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Incontinence: Causes and Pathophysiology

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Abstract

Faecal incontinence is thought to have a prevalence of between 1 and 10 %. This chapter considers the reasons why normal continence mechanisms break down. Several theories of continence exist including the flutter valve theory, the flap valve theory and sphincteric theories. Any disruption to these processes, such as damage to the internal or external sphincters or their nerve supply, can reduce continence. In addition rapid, uncontrolled delivery of stool into the rectum, or a loss of rectal compliance, may overwhelm the normal processes of continence. Abnormalities in anorectal sensation in conditions such as rectal prolapse may contribute to a loss of continence, as well as abnormal sampling, reliant on the anorectal inhibitory complex. Understanding the mechanism of continence helps to understand the aetiology of incontinence including obstetric injuries, trauma and previous surgery. This chapter ends by considering how to take a history from a patient with incontinence, examine and investigate them as well as how treatments may address the underlying problems described. Surgical methods such as sphincter repair will be discussed but also newer methods such as secca and sacral nerve stimulation.

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References

  1. Phillips SF, Edwards DAW. Some aspects of anal continence and defecation. Gut. 1965;6:396–405.

    Article  CAS  PubMed  Google Scholar 

  2. Duthie H. Anal incontinence. Gut. 1971;12:844–52.

    Article  CAS  PubMed  Google Scholar 

  3. Parks A. Anorectal incontinence. Proc R Soc Med. 1975;68:681–90.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Bartolo D, Roe A, Locke-Edmunds J, et al. Flap-valve theory of ano-rectal incontinence. Br J Surg. 1986;73:1012–4.

    Article  CAS  PubMed  Google Scholar 

  5. Miller R, Bartolo DCC, Locke-Edmunds JC, Mortensen NJ. Prospective study of conservative and operative treatments for faecal incontinence. Br J Surg. 1988;75:101–5.

    Article  CAS  PubMed  Google Scholar 

  6. Lestar B, Penninckx F, Kerremans R. The internal anal sphincter cannot close the anal canal completely. Int J Colorectal Dis. 1992;7:159–61.

    Article  CAS  PubMed  Google Scholar 

  7. Taylor BM, Beart RW, Phillips SE. Longitudinal and radial variations of pressure in the human anal canal. Gastroenterology. 1984;86:993–7.

    Google Scholar 

  8. Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC. The role of transient internal sphincter relaxation in faecal incontinence. Int J Colorectal Dis. 1991;5:31–6.

    Article  Google Scholar 

  9. Krogh K, Ryhammer AM, Lundby L, Gregersen H, Laurberg TS. Comparison of methods used for measurement of rectal compliance. Dis Colon Rectum. 2001;44:199–206.

    Article  CAS  PubMed  Google Scholar 

  10. Duthie H, Gairns F. Sensory nerve endings and sensation in the anal region of the man. Br J Surg. 1960;47:585–95.

    Article  CAS  PubMed  Google Scholar 

  11. Roe A, Bartolo D, Mortensen N. New method for assessment of anal sensation in various anorectal disorders. Br J Surg. 1986;73:310–2.

    Article  CAS  PubMed  Google Scholar 

  12. Orrom WJ, Miller R, Cornes H, Duthie GS, Mortensen NJ, Bartolo DCC. Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic faecal incontinence. Dis Colon Rectum. 1991;34:305–10.

    Article  CAS  PubMed  Google Scholar 

  13. Lane R, Parks A. Function of the anal sphincters following colo-anal anastomosis. Br J Surg. 1977;64:596–9.

    Article  CAS  PubMed  Google Scholar 

  14. Farouk R, Duthie GS, Pryde A, McGregor AB, Bartolo DC. Internal anal sphincter dysfunction in neurogenic faecal incontinence. Br J Surg. 1993;80:259–61.

    Article  CAS  PubMed  Google Scholar 

  15. Farouk R, Duthie GS, MacGregor AB, Bartolo DC. Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence. Dis Colon Rectum. 1994;37:595–601.

    Article  CAS  PubMed  Google Scholar 

  16. Swash M, Gray A, Lubowski D, Nicholls R. Ultrastructural changes in internal anal sphincter in neurogenic faecal incontinence. Gut. 1988;29:1692–8.

    Article  CAS  PubMed  Google Scholar 

  17. Swash M, Snook S, Henry M. Unifying concepts of pelvic floor disorders and incontinence. J R Soc Med 1985;78(11):906–11.

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Kiff E, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg. 1984;71:614–6.

    Article  CAS  PubMed  Google Scholar 

  19. Schizas A, Williams A. Anorectal investigation. In: Phillips R, editor. Colorectal surgery. 4th ed. Edinburgh: Saunders/Elsevier; 2009.

    Google Scholar 

  20. Laurberg S, Swash M, Snooks S, Henry M. Neurologic cause of idiopathic incontinence. Arch Neurol. 1988;45:1250–3.

    Article  CAS  PubMed  Google Scholar 

  21. Read N, Bartolo D, Read M, et al. Differences in anorectal manometry between patients with haemorrhoids and patients with descending perineum syndrome: implications for management. Br J Surg. 1983;70(11):656–9.

    Article  CAS  PubMed  Google Scholar 

  22. Kerremans R. Morphological and physiological aspects of anal continence and defaecation. Brussels: Arscia; 1969.

    Google Scholar 

  23. Milligan M, Morgan C, Jones H, Officer R. Surgical Anatomy of the anal canal, and the operative treatment of haemorrhoids. The Lancet 1937;1150–6.

    Google Scholar 

  24. Bharucha A, Fletcher J, Harper C, et al. Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut. 2005;54:546–55.

    Article  CAS  PubMed  Google Scholar 

  25. Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries – myth or reality? BJOG. 2006;113:195–200.

    Article  PubMed  Google Scholar 

  26. Sakse A, Secher NJ, Ottesen M, Starck M. Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle. Ultrasound Obstet Gynecol. 2009;34(6):693–8.

    Article  CAS  PubMed  Google Scholar 

  27. Williams A, Bartram C, Modhwadia D, et al. Endocoil MRI quantifications of external anal sphincter atrophy. Br J Surg. 2001;88:8539.

    Article  Google Scholar 

  28. Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg. 1991;78:1429–30.

    Article  CAS  PubMed  Google Scholar 

  29. Sanino P. A manometric study of anorectal function after surgery for anal fistula, with special reference to incontinence. Acta Chir Scand. 1985;151:695–700.

    Google Scholar 

  30. Snooks SJ, Barnes RPH, Swash M. Damage to the voluntary anal and urinary sphincter musculature in childbirth. J Neurol Neurosurg Psychiatry. 1984;47:1269–73.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Royal Berkshire Hospital, London Road, Reading, Berkshire, RG1 5AN, UK

    Jonathan Randall FRCS

  2. Department of Surgery, Royal Berkshire NHS Trust, Reading, Berkshire, UK

    Ridzuan Farouk MD, MCh, FRCS

Authors
  1. Jonathan Randall FRCS
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  2. Ridzuan Farouk MD, MCh, FRCS
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Editor information

Editors and Affiliations

  1. Department of GI Surgery, University College London Hospitals, London, United Kingdom

    Richard Cohen

  2. Department of GI Surgery, University College London Hospitals, London, United Kingdom

    Alastair Windsor

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© 2014 Springer-Verlag London

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Randall, J., Farouk, R. (2014). Incontinence: Causes and Pathophysiology. In: Cohen, R., Windsor, A. (eds) Anus. Springer, London. https://doi.org/10.1007/978-1-84882-091-3_10

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  • DOI: https://doi.org/10.1007/978-1-84882-091-3_10

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-090-6

  • Online ISBN: 978-1-84882-091-3

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