Physiological Parameters Predicting the Outcome of Surgical and Nonsurgical Treatment of Fecal Incontinence

  • Donato F. Altomare
  • Marcella Rinaldi


Fecal incontinence is a multifactorial disease. Anorectal physiology studies play an outstanding role in the evaluation of its etiology and severity, the two main factors that constitute the basis for the correct choice of treatment. However, the prognostic role of clinical factors and anorectal physiological tests in predicting the outcome to either conservative or surgical treatment is questionable.


Fecal Incontinence Anal Sphincter External Anal Sphincter Pudendal Nerve Sacral Nerve Stimulation 
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  1. 1.
    Enck P (1993) Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 38:1953–1560PubMedCrossRefGoogle Scholar
  2. 2.
    Cerulli MA, Nikoomanesh P, Schuster MM (1979) Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 76:742–746PubMedGoogle Scholar
  3. 3.
    Wald A (1981) Biofeedback therapy for fecal incontinence. Ann Intern Med 95:146–149PubMedGoogle Scholar
  4. 4.
    Sangwan YP, Coller JA, Barrett RC et al (1995) Can manometric parameters predict response to biofeed-back therapy in fecal incontinence? Dis Colon Rectum 38:1021–1025PubMedCrossRefGoogle Scholar
  5. 5.
    Fernandez-Fraga X, Azpiroz F, Aparici A et al (2003) Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 46:1218–1225PubMedCrossRefGoogle Scholar
  6. 6.
    Rieger NA, Wattchow DA, Sarre RG et al (1997) Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Colon Rectum 40:821–826PubMedCrossRefGoogle Scholar
  7. 7.
    Chiarioni G, Bassotti G, Stegagnini S et al (2002) Senso-ry retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97:109–117PubMedCrossRefGoogle Scholar
  8. 8.
    Rao SS, Welcher KD, Happel J (1996) Can biofeedback therapy improve anorectal function in fecal incontinence? Am J Gastroenterol 91:2360–2366PubMedGoogle Scholar
  9. 9.
    Leroi AM, Dorival MP, Lecouturier MF et al (1999) Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 42:762–769PubMedCrossRefGoogle Scholar
  10. 10.
    Setti-Carraro P, Kamm MA, Nicholls RJ (1994) Longterm results of postanal repair for neurogenic faecal incontinence. Br J Surg 81:140–144PubMedCrossRefGoogle Scholar
  11. 11.
    Mavrantonis C, Matsuoka H, Wexner SD et al (2000) Postanal repair for fecal incontinence: is it worthwhile? Dis Colon Rectum 43:1561–1567.PubMedCrossRefGoogle Scholar
  12. 12.
    Slade MS, Goldberg SM, Schottler JL et al (1977) Sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 20:33–35PubMedCrossRefGoogle Scholar
  13. 13.
    Laurberg S, Swash M, Snooks SJ, Henry MM (1988) Neurologic cause of idiopathic incontinence. Arch Neurol 45:1250–1253PubMedGoogle Scholar
  14. 14.
    Wexner SD, Marchetti F, Jagelman DG (1991) The role of sphincteroplasty for fecal incontinence re-evaluated: a prospective physiologic and functional review. Dis Colon Rectum 34:22–30PubMedCrossRefGoogle Scholar
  15. 15.
    Oliveira L, Pfeifer J, Wexner SD (1996) Physiological and clinical outcome of anterior sphincteroplasty. Br J Surg 83:502–505PubMedCrossRefGoogle Scholar
  16. 16.
    Gilliland R, Altomare DF, Moreira H Jr et al (1998) Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum 41:1516–1522PubMedCrossRefGoogle Scholar
  17. 17.
    Londono-Schimmer EE, Garcia-Duperly R, Nicholls RJ et al (1994) Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five year follow-up functional results. Int J Colorectal Dis 9:110–113PubMedCrossRefGoogle Scholar
  18. 18.
    Simmang C, Birnbaum EH, Kodner IJ et al (1994) Anal sphincter construction in the elderly: does advancing age affect outcome? Dis Colon Rectum 37:1065–1069PubMedCrossRefGoogle Scholar
  19. 19.
    Sangwan YP, CollerJ A, Barrett RC et al (1996) Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum 39:686–689PubMedCrossRefGoogle Scholar
  20. 20.
    Jacobs PP, Scheuer M, Juijpers JH, Vingerhoets MH (1990) Obstetric fecal incontinence: role of pelvic floor denervation and results of delayed sphincter repair. Dis Colon Rectum 33:494–497PubMedCrossRefGoogle Scholar
  21. 21.
    Sitzler PJ, Thomson JPS (1996) Overlap repair of damaged anal sphincter. A single surgeon’s series. Dis Colon Rectum 39:1356–1360PubMedCrossRefGoogle Scholar
  22. 22.
    Engel AF, Kamm MA, Sultan AH, (1994) Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg 81:1231–1234PubMedCrossRefGoogle Scholar
  23. 23.
    Felt-Bersma RJF, Ciesta MA, Koorevaar M (1996) Anal sphincter repair improves anorectal function and endosonographic image. A prospective clinical study. Dis Colon Rectum 39:878–885PubMedCrossRefGoogle Scholar
  24. 24.
    Nikiteas N, Korsgen S, Kumar D, Keighley MRB (1996) Audit of sphincter repair. Factors associated with poor outcome. Dis Colon Rectum 39:1164–1170PubMedCrossRefGoogle Scholar
  25. 25.
    Rasmussen OO, Colstrup H, Lose G, Christiansen J (1990) A technique for the dynamic assessment of anal sphincter function. Int J Colorectal Dis 5:135–141PubMedCrossRefGoogle Scholar
  26. 26.
    Young CJ, Mathur MN, Eyers AA, Solomon MJ (1998) Successful overlapping anal sphincter repair: relationship to patient age, neuropathy and colostomy formation. Dis Colon Rectum 41:344–349PubMedCrossRefGoogle Scholar
  27. 27.
    Chen AS, Luchtefeld MA, Senagore AJ et al (1998) Pudendal nerve latency. Does it predict outcome of anal sphincter repair? Dis Colon Rectum 41:1005–1009PubMedCrossRefGoogle Scholar
  28. 28.
    Buie WD, Lowry AC, Rothenberger DA, Madoff RD (2001) Clinical rather than laboratory assessment predicts continence after anterior sphincteroplasty. Dis Colon Rectum 44:1255–1260PubMedCrossRefGoogle Scholar
  29. 29.
    Pickrell KL, Broadbent TR, Masters FW, Metzger JT et al (1952) Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle. Ann Surg 135:853–862PubMedCrossRefGoogle Scholar
  30. 30.
    Korsgen S, Keighley MRB (1995) Stimulated gracilis neosphincter-not as good as previously thought. Report of four cases. Dis Colon Rectum 38:1331–1333PubMedCrossRefGoogle Scholar
  31. 31.
    Baeten CG, Geerdes BP, Adang EM Et al (1995) Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med 332:1600–1605PubMedCrossRefGoogle Scholar
  32. 32.
    Koch SM, Uludag O, Rongen MJ et al (2004) Dynamic graciloplasty in patients born with an anorectal malformation. Dis Colon Rectum 47:1711–1719PubMedCrossRefGoogle Scholar
  33. 33.
    Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1994). Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127CrossRefGoogle Scholar
  34. 34.
    Matzel KE, Stadelmaier U, Bittorf B et al (2002) Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis 17:430–434PubMedCrossRefGoogle Scholar
  35. 35.
    Ratto C, Grillo E, Parello A et al (2005) Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum 48:1027–1036PubMedCrossRefGoogle Scholar
  36. 36.
    Kenefick NJ, Christiansen J (2004) A review of sacral nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 6:75–80PubMedCrossRefGoogle Scholar
  37. 37.
    Jarrett MED, Mowatt G, Glazener CMA et al (2004) Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559–1569PubMedCrossRefGoogle Scholar
  38. 38.
    Altomare DF, Rinaldi M, Petrolino M et al (2004) Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence. Dis Colon Rectum 47:853–857PubMedCrossRefGoogle Scholar
  39. 39.
    Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm MA (2000) Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 232:143–148PubMedCrossRefGoogle Scholar
  40. 40.
    Leroi AM, Michot F, Grise P, Denis P (2001) Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis Colon Rectum 44:779–789PubMedCrossRefGoogle Scholar
  41. 41.
    Fowler CJ, Swinn MJ, Goodwin RJ et al (2000) Studies of the latency of pelvic floor contraction during peripheral nerve evaluation show that the muscle response is reflexly mediated. J Urol 163:881–883PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 2007

Authors and Affiliations

  • Donato F. Altomare
  • Marcella Rinaldi

There are no affiliations available

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