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Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence

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Abstract

Purpose

Fecal incontinence (FI) is common in patients with rectal intussusception (RI), although the mechanism behind its formation is unclear. Recent data indicate that a reduction in internal sphincter tone may cause FI, which becomes notable with increasing RI levels. However, the roles of other anatomical abnormalities in anal function remain unclear. This study assessed the relationships between various pelvic floor abnormalities and anal sphincter function in patients with RI and FI.

Methods

Data for patients with RI, collected in a prospective pelvic floor database, were assessed retrospectively. All women with FI, without anal sphincter defect, were included. Data on anorectal physiology and evacuation proctography were analyzed.

Results

Of 397 patients with RI, 85, who had predominantly passive FI, met the inclusion criteria. Maximum resting pressure (MRP) was significantly lower in patients with rectoanal intussusception (RAI) than in those with rectorectal intussusception (RRI) [51.1 (17.9–145.8) vs. 70.7 (34.7–240.6) cmH2O, P = 0.007]. Moreover, MRP was significantly lower in RI patients without rectocele than in RI patients with rectocele [50.1 (17.9–111.0) vs. 69.9 (34.7–240.6) cmH2O, P < 0.0001]. Regression analysis showed that RAI rather than RRI and RI without rectocele rather than RI with rectocele were predictive of decreased MRP. However, no variable was significantly associated with decreased maximum squeeze pressure on multivariate analysis.

Conclusion

In addition to an advanced level of intussusception, the absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with RI and FI.

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References

  1. Mellgren A, Bremmer S, Johansson C (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141

    Article  CAS  PubMed  Google Scholar 

  2. Wijffels NA, Jones OM, Cunningham C, Bemelman WA, Lindsey I (2013) What are the symptoms of internal rectal prolapse? Color Dis 15:368–373

    Article  CAS  Google Scholar 

  3. Collinson R, Cunningham C, D'Costa H, Lindsey I (2009) Rectal intussusception and unexplained faecal incontinence: findings of a proctographic study. Color Dis 11:77–83

    Article  CAS  Google Scholar 

  4. Harmston C, Jones OM, Cunningham C, Lindsey I (2011) The relationship between internal rectal prolapse and internal anal sphincter function. Color Dis 13:791–795

    Article  CAS  Google Scholar 

  5. Bloemendaal AL, Buchs NC, Prapasrivorakul S et al (2016) High-grade internal rectal prolapse: does it explain so-called "idiopathic" faecal incontinence? Int J Surg 25:118–122

    Article  CAS  PubMed  Google Scholar 

  6. Lazorthes F, Gamagami R, Cabarrot P, Muhammad S (1998) Is rectal intussusception a cause of idiopathic incontinence? Dis Colon Rectum 41:602–605

    Article  CAS  PubMed  Google Scholar 

  7. Hawkins AT, Olariu AG, Savitt LR, Gingipally S, Wakamatsu MM, Pulliam S, Weinstein MM, Bordeianou L (2016) Impact of rising grades of internal rectal intussusception on fecal continence and symptoms of constipation. Dis Colon Rectum 59:54–61

    Article  PubMed  Google Scholar 

  8. Hotouras A, Murphy J, Boyle DJ, Allison M, Williams NS, Chan CL (2013) Assessment of female patients with rectal intussusception and prolapse: is this a progressive spectrum of disease? Dis Colon Rectum 56:780–785

    Article  PubMed  Google Scholar 

  9. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532

    Article  CAS  PubMed  Google Scholar 

  10. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13:72–80

    Article  CAS  PubMed  Google Scholar 

  12. Hiltunen KM, Matikainen M, Auvinen O, Hietanen P (1986) Clinical and manometric evaluation of anal sphincter function in patients with rectal prolapse. Am J Surg 151:489–492

    Article  CAS  PubMed  Google Scholar 

  13. Ihre T (1974) Studies on anal function in continent and incontinent patients. Scand J Gastroenterol Suppl 25:1–64

    CAS  PubMed  Google Scholar 

  14. Yagi Y, Tsunoda A, Takaashi T, Kusanagi H (2018) Rectoanal intussusception is very common in patients with fecal incontinence. J Anus Rectum Colon 2:162–167

    Article  PubMed  PubMed Central  Google Scholar 

  15. Farouk R, Duthie GS, MacGregor AB, Bartolo DC (1994) Rectoanal inhibition and incontinence in patients with rectal prolapse. Br J Surg 81:743–746

    Article  CAS  PubMed  Google Scholar 

  16. Otto SD, Ritz JP, Gröne J, Buhr HJ, Kroesen AJ (2010) Abdominal resection rectopexy with an absorbable polyglactin mesh: prospective evaluation of morphological and functional changes with consecutive improvement of patient's symptoms. World J Surg 34:2710–2716

    Article  CAS  PubMed  Google Scholar 

  17. Schultz I, Mellgren A, Dolk A, Johansson C, Holmström B (1996) Continence is improved after the Ripstein rectopexy. Different mechanizms in rectal prolapse and rectal intussusception? Dis Colon Rectum 39:300–306

    Article  CAS  PubMed  Google Scholar 

  18. Tsunoda A, Takahashi T, Hayashi K, Yagi Y, Kusanagi H (2018) Laparoscopic ventral rectopexy in patients with fecal incontinence associated with rectoanal intussusception: prospective evaluation of clinical, physiological and morphological changes. Tech Coloproctol 22:425–431

    Article  CAS  PubMed  Google Scholar 

  19. Ayabaca SM, Zbar AP, Pescatori M (2002) Anal continence after rectocele repair. Dis Colon Rectum 45:63–69

    Article  PubMed  Google Scholar 

  20. Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274:559–561

    Article  CAS  PubMed  Google Scholar 

  21. Corman ML, Carriero A, Hager T, Herold A, Jayne DG, Lehur PA, Lomanto D, Longo A, Mellgren AF, Nicholls J, Nystrom PO, Senagore AJ, Stuto A, Wexner SD (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Color Dis 8:98–101

    Article  CAS  Google Scholar 

  22. Ho YH, Ang M, Nyam D, Tan M, Seow-Choen F (1998) Transanal approach to rectocele repair may compromise anal sphincter pressures. Dis Colon Rectum 41:354–358

    Article  CAS  PubMed  Google Scholar 

  23. Heriot AG, Skull A, Kumar D (2004) Functional and physiological outcome following transanal repair of rectocele. Br J Surg 91:1340–1344

    Article  CAS  PubMed  Google Scholar 

  24. Nieminen K, Hiltunen KM, Laitinen J, Oksala J, Heinonen PK (2004) Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum 47:1636–1642

    Article  PubMed  Google Scholar 

  25. Thornton MJ, Lam A, King DW (2005) Laparoscopic or transanal repair of rectocele? A retrospective matched cohort study. Dis Colon Rectum 48:792–798

    Article  CAS  PubMed  Google Scholar 

  26. Roman H, Michot F (2005) Long-term outcomes of transanal rectocele repair. Dis Colon Rectum 48:510–517

    Article  PubMed  Google Scholar 

  27. Yamana T, Takahashi T, Iwadare J (2006) Clinical and physiologic outcomes after transvaginal rectocele repair. Dis Colon Rectum 49:661–667

    Article  PubMed  Google Scholar 

  28. Chung CS, Yu SH, Lee JE, Lee DK (2012) Comparison of long-term clinical outcomes according to the change in the rectocele depth between transanal and transvaginal repairs for a symptomatic rectocele. J Korean Soc Coloproctol 28:140–144

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors thank Yuko Tsunoda for her assistance with the statistical analysis. We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan

    Akira Tsunoda, Tomoko Takahashi & Hiroshi Kusanagi

Authors
  1. Akira Tsunoda
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  2. Tomoko Takahashi
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  3. Hiroshi Kusanagi
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Correspondence to Akira Tsunoda.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of Kameda Medical Center (2018-214).

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Tsunoda, A., Takahashi, T. & Kusanagi, H. Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence. Int J Colorectal Dis 34, 1681–1687 (2019). https://doi.org/10.1007/s00384-019-03382-3

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  • DOI: https://doi.org/10.1007/s00384-019-03382-3

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