INTRODUCTION
Anal incontinence commonly results from external anal sphincter dysfunction. The muscle is routinely assessed by anorectal physiology studies. Fatigability is not routinely measured but should be an important factor in the maintenance of continence. The fatigue rate index has been developed to address this. The purpose of this study was to investigate the fatigability of the external anal sphincter in incontinent patients compared with that in controls and to determine its correlation with symptom severity and pudendal nerve terminal motor latency measurement.
METHODS
Forty-two patients with anal incontinence (33 female, 9 male) and 20 control patients (17 female, 3 male) were studied. As part of anorectal physiology studies, manometry was measured by a station pull-through technique with a closed-system microballoon. After a rest period of one minute, fatigue was measured over a 20-second squeeze at 1.5 cm in the anal canal with two consecutive readings separated by a further one-minute rest period. The fatigue rate index was calculated from the maximum squeeze pressure and fatigue rate. A validated symptom severity scoring system was used to assess symptomatology in patients with anal incontinence.
RESULTS
No difference was detected in demographic factors between the two groups. The fatigue rate index was significantly different between the control and incontinent groups (1.85 vs. 0.67 minutes, P = 0.001). No other factors were significantly different between the two groups (maximum squeeze pressure, 89.1 vs. 79 cm H2O, P = 0.42; fatigue rate, −85.8 vs. −101.2 cm H2O/min, P = 0.62). The fatigue rate index demonstrated a significant correlation with symptom score (r = −0.44, P = 0.005). The fatigue rate index did not correlate with latency measurement.
CONCLUSIONs
A significant difference was detected in the fatigue rate index between incontinent and control patients. The Fatigue Rate Index demonstrated a significant correlation with symptom severity score and it may be a useful discriminating measure of external anal sphincter function.
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To the Invited Commentary
PW Marcello RC Barrett JA Coller et al. (1998) ArticleTitleFatigue rate index (FRI) as a new measurement of external sphincter function Dis Colon Rectum 41 336–43
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Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002, and at the meeting of the Association of Coloproctology of Great Britain and Ireland, Harrogate, United Kingdom, July 2 to 5, 2002.
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Telford, K., Ali, A., Lymer, K. et al. Fatigability of the External Anal Sphincter in Anal Incontinence. Dis Colon Rectum 47, 746–752 (2004). https://doi.org/10.1007/s10350-003-0122-6
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DOI: https://doi.org/10.1007/s10350-003-0122-6