RL, Pearl RK, Abcarian H (1996) Island flap anoplasty for treatment of transsphincteric fistula-in-ano. Dis Colon Rectum 39:224–226
Abbsakoor F, Nelson M, Beynon J et al (1998) Anal endosonography in patients with anorectal symptoms after hemorrhoidectomy. Br J Surg 85:1522–1524
Guenin MO, Rosenthal R, Kern B et al (2005) Ferguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson’s hemorrhoidectomy. Dis Colon Rec 48(8):1523–1527
Hayne D, Vaizey CJ, Boulos PB (2001) Anorectal injury following pelvic radiotherapy. Br J Surg 88:1037–1048
Engel AF, Kamm MA, Talbot IC (1994) Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence. Gut 35:857–859
Vaizey JS, Kamm MA, Bartram CI (1997) Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence. Lancet 349:612–615
Glickman S, Kamm MA (1996) Bowel dysfunction in spinal cord injury patients. Lancet 347:1651–1653
Caruana BJ, Wald A, Hinds J et al (1991) Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology 100:465–470
Krogh K, Nielson J, Djurhuus JC et al (1997) Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 40:1233–1239
Brittain KR, Peet SM, Castleden CM (1998) Stroke and incontinence (review) Stroke 29:524–528
Sun WM, Katsinelos P, Horowitz M et al (1996) Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence. Eur J Gastroenterol Hepatol 8:1007–1012
Schiller LR, Santa Ana CA, Schmulen AC et al (1982) Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. N Engl J Med 307:1666–1671
Parks AG, Nicholls FJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2:85–88
Berger A, Tiret E, Parc R et al (1992) Excision of the rectum with colonic J pouch-anal anastomosis for the adenocarcinoma of the low and mid-rectum. World J Surg 16:470–477
Levitt MD, Kamm MA, Van DS Jr et al (1994) Ambulatory pouch and anal motility in patients with ileo-anal reservoirs. Int J Colorectal Dis 9:40–44
Farouk R, Duthie GS, MacGregor AB et al (1994) Rectoanal inhibition and incontinence in patients with rectal prolapse. Br J Surg 81:743–746
Farouk R, Duthie GS, Bartolo DC et al (1992) Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram. Br J Surg 79:439–440
Felt-Bersma RJF, Cuesta MA (2001) Rectal prolapse, rectal intussusception, rectocele and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222
Rao SSC, Read NW, Davison P et al (1987) Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology 89:1020–1026
Farthing MJG, Lennard-Jones JE (1978) Sensibility of the rectum to distention and the anorectal distention reflex in ulcerative colitis. Gut 19:64–69
Herbst F, Kamm MA, Morris GP et al (1997) Gastrointestinal transit and prolonged ambulatory colonie motility in health and feacal incontinence. Gut 41:381–389
Rao SSC, Kempf J, Stessman M (1998) Anal seepage: sphincter dysfunction or incomplete evacuation? Gastroenterology 114:A824
Rao SSC, Kempf J, Stessman M (1999) Is biofeedback therapy (BT) useful in patients with anal seepage? Gastroenterology 116:G4636
Leigh RJ, Turnberg LA (1982) Faecal incontinence: the unvoiced symptom. Lancet 1:1349–1351
Rao SSC (2004) Diagnosis and management of fecal incontinence. Practice guidelines: American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 99(8): 1585–1604
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence [review]. Dis Colon Rectum 36(l):77–97
Vaizey CJ, Carapeti E, Cahill JA et al (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80
Harewood GC, Coulie B, Camilleri M et al (1999) Descending perineum syndrome: audit of clinical and laboratory features and outcome of pelvic floor retraining. Am J Gastroenterol 94:126–130
Rao SSC, Sun WM (1997) Current techniques of assessing defecation dynamics. Dig Dis 15(Suppl 1): 64–67
Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM (1988) Investigation of anorectal function. Br J Surg 75:53–55
Eckhardt VF, Kanzler G (1993) How reliable is digital rectal examination for the evaluation of anal sphincter tone? Int J Colorectal Dis 8:95–97
Diamant NE, Kamm MA, Wald A et al (1999) AGA technical review on anorectal testing techniques. Gastroenterology 94:735–760
Rao SSC (1997) Manometric evaluation of defecation disorders, part II: fecal incontinence. Gastroenterologist 5(2):99–111
Rao SSC, Hatfield R, Leistikow J et al (1999) Manometric tests of anorectal function in healthy humans. Am J Gastroenterol 94:773–783
McHugh SM, Diamant NE (1987) Effect of age, gender and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 32:726–736
Read NW, Harford WF, Schmulen AC et al (1979) A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 76:747–756
Read NW, Bartollo DC, Read MG (1989) Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 71:39–42
Sun W, MacDonagh R, Forster D et al (1995) Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy. Gastroenterology 108:990–998
MacDonagh R, Sun WM, Thomas DG et al (1992) Anorectal function in patients with complete supraconal spinal cord lesions. Gut 33:1532–1538
Wald A, Tunugunta AK (1984) Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Eng J Med 310:1282–1287
Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testings: review of collective experience. Am J Gastroenterol 97:232–240
Hancke E, Schurholz M (1987) Impaired rectal sensation in idiopathic faecal incontinence. Int J Colorectal Dis 2:146–148
Lubowski DZ, Nicholls RJ (1988) Faecal incontinence associated with reduced pelvic sensation. Br J Surg 75:1086–1088
Sun WM, Read NW, Miner PB (1990) Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut 31:1056–1061
Hoffmann BA, Timmcke AE, Gathright JB Jr et al (1995) Fecal seepage and soiling: a problem of rectal sensation. Dis Colon Rectum 38:746–748
Rogers J, Henry MM, Misiewicz JJ (1988) Combined motor and sensory deficit in primary neuropathic fecal incontinence. Gut 29:5–9
Cornes H, Bartlolo DC, Stirrat GM (1991) Changes in anal canal sensation after child birth. Br J Surg 78(l):74–77
Rogers J, Haywood MP, Henry MM et al (1988) Temperature gradient between the rectum and anal canal: evidence against the role of temperature sensation modality in the anal canal or normal subjects. Br J Surg 75:1082–1085
Wald A (1994) Colonie and anorectal motility testing in clinical practice. Am J Gastroenterol 89:2109–2115
Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM (1990) Anorectal function investigations in incontinent and continent patients: differences in discriminatory value. Dis Colon Rectum 33:479–486
Rao SSC, Azpiroz F, Diamant N et al (2002) Minimum standards of anorectal manometry. Neurogastroentrol Mot 14:553–559
Sun W, Donnelly TC (1996) Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhea and faecal incontinence. Scand J Gastroenterol 32:34–38
Rao SSC, Happel J, Welcher K (1996) Can biofeedback therapy improve anorectal function in fecal incontinence? Am J Gastroenterol 91:2360–2366
Felt-Bersma RJ, Cuesta MA, Bartram CI (1994) Faecal incontinence 1994: which test and which treatment? Neth J Med 44(5):182–188
Pelsang R, Rao SSC, Welcher K (1999) FECOM: a new artificial stool for evaluating defecation. Am J Gastroenterol 94:183–186
Olsen AL, Rao SSC (2001) Clinical neurophysiology and electrodiagnostic testing of the pelvic floor. Gastroenterol Clin North Am 30(l):33–54
Laurberg S, Swash M, Henry MM (1988) Delayed external sphincter repair for obstetric tear. Br J Surg 75:786–788
Snooks SJ, Swash M, Henry MM et al (1986) Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Colorectal Dis l(l):20–24
Donnelly V, Fynes M, Campbell D et al (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961
Tetzschner T, Sorensen M, Lose G et al (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynecol 103:1034–1040
Engel AF, Kamm MA, Sultan AH et al (1994) Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg 81:1231–1234
Rothholtz NA, Wexner SD (2001) Surgical treatment of constipation and fecal incontinence. Gastroenterol Clin North Am 30(l):131–166
Di Lazzaro V, Pilato F et al (2004) Role of motor evoked potential in diagnosis of cauda equina and lumbosacral cord lesions. Neurology 63(12):2266–2271
Rao SSC, Read NW, Stobhart JAH et al (1988) Anorectal contractility under basal conditions and during rectal infusion of saline in ulcerative colitis. Gut 29:769–777
Wexner SD, Jorge JM (1994) Colorectal physiology tests: use or abuse of technology? Br Jr Surg 160(3):167–174
Tjandra JJ, Sharma BR, McKirdy HC et al (1994) Anorectal physiology testing in defecatory disorders: a prospective study. Aus N Z J Surg 64(5):322–326
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag Italia
About this chapter
Cite this chapter
Rao, S.S., Siddiqui, J. (2007). Diagnosis of Fecal Incontinence. In: Ratto, C., Doglietto, G.B., Lowry, A.C., PÃ¥hlman, L., Romano, G. (eds) Fecal Incontinence. Springer, Milano. https://doi.org/10.1007/978-88-470-0638-6_9
Download citation
DOI: https://doi.org/10.1007/978-88-470-0638-6_9
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-0637-9
Online ISBN: 978-88-470-0638-6
eBook Packages: MedicineMedicine (R0)