Skip to main content

Advertisement

SpringerLink
Log in

Pelvic floor architectural defects in female patients with urge fecal incontinence versus passive fecal leakage: a dynamic ultrasound study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Fecal incontinence (FI) has two primary subtypes: urgency fecal incontinence (UFI) and passive fecal leakage (PFL). The pathophysiology underlying the subtypes is incompletely understood.

Objectives

To compare the bowel habits, physical examinations and pelvic floor anatomical defects in patients with UFI-dominant FI versus patients with PFL-dominant FI.

Study design

This is a retrospective cross-sectional study of female patients who presented with fecal incontinence symptoms to our tertiary urogynecology center. All subjects underwent a comprehensive history, physical examination, 3D-static pelvic floor ultrasound, and 2D-dynamic ultrasound of the posterior compartment. Patients with UFI-dominant FI were compared to patients with PFL-dominant FI.

Results

One hundred forty-five patients were included in the analysis; 57 categorized as UFI-dominant FI, 69 PFL-dominant FI and 19 categorized as having “both” leakage patterns. In comparing bowel habits, patient with UFI-dominant FI had more frequent bowel movements (15.5 ± SD 13.0/week vs. 10.9 ± SD 7.6 /week, p = 0.022) and were more likely to have loose stools (48.2% vs. 26.1%, p = 0.01). No statistically significant differences were observed in the prevalence of external anal sphincter defect (11.3% vs. 17.2%, p = 0.38) or internal anal sphincter defect (11.3% vs. 19%, p = 0.26) between groups. Finally, patients with UFI-dominant FI had a higher incidence of rectal hypermobility (loss of rectal support on Valsalva) (58% vs. 36.9%, p = 0.025).

Conclusion

Patients with urge-predominant FI have increased frequency of bowel movements, looser stools, and increased rectal folding diagnosed via dynamic ultrasound as compared to patients with passive-dominant FI.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005;129:42–9. https://doi.org/10.1053/j.gastro.2005.04.006.

    Article  PubMed  Google Scholar 

  2. Sharma A, Yuan L, Marshall RJ, Merrie AEH, Bissett IP. Systematic review of the prevalence of faecal incontinence. Br J Surg. 2016;103:1589–97. https://doi.org/10.1002/bjs.10298.

    Article  CAS  PubMed  Google Scholar 

  3. Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137:512–7, 517.e1–2. https://doi.org/10.1053/j.gastro.2009.04.054.

    Article  PubMed  Google Scholar 

  4. Bezerra LRPS, Vasconcelos Neto JA, Vasconcelos CTM, Karbage SAL, Lima AC, Frota IPR, et al. Prevalence of unreported bowel symptoms in women with pelvic floor dysfunction and the impact on their quality of life. Int Urogynecology J. 2014;25:927–33. https://doi.org/10.1007/s00192-013-2317-2.

    Article  Google Scholar 

  5. Rao SSC. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126:S14–22. https://doi.org/10.1053/j.gastro.2003.10.013.

    Article  PubMed  Google Scholar 

  6. Pahwa AK, Khanijow KD, Harvie HS, Arya LA, Andy UU. Comparison of patient impact and clinical characteristics between urgency and passive fecal incontinence phenotypes. Female Pelvic Med Reconstr Surg. 2018. https://doi.org/10.1097/SPV.0000000000000603.

  7. Hotouras A, Thaha MA, Boyle DJ, Allison ME, Currie A, Knowles CH, et al. Short-term outcome following percutaneous tibial nerve stimulation for faecal incontinence: a single-Centre prospective study. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2012;14:1101–5. https://doi.org/10.1111/j.1463-1318.2011.02906.x.

    Article  CAS  Google Scholar 

  8. Kamm MA. Faecal incontinence. BMJ. 1998;316:528–32. https://doi.org/10.1136/bmj.316.7130.528.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Engel AF, Kamm MA, Bartram CI, Nicholls RJ. Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Color Dis. 1995;10:152–5. https://doi.org/10.1007/BF00298538.

    Article  CAS  Google Scholar 

  10. Rostaminia G, White D, Quiroz LH, Shobeiri SA. 3D pelvic floor ultrasound findings and severity of anal incontinence. Int Urogynecology J. 2014;25:623–9. https://doi.org/10.1007/s00192-013-2278-5.

    Article  CAS  Google Scholar 

  11. Rostaminia G, Abramowitch S, Chang C, Goldberg RP. Descent and hypermobility of the rectum in women with obstructed defecation symptoms. Int Urogynecology J. 2020;31:337–49. https://doi.org/10.1007/s00192-019-03934-9.

    Article  Google Scholar 

  12. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–95. https://doi.org/10.1067/mob.2001.118659.

    Article  CAS  PubMed  Google Scholar 

  13. van Delft KWM, Sultan AH, Thakar R, Shobeiri SA, Kluivers KB. Agreement between palpation and transperineal and endovaginal ultrasound in the diagnosis of levator ani avulsion. Int Urogynecology J. 2015;26:33–9. https://doi.org/10.1007/s00192-014-2426-6.

    Article  Google Scholar 

  14. Shobeiri SA, Chesson RR, Gasser RF. The internal innervation and morphology of the human female levator ani muscle. Am J Obstet Gynecol. 2008;199:686.e1–6. https://doi.org/10.1016/j.ajog.2008.07.057.

    Article  Google Scholar 

  15. Routzong MR, Abramowitch SD, Chang C, Goldberg RP, Rostaminia G. Obstructed defecation symptom severity and degree of rectal hypermobility and folding detected by dynamic ultrasound. Ultrasound Q Publish Ahead of Print. 2021. https://doi.org/10.1097/RUQ.0000000000000565.

  16. Chan CLH, Scott SM, Williams NS, Lunniss PJ. Rectal hypersensitivity worsens stool frequency, urgency, and lifestyle in patients with urge fecal incontinence. Dis Colon Rectum. 2005;48:134–40. https://doi.org/10.1007/s10350-004-0774-x.

    Article  PubMed  Google Scholar 

  17. Hawkins AT, Olariu AG, Savitt LR, Gingipally S, Wakamatsu MM, Pulliam S, et al. Impact of rising grades of internal rectal intussusception on fecal continence and symptoms of constipation. Dis Colon Rectum. 2016;59:54–61. https://doi.org/10.1097/DCR.0000000000000510.

    Article  PubMed  Google Scholar 

  18. Yagi Y, Tsunoda A, Takahashi T, Kusanagi H. Rectoanal intussusception is very common in patients with fecal incontinence. J Anus Rectum Colon. 2018;2:162–7. https://doi.org/10.23922/jarc.2017-048.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA

    Joseph B. Pincus, Nani P. Moss, Roger P. Goldberg & Ghazaleh Rostaminia

  2. Division of Urogynecology, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA

    Joseph B. Pincus

  3. NorthShore University HealthSystem Research Institute, Evanston, IL, USA

    Cecilia Chang

Authors
  1. Joseph B. Pincus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nani P. Moss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roger P. Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ghazaleh Rostaminia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph B. Pincus.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 17 kb)

ESM 2

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pincus, J.B., Moss, N.P., Chang, C. et al. Pelvic floor architectural defects in female patients with urge fecal incontinence versus passive fecal leakage: a dynamic ultrasound study. Int Urogynecol J 33, 2133–2141 (2022). https://doi.org/10.1007/s00192-021-04919-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04919-3

Keywords

Search

Navigation