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Comparison of clinical and paraclinical characteristics of patients with urge, mixed, and passive fecal incontinence: a systematic literature review

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Abstract

Purpose

Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations.

Methods

This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases.

Results

Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0–5.0 and 15.0–35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups.

Conclusion

There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.

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Authors and Affiliations

  1. GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France

    Charlotte Desprez, N. Turmel, C. Chesnel, P. Mistry, M. Tamiatto, R. Haddad, F. Le Breton, C. Hentzen & G. Amarenco

  2. Digestive physiology Unit, Rouen University Hospital, 1 rue de Germont, 76031, Rouen, France

    Charlotte Desprez & A-M. Leroi

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  1. Charlotte Desprez
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  2. N. Turmel
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  3. C. Chesnel
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Contributions

DC, AG, and TN designed the research study and wrote the paper, and DC, TN, CC, MP, TM, HR, FLB, LAM, HC, and AG contributed to the editing of the manuscript. All authors approved the final version of the article, including the authorship list.

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Correspondence to Charlotte Desprez.

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Desprez, C., Turmel, N., Chesnel, C. et al. Comparison of clinical and paraclinical characteristics of patients with urge, mixed, and passive fecal incontinence: a systematic literature review. Int J Colorectal Dis 36, 633–644 (2021). https://doi.org/10.1007/s00384-020-03803-8

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