Skip to main content

Diagnosis of Fecal Incontinence

  • Chapter
Book cover Fecal Incontinence
  • 1140 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. William PL, Warwick R (1980) Splanchnology. In: Grays Anatomy, 36th edn. Churchill Livingston London, pp 1356–1364

    Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. William PL, Warwick R (1980) Neurology. In: Gray’s Anatomy, 36th edn. Churchill Livingston London, pp 1122–1136

    Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. Frenckner B, Ihre T (1976) Influence of autonomic nerve on the internal anal sphincter in man. Gut 17:306–312

    Article  PubMed  CAS  Google Scholar 

  6. Fernandez Fraga X, Azpinoz F, Malagelada JR (2002) Significance of pelvic floor muscles in anal incontinence. Gastroenterology 123:1441–1450

    Article  Google Scholar 

  7. Bassotti G, Crowell MD, Whitehead WE (1993) contractile activity of the human colon: lessons from 24 hour studies. Gut 34:129–133

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Miller R, Bartolo DC, Cervero F et al (1988) Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 75:44–47

    Article  PubMed  CAS  Google Scholar 

  10. Duthie HL, Gaines FW (1960) Sensory nerve endings and sensation in the anal region of man. Br J Surg 47:585–595

    Article  PubMed  CAS  Google Scholar 

  11. Goligher JC, Huges ESR (1951) Sensibility of the rectum and colon. Its role in the mechanism of anal continence. Lancet 1:543–547

    Article  PubMed  CAS  Google Scholar 

  12. Rogers J (1992) Anal and rectal sensation. In: Henry MM, ed. Bailliere clinical gastroenterology. Bailliere Tindall London, pp 179–181

    Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. 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

    CAS  Google Scholar 

  17. Rao SSC (1999) Fecal incontinence. Clinical perspectives in gastroenterology 2:277–288

    Google Scholar 

  18. Samuelsson E, Ladfors L, Wennerholm UB et al (2000) Anal sphincter tears: prospective study of obstetric risk factors. BJOG 107:926–931

    Article  PubMed  CAS  Google Scholar 

  19. Sultan AH, Kamm MA, Hudson CN et al (1993) Analsphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911

    Article  PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  CAS  Google Scholar 

  21. Gee AS, Durdey P (1995) Urge incontinence of faeces is a maker of severe external anal sphincter dysfunction. Br J Surg 82:1179–1182

    Article  PubMed  CAS  Google Scholar 

  22. 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

    Article  PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. Rotholtz NA, Bun M et al (2005) Long-term assessment of fecal incontinence after lateral internal sphincterotomy. Tech Coloproctol 9(2):115–118

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. Abbsakoor F, Nelson M, Beynon J et al (1998) Anal endosonography in patients with anorectal symptoms after hemorrhoidectomy. Br J Surg 85:1522–1524

    Article  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. Hayne D, Vaizey CJ, Boulos PB (2001) Anorectal injury following pelvic radiotherapy. Br J Surg 88:1037–1048

    Article  PubMed  CAS  Google Scholar 

  29. Engel AF, Kamm MA, Talbot IC (1994) Progressive systemic sclerosis of the internal anal sphincter leading to passive faecal incontinence. Gut 35:857–859

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  CAS  Google Scholar 

  31. Glickman S, Kamm MA (1996) Bowel dysfunction in spinal cord injury patients. Lancet 347:1651–1653

    Article  PubMed  CAS  Google Scholar 

  32. 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

    PubMed  CAS  Google Scholar 

  33. Krogh K, Nielson J, Djurhuus JC et al (1997) Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 40:1233–1239

    Article  PubMed  CAS  Google Scholar 

  34. Brittain KR, Peet SM, Castleden CM (1998) Stroke and incontinence (review) Stroke 29:524–528

    PubMed  CAS  Google Scholar 

  35. 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

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  CAS  Google Scholar 

  37. Parks AG, Nicholls FJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2:85–88

    PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. 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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  41. 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

    Article  PubMed  CAS  Google Scholar 

  42. Felt-Bersma RJF, Cuesta MA (2001) Rectal prolapse, rectal intussusception, rectocele and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 30:199–222

    Article  PubMed  CAS  Google Scholar 

  43. 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

    Google Scholar 

  44. Farthing MJG, Lennard-Jones JE (1978) Sensibility of the rectum to distention and the anorectal distention reflex in ulcerative colitis. Gut 19:64–69

    Article  PubMed  CAS  Google Scholar 

  45. 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

    Article  PubMed  CAS  Google Scholar 

  46. Rao SSC, Kempf J, Stessman M (1998) Anal seepage: sphincter dysfunction or incomplete evacuation? Gastroenterology 114:A824

    Google Scholar 

  47. Rao SSC, Kempf J, Stessman M (1999) Is biofeedback therapy (BT) useful in patients with anal seepage? Gastroenterology 116:G4636

    Google Scholar 

  48. Leigh RJ, Turnberg LA (1982) Faecal incontinence: the unvoiced symptom. Lancet 1:1349–1351

    Article  PubMed  CAS  Google Scholar 

  49. 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

    Article  PubMed  Google Scholar 

  50. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence [review]. Dis Colon Rectum 36(l):77–97

    Article  PubMed  CAS  Google Scholar 

  51. Vaizey CJ, Carapeti E, Cahill JA et al (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80

    Article  PubMed  CAS  Google Scholar 

  52. 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

    Article  PubMed  CAS  Google Scholar 

  53. Rao SSC, Sun WM (1997) Current techniques of assessing defecation dynamics. Dig Dis 15(Suppl 1): 64–67

    Article  PubMed  Google Scholar 

  54. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM (1988) Investigation of anorectal function. Br J Surg 75:53–55

    Article  PubMed  CAS  Google Scholar 

  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

    Article  Google Scholar 

  56. Diamant NE, Kamm MA, Wald A et al (1999) AGA technical review on anorectal testing techniques. Gastroenterology 94:735–760

    Article  Google Scholar 

  57. Rao SSC (1997) Manometric evaluation of defecation disorders, part II: fecal incontinence. Gastroenterologist 5(2):99–111

    PubMed  CAS  Google Scholar 

  58. Rao SSC, Hatfield R, Leistikow J et al (1999) Manometric tests of anorectal function in healthy humans. Am J Gastroenterol 94:773–783

    Article  PubMed  CAS  Google Scholar 

  59. 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

    Article  PubMed  CAS  Google Scholar 

  60. Read NW, Harford WF, Schmulen AC et al (1979) A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 76:747–756

    PubMed  CAS  Google Scholar 

  61. 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

    Article  Google Scholar 

  62. 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

    Article  PubMed  CAS  Google Scholar 

  63. MacDonagh R, Sun WM, Thomas DG et al (1992) Anorectal function in patients with complete supraconal spinal cord lesions. Gut 33:1532–1538

    Article  PubMed  CAS  Google Scholar 

  64. 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

    Article  CAS  Google Scholar 

  65. Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testings: review of collective experience. Am J Gastroenterol 97:232–240

    PubMed  Google Scholar 

  66. Hancke E, Schurholz M (1987) Impaired rectal sensation in idiopathic faecal incontinence. Int J Colorectal Dis 2:146–148

    Article  PubMed  CAS  Google Scholar 

  67. Lubowski DZ, Nicholls RJ (1988) Faecal incontinence associated with reduced pelvic sensation. Br J Surg 75:1086–1088

    Article  PubMed  CAS  Google Scholar 

  68. 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

    Article  PubMed  CAS  Google Scholar 

  69. 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

    Article  PubMed  CAS  Google Scholar 

  70. Rogers J, Henry MM, Misiewicz JJ (1988) Combined motor and sensory deficit in primary neuropathic fecal incontinence. Gut 29:5–9

    Article  PubMed  CAS  Google Scholar 

  71. Cornes H, Bartlolo DC, Stirrat GM (1991) Changes in anal canal sensation after child birth. Br J Surg 78(l):74–77

    Article  PubMed  CAS  Google Scholar 

  72. 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

    Google Scholar 

  73. Wald A (1994) Colonie and anorectal motility testing in clinical practice. Am J Gastroenterol 89:2109–2115

    PubMed  CAS  Google Scholar 

  74. 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

    Article  PubMed  CAS  Google Scholar 

  75. Rao SSC, Azpiroz F, Diamant N et al (2002) Minimum standards of anorectal manometry. Neurogastroentrol Mot 14:553–559

    Article  CAS  Google Scholar 

  76. 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

    Google Scholar 

  77. Rao SSC, Happel J, Welcher K (1996) Can biofeedback therapy improve anorectal function in fecal incontinence? Am J Gastroenterol 91:2360–2366

    PubMed  CAS  Google Scholar 

  78. Felt-Bersma RJ, Cuesta MA, Bartram CI (1994) Faecal incontinence 1994: which test and which treatment? Neth J Med 44(5):182–188

    Article  PubMed  CAS  Google Scholar 

  79. Pelsang R, Rao SSC, Welcher K (1999) FECOM: a new artificial stool for evaluating defecation. Am J Gastroenterol 94:183–186

    Article  PubMed  CAS  Google Scholar 

  80. Olsen AL, Rao SSC (2001) Clinical neurophysiology and electrodiagnostic testing of the pelvic floor. Gastroenterol Clin North Am 30(l):33–54

    Article  PubMed  CAS  Google Scholar 

  81. Laurberg S, Swash M, Henry MM (1988) Delayed external sphincter repair for obstetric tear. Br J Surg 75:786–788

    Article  PubMed  CAS  Google Scholar 

  82. 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

    Article  Google Scholar 

  83. Donnelly V, Fynes M, Campbell D et al (1998) Obstetric events leading to anal sphincter damage. Obstet Gynecol 92:955–961

    Article  PubMed  CAS  Google Scholar 

  84. 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

    CAS  Google Scholar 

  85. Engel AF, Kamm MA, Sultan AH et al (1994) Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg 81:1231–1234

    Article  PubMed  CAS  Google Scholar 

  86. Rothholtz NA, Wexner SD (2001) Surgical treatment of constipation and fecal incontinence. Gastroenterol Clin North Am 30(l):131–166

    Article  Google Scholar 

  87. 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

    Google Scholar 

  88. 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

    Article  PubMed  CAS  Google Scholar 

  89. Wexner SD, Jorge JM (1994) Colorectal physiology tests: use or abuse of technology? Br Jr Surg 160(3):167–174

    CAS  Google Scholar 

  90. 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

    CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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., Påhlman, 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)

Publish with us

Policies and ethics