Abstract
Background
The etiology of anal incontinence (AI) is often multifactorial. There is little data on the relationship between the etiology of AI, symptom severity, and the need for surgery. The aim of our study was to investigate this association in a large number of unselected patients with AI referred to a tertiary specialist coloproctological practice.
Methods
Patients with AI seen at our unit between 1983 and 2008 were analyzed. The main etiologies were categorized as congenital, traumatic, neurologic, idiopathic, post-operative, post-obstetric, secondary to rectal prolapse, or inflammatory bowel disease. The severity of AI was graded using the validated Pescatori incontinence scale.
Results
Overall, 1,046 patients were studied. The AI score was higher in patients with congenital (4.7 ± 1.1), traumatic (4.6 ± 1.4), and neurological (4.4 ± 1.2) incontinence. Surgical treatment was indicated in 214 cases (20.5%). Patients with AI related to trauma and congenital anomalies required surgery in 43.5 and 31.4% of cases, respectively, a percentage significantly higher than that for patients with other etiologies (P = 0.002). Prolapse-related AI usually responded to correction of the prolapse.
Conclusions
Patients with congenital, traumatic, and neurological AI tend to have greater symptom severity. Traumatic, rectal prolapse-related, and congenital AI cases more often require surgery.
Similar content being viewed by others
References
Soffer EE, Hull T (2000) Fecal incontinence: a practical approach to evaluation and treatment. Am J Gastroenterol 95:1873–1880
Perry S, Shaw C, McGrother C et al (2002) Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 50:480–484
Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126:S3–S7
Akpan A, Gosney MA, Barret J (2007) Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings. Clin Interv Aging 2:139–145
Rothbarth J, Bemelman WA, Meijerink WJ et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71
Farage MA, Miller KW, Berardesca E, Maibach HI (2008) Psychosocial and societal burden of incontinence in the aged population: a review. Arch Gynecol Obstet 277:285–290
Williams A, Lavender T, Richmond DH, Tincello DG (2005) Women’s experiences after a third-degree obstetric anal sphincter tear: a qualitative study. Birth 32:129–136
Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35:482–487
Boffi F, Ayabaca S, Corradi A, Renzi C, Pescatori M (2002) Etiology and severity of symptoms of fecal incontinence: is there a correlation? Int J Colorectal Dis 17:59–60
Nichols CM, Ramakrishnan V, Gill EJ, Hurt WG (2005) Anal incontinence in women with and those without pelvic floor disorders. Obstet Gynecol 106:1266–1271
Engel AF, Kamm MA, Bartram CI, Nicholls RJ (1995) Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorect Dis 10:152–155
Fisher K, Bliss DZ, Savik K (2008) Comparison of recall and daily self-report of fecal incontinence severity. J Wound Ostomy Cont Nurs 35:515–520
Terra MP, Deutekom M, Dobben AC et al (2008) Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted? Int J Colorectal Dis 23:503–511
Bordeianou L, Lee KY, Rockwood T et al (2008) Anal resting pressures at manometry correlate with the fecal incontinence severity index and with the presence of sphincter defects on ultrasound. Dis Colon Rectum 51:1010–1014
Deutekom M, Dobben AC, Terra MP (2007) Clinical presentation of fecal incontinence and anorectal function: what is the relationship? Am J Gastroenterol 102:351–361
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
Fox JC, Fletcher JG, Zinsmeister AR, Seide B, Riederer SJ, Bharucha AE (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49:1726–1735
Titi M, Jenkins JT, Urie A, Molloy RG (2007) Prospective study of the diagnostic evaluation of faecal incontinence and leakage in male patients. Colorect Dis 9:647–652
Rao SS, Ozturk R, Stessman M (2004) Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 99:2204–2209
Bharucha AE, Seide BM, Zinsmeister AR, Melton LJ 3rd (2008) Relation of bowel habits to fecal incontinence in women. Am J Gastroenterol 103:1470–1475
Thekkinkattil DK, Lim M, Stojkovic SG, Finan PJ, Sagar PM, Burke D (2008) A classification system for faecal incontinence based on anorectal investigations. Br J Surg 95:222–228
Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 54:546–555
Mimura T, Kaminishi M, Kamm MA (2004) Diagnostic evaluation of patients with faecal incontinence at a specialist institution. Dig Surg 21:235–241
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Rockwood TH, Church J, Fleshman JW et al (2000) Fecal Incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16
Pescatori M, Zbar AP (2009) Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period. Colorectal Dis Jul 15 [Epub ahead of print]
Rintala R, Mildh L, Lindahl H (1994) Fecal continence and quality of life for adult patients with an operated high or intermediate anorectal malformation. J Pediatr Surg 29:777–780
Iwai N, Deguchi E, Kimura O, Kubota Y, Ono S, Shimadera S (2007) Social quality of life for adult patients with anorectal malformations. J Pediatr Surg 42:313–317
Zbar AP, Beer-Gabel M, Chiappa AC, Aslam M (2001) Fecal incontinence after minor anorectal surgery. Dis Colon Rectum 44:1610–1623
Abbasakoor F, Nelson M, Beynon J, Patel B, Carr ND (1998) Anal endosonography in patients with anorectal symptoms after haemorrhoidectomy. Br J Surg 85:1522–1524
Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48:1193–1199
Sultan AH, Kamm MA, Nicholls RJ, Bartram CI (1994) Prospective study of the extent of lateral anal sphincterotomy division during lateral sphincterotomy. Dis Colon Rectum 37:1031–1033
Zbar AP, Kmiot WA, Aslam M et al (1999) Use of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction. Dis Colon Rectum 42:1411–1418
Cotterill N, Norton C, Avery KN, Abrams P, Donovan JL (2008) A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon Rectum 51:82–87
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bondurri, A., Zbar, A.P., Tapia, H. et al. The relationship between etiology, symptom severity and indications of surgery in cases of anal incontinence: a 25-year analysis of 1,046 patients at a tertiary coloproctology practice. Tech Coloproctol 15, 159–164 (2011). https://doi.org/10.1007/s10151-011-0682-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-011-0682-8