Skip to main content
SpringerLink
Log in

Etiology and management of fecal incontinence

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

Fecal incontinence is a challenging condition of diverse etiology and devastating psychosocial impact. Multiple mechanisms may be involved in its pathophysiology, such as altered stool consistency and delivery of contents to the rectum, abnormal rectal capacity or compliance, decreased anorectal sensation, and pelvic floor or anal sphincter dysfunction. A detailed clinical history and physical examination are essential. Anorectal manometry, pudendal nerve latency studies, and electromyography are part of the standard primary evaluation. The evaluation of idiopathic fecal incontinence may require tests such as cinedefecography, spinal latencies, and anal mucosal electrosensitivity. These tests permit both objective assessment and focused therapy. Appropriate treatment options include biofeedback and sphincteroplasty. Biofeedback has resulted in 90 percent reduction in episodes of incontinence in over 60 percent of patients. Overlapping anterior sphincteroplasty has been associated with good to excellent results in 70 to 90 percent of patients. The common denominator between the medical and surgical treatment groups is the necessity of pretreatment physiologic assessment. It is the results of these tests that permit optimal therapeutic assignment. For example, pudendal nerve terminal motor latencies (PNTML) are the most important predictor factor of functional outcome. However, even the most experienced examiner's digit cannot assess PNTML. In the absence of pudendal neuropathy, sphincteroplasty is an excellent option. If neuropathy exists, however, then postanal or total pelvic floor repair remain viable surgical options for the treatment of idiopathic fecal incontinence. In the absence of an adequate sphincter muscle, encirclement procedures using synthetic materials or muscle transfer techniques might be considered. Implantation of a stimulating electrode into the gracilis neosphincter and artificial sphincter implantation are other valid alternatives. The final therapeutic option is fecal diversion. This article reviews the current status of the etiology and incidence of incontinence as well as the evaluation and treatment of this disabling condition.

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

Similar content being viewed by others

References

  1. Elliot MS, Hancke E, Henry MM,et al. Faecal incontinence. Symposium. Int J Colorectal Dis 1987;2:173–86.

    Article  PubMed  CAS  Google Scholar 

  2. Cheskin LJ, Schuster MM. Fecal incontinence. In: Hazzard WR, Andres R, Bierman EL, Blass JP, eds. Principles of geriatric medicine and gerontology. 2nd. ed. New York: McGraw-Hill, 1990:1143–5.

    Google Scholar 

  3. Lahr CJ. Evaluation and treatment of incontinence. Practical Gastroenterol 1988;12:27–35.

    Google Scholar 

  4. Welbourn H. Spina bifida children attending ordinary schools. BMJ 1975;1:142–5.

    PubMed  CAS  Google Scholar 

  5. Enck P, Bielefeldt K, Rathamann W, Purrmann J, Tschope D, Erckenbrecht JF. Epidemiology of faecal incontinence in selected patients groups. Int J Colorectal Dis 1991;6:143–6.

    Article  PubMed  CAS  Google Scholar 

  6. Drossman DA, Sandler RS, Broom CM, McKee DC. Urgency and fecal soiling in people with bowel dysfunction. Dig Dis Sci 1986;31:1221–5.

    Article  PubMed  CAS  Google Scholar 

  7. Mandelstam DA. Faecal incontinence. Social and economic factors. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. Pathophysiology and management. London: Butterworths, 1984:217–22.

    Google Scholar 

  8. Thomas TM, Egan M, Walgrove A, Meade TW. The prevalence of fecal and double incontinence. Community Med 1984;6:2l6–20.

    Google Scholar 

  9. Henry MM. Pathogenesis and management of fecal incontinence in the adult. Gastroenterol Clin North Am 1987;16:35–45.

    PubMed  CAS  Google Scholar 

  10. Snooks SJ, Swash M, Mathers SE, Henry MM. Effect of vaginal delivery on the pelvic floor: a 5 year follow-up. Br J Surg 1990;77:1358–60.

    PubMed  CAS  Google Scholar 

  11. Leigh RJ, Turnberg LA. Faecal incontinence: the unvoiced symptom. Lancet 1982;1:1349–51.

    Article  PubMed  CAS  Google Scholar 

  12. Phillips SF, Giller J. The contribution of the colon to the electrolyte and water absorption in man. J Lab Clin Med 1973;81:733–46.

    PubMed  CAS  Google Scholar 

  13. Schiller LR. Faecal incontinence. Clin Gastroenterol 1986;15:687–704.

    PubMed  CAS  Google Scholar 

  14. Arhan P, Faverdin C, Persoz B,et al. Relationship between viscoelastic properties of the rectum and anal pressure in man. J Appl Physiol 1976;41:677–82.

    PubMed  CAS  Google Scholar 

  15. Ihre T. Studies on anal function in continent and incontinent patients. Scand J Gastroenterol 1974;9:1–80.

    PubMed  Google Scholar 

  16. Read NW, Harford WV, Schmulen AC, Read MG, Santa Ana C, Fordtran JS. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 1979;76:747–56.

    PubMed  CAS  Google Scholar 

  17. Womack NR, Morrison JF, Williams NS. The role of pelvic floor denervation in the etiology of idiopathic faecal incontinence. Br J Surg 1986;73:404–7.

    PubMed  CAS  Google Scholar 

  18. Rasmussen O, Christensen B, Sorensen M, Tetzschner T, Christiansen J. Rectal compliance in the assessment of patients with fecal incontinence. Dis Colon Rectum 1990;33:650–3.

    PubMed  CAS  Google Scholar 

  19. Read NW, Haynes WE, Bartolo DC,et al. Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. Gastroenterology 1983;85:105–13.

    PubMed  CAS  Google Scholar 

  20. Bartolo DC, Jarrat JA, Read NW. The use of conventional electromyography to assess external sphincter neuropathy in man. J Neurol Neurosurg Psychiatry 1983;46:1115–8.

    PubMed  CAS  Google Scholar 

  21. Allen ML, Orr WC, Robinson MG. Anorectal functioning in fecal incontinence. Dig Dis Sci 1988;33:36–40.

    Article  PubMed  CAS  Google Scholar 

  22. Denis PH, Colin R, Galmiche JP,et al. Elastic properties of the rectal wall in normal adults and in patients with ulcerative colitis. Gastroenterology 1979;77:45–8.

    PubMed  CAS  Google Scholar 

  23. Suzuki H, Fujoka M. Rectal pressure and rectal compliance in ulcerative colitis. Jpn J Surg 1982;12:79–81.

    PubMed  CAS  Google Scholar 

  24. Varma JS, Smith AN, Busuttil A. Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 1985;72:875–8.

    PubMed  CAS  Google Scholar 

  25. Devroede G, Vobecky S, Masse S,et al. Ischemicfecal incontinence and rectal angina. Gastroenterology 1982;83:970–80.

    PubMed  CAS  Google Scholar 

  26. Batignani G, Monaci I, Ficari F, Tonelli F. What affects continence after anterior resection of the rectum? Dis Colon Rectum 1991;34:329–35.

    PubMed  CAS  Google Scholar 

  27. Nasmyth DG, Johnston D, Godwin PG, Dixon MF, Smith A, Williams NS. Factors influencing bowel function after pouch anal anastomosis. Br J Surg 1986;73:469–73.

    PubMed  CAS  Google Scholar 

  28. Carmona JA, Ortiz H, Perez-Cabanas. Alterations in anorectal function after anterior resection for cancer of the rectum. Int J Colorectal Dis 1991;6:108–10.

    Article  PubMed  CAS  Google Scholar 

  29. Suzuki H, Motsumoto K, Amuno J, Fujioka M, Honzumi M. Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 1980;67:655–7.

    PubMed  CAS  Google Scholar 

  30. Williams NS, Price R, Johnston D. The long term effects of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg 1980;67:203–8.

    PubMed  CAS  Google Scholar 

  31. Madoff RD, Orrom WI, Rothenberger DA, Goldberg SM. Rectal compliance: a critical reappraisal. Int J Colorectal Dis 1990;5:37–40.

    Article  PubMed  CAS  Google Scholar 

  32. Parks AG. Anorectal incontinence. J R Soc Med 1975;68:681–90.

    CAS  Google Scholar 

  33. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 1984;310:1282–7.

    Article  PubMed  CAS  Google Scholar 

  34. Goligher JC, Hughes ES. Sensibility of the rectum and colon: its role in the mechanism of anal incontinence. Lancet 1951;1:543–8.

    Article  PubMed  CAS  Google Scholar 

  35. Read NW, Abouzekry L. Why do patients with fecal impaction have fecal incontinence? Gut 1986;27:283–7.

    PubMed  CAS  Google Scholar 

  36. Hancke E, Schurholz M. Impaired rectal sensation in idiopathic faecal incontinence. Int J Colorectal Dis 1987;2:146–8.

    Article  PubMed  CAS  Google Scholar 

  37. Lubowski DZ, Nicholls RJ. Faecal incontinence associated with reduced pelvic sensation. Br J Surg 1988;75:1086–8.

    PubMed  CAS  Google Scholar 

  38. Buser WD, Miner PB Jr. Delayed rectal sensation with fecal incontinence. Gastroenterology 1986;91:1186–91.

    PubMed  CAS  Google Scholar 

  39. Gowers WR. The automatic action of the sphincterani. Proc R Soc Lond 1877;26:77–84.

    Google Scholar 

  40. Denny-Brown D, Robertson EG. An investigation of the nervous control of defecation. Brain 1935;58:256–310.

    Google Scholar 

  41. Duthie HL, Bennett RC. The relation of sensation in the anal canal to the functional sphincter length: a possible factor in anal continence. Gut 1963;4:179–82.

    PubMed  CAS  Google Scholar 

  42. Duthie HL, Gairns FW. Sensory nerve endings and sensation in the anal region in man. Br J Surg 1960;47:585–95.

    PubMed  CAS  Google Scholar 

  43. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 1988;75:44–7.

    PubMed  CAS  Google Scholar 

  44. Roe AM, Bartolo DC, Mortensen NJ. New method for assessment of anal sensation in various anorectal disorders. Br J Surg 1986;73:310–2.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  46. Bielefeldt K, Enck P, Erckenbrecht JF. Sensory and motor function in the maintenance of anal continence. Dis Colon Rectum 1990;33:674–8.

    PubMed  CAS  Google Scholar 

  47. Cornes H, Bartolo DC, Stirra T. Changes in anal canal sensation after childbirth. Br J Surg 1991;78:74–7.

    PubMed  CAS  Google Scholar 

  48. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Differences in anal sensation in continent and incontinent patients with perineal descent. Int J Colorectal Dis 1989;4:45–9.

    Article  PubMed  CAS  Google Scholar 

  49. Keighley MR. Abdominal mucosectomy reduces the incidence of soiling and sphincter damage after restorative proctocolectomy and J-pouch. Dis Colon Rectum 1987;30:386–90.

    PubMed  CAS  Google Scholar 

  50. Johnston D, Holdsworth PJ, Nasmyth DG,et al. Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis. Br J Surg 1987;74:940–5.

    PubMed  CAS  Google Scholar 

  51. King DW, Lubowski DZ, Cook TA. Anal canal mucosa in restorative proctocolectomy for ulcerative colitis. Br J Surg 1989;76:970–2.

    PubMed  CAS  Google Scholar 

  52. O'Connell PR, Williams NS. Mucosectomy in restorative proctocolectomy. Br J Surg 1991;78:129–30.

    PubMed  Google Scholar 

  53. Wexner SD, James K, Jagelman DG. The double-stapled ileal reservoir and ileoanal anastomosis: a prospective review of sphincter function and clinical outcome. Dis Colon Rectum 1991;34:487–94.

    Article  PubMed  CAS  Google Scholar 

  54. Ustach TJ, Tobon F, Hambrecht T, Bass DD, Schuster MM. Electrophysiological aspects of human sphincter function. J Clin Invest 1970;49:41–8.

    Article  PubMed  CAS  Google Scholar 

  55. Dickinson VA. Maintenance of anal continence: a review of pelvic floor physiology. Gut 1978;19; 1163–74.

    PubMed  CAS  Google Scholar 

  56. Meunier P, Mollard P. Control of the internal anal sphincter (manometric study with human subjects). Pflugers Arch 1977;370:233–9.

    Article  PubMed  CAS  Google Scholar 

  57. Lestar B, Penninckx F, Kerremans R. The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis 1989;4:118–22.

    Article  PubMed  CAS  Google Scholar 

  58. Bennett RC, Duthie HL. The functional importance of the internal anal sphincter. Br J Surg 1964;51:355–7.

    PubMed  CAS  Google Scholar 

  59. Duthie HL, Watts JM. Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 1965;6:64–8.

    PubMed  CAS  Google Scholar 

  60. Frenckner B, Euler CH. Influence of pudendal block on the function of the anal sphincters. Gut 1975;16:482–9.

    PubMed  CAS  Google Scholar 

  61. Schweiger M. Method for determining individual contributions of voluntary and involuntary anal sphincters to resting tone. Dis Colon Rectum 1979;22:415–6.

    PubMed  CAS  Google Scholar 

  62. Gibbons CP, Trowbridge EA, Bannister JJ, Read W. Role of anal cushions in maintaining continence. Lancet 1986;1:886–7.

    Article  PubMed  CAS  Google Scholar 

  63. Gibbons CP, Bannister JJ, Trowbridge EA, Read NW. An analysis of anal sphincter pressure and anal compliance in normal subjects. Int J Colorectal Dis 1986;1:231–7.

    PubMed  CAS  Google Scholar 

  64. Sun WM, Read NW, Donnelly TC. Impaired internal anal sphincter in a subgroup of patients with idiopathic fecal incontinence. Gastroenterology 1989;97:130–5.

    PubMed  CAS  Google Scholar 

  65. Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC. The role of transient internal sphincter relaxation in faecal incontinence? Int J Colorectal Dis 1990;5:31–6.

    Article  PubMed  CAS  Google Scholar 

  66. Goligher J. Surgery of the anus rectum and colon. Eastbourne: Bailliere Tindall, 1984:1–47.

    Google Scholar 

  67. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. I. The external anal sphincter: a triple loop system. Invest Urol 1975;12:412.

    PubMed  CAS  Google Scholar 

  68. Russell KP. Anatomy of the pelvic floor, rectum and anal canal. In: Smith LE. Practical guide to anorectal testing. New York: Igaku-Shoin Medical Publishers, 1991;744–7.

    Google Scholar 

  69. Schuster MM. The riddle of the sphincters. Gastroenterology 1975;69:249–62.

    PubMed  CAS  Google Scholar 

  70. Percy JP, Neill ME, Swash M, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1980;1:16–7.

    PubMed  Google Scholar 

  71. Neill ME, Parks AG, Swash M. Physiological studies of the anal sphincter musculature in fecal incontinence and rectal prolapse. Br J Surg 1981;68:531–6.

    PubMed  CAS  Google Scholar 

  72. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. II. Anatomy of the levator ani muscle with special reference to puborectalis. Invest Urol 1975;13:175–82.

    PubMed  CAS  Google Scholar 

  73. Floyd WF, Walls EW. Electromyography of the sphincter ani externus in man. J Physiol 1953;122:599–609.

    PubMed  CAS  Google Scholar 

  74. Johnston MA, Polgar J, Weightman D, Appleton D. Data on the distribution of the fibers types in thirty-six human muscles: an autopsy study. J Neurol Sci 1973;18:111–29.

    Article  PubMed  Google Scholar 

  75. Parks AG, Swash M. Denervation of the anal sphincter causing idiopathic ano-rectal incontinence. J R Coll Surg Edinb 1979;24:94–6.

    PubMed  CAS  Google Scholar 

  76. Swash M. Histopathology of the pelvic floor muscles. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. London: Butterworths, 1985:129–49.

    Google Scholar 

  77. Phillips SF, Edwards DA. Some aspects of anal continence and defaecation. Gut 1965;6:396–406.

    PubMed  CAS  Google Scholar 

  78. Schuster MM, Hookman P, Hendrix TR, Mendeloff AI. Simultaneous manometric recording to internal and external anal sphincter reflexes. Bull Johns Hopkins Hosp 1965;116:79–88.

    PubMed  CAS  Google Scholar 

  79. Duthie HL. Anal continence. Progress report. Gut 1971;12:844–52.

    PubMed  CAS  Google Scholar 

  80. Kuijpers HC, Strijk SP. Diagnosis of disturbances of continence and defecation. Dis Colon Rectum 1984;27:658–62.

    PubMed  CAS  Google Scholar 

  81. Parks AG, Porter NH, Hardcastle J. The syndrome of the descending perineum. J R Soc Med 1966;59:477–82.

    CAS  Google Scholar 

  82. Bartolo DC, Roe AM, Locke-Edmunds JC, Virjee J, Mortensen NJ. Flap-valve theory of anorectal continence. Br J Surg 1986;73:1012–4.

    PubMed  CAS  Google Scholar 

  83. Bannister JJ, Gibbons C, Read NW. Preservation of faecal continence during rises in intra-abdominal pressure: is there a role for the flap valve? Gut 1987;28:1242–5.

    PubMed  CAS  Google Scholar 

  84. Blaisdell PC. Repair of the incontinent sphincter ani. Surg Gynecol Obstet 1940;70:692–7.

    Google Scholar 

  85. Stricker JW, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Surgical correction of anal incontinence. Dis Colon Rectum 1988;31:533–40.

    PubMed  CAS  Google Scholar 

  86. Cherry DA, Greenwald ML. Anal incontinence. In: Beck DE, Wexner SD, eds. Fundamentals of anorectal surgery. New York: McGraw Hill, 1992:104–30.

    Google Scholar 

  87. Shouler PJ, Grimley RP, Keighley MR, Alexander-Williams J. Fistula in ano is usually simple to manage surgically. Int J Colorectal Dis 1986;1:113–5.

    Article  PubMed  CAS  Google Scholar 

  88. Sainio P, Husa A. Fistula in ano. Clinical features and long term results of surgery in 199 adults. Acta Chir Scand 1985;151:169–76.

    PubMed  CAS  Google Scholar 

  89. Belliveau P, Thomson JP, Parks AG. Fistula in ano: a manometric study. Dis Colon Rectum 1983;26:152–4.

    PubMed  CAS  Google Scholar 

  90. Sainio P. A manometric study of anorectal function after surgery for anal fistula, with special reference to incontinence. Acta Chir Scand 1985;151:695–700.

    PubMed  CAS  Google Scholar 

  91. Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg 1991;78:1159–61.

    PubMed  CAS  Google Scholar 

  92. Ramaniyam PS, Prasad ML, Abcarian H. The role of seton in fistulotomy of the anus. Surg Gynecol Obstet 1983;157:419–22.

    PubMed  Google Scholar 

  93. Rothenberger DA, Christenson CE, Balcos EG,et al. Endorectal advancement flap for treatment of simple rectovaginal fistula. Dis Colon Rectum 1982;25:297–300.

    PubMed  CAS  Google Scholar 

  94. Jones IT, Fazio VW, Jagelman DG. The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 1987;30:919–23.

    PubMed  CAS  Google Scholar 

  95. Arabia Y, Gatehouse D, Alexander-Williams J,et al. Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of hemorrhoids. Br J Surg 1977;64:737–40.

    PubMed  Google Scholar 

  96. El-Gendi MA-F, Abdel-Baky N. Anorectal pressure in patients with symptomatic hemorrhoids. Dis Colon Rectum 1986;29:388–91.

    PubMed  CAS  Google Scholar 

  97. Deutsch AA, Moshkovitz M, Nudelman I, Dinari G, Reiss R. Anal pressure measurements in the study of hemorrhoid etiology and their relation to treatment. Dis Colon Rectum 1987;30:855–7.

    PubMed  CAS  Google Scholar 

  98. Roe AM, Bartolo DC, Vellacot KD, Locke-Edmunds J, McMortensen C. Submucosal versus excisional haemorrhoidectomy: a comparison of anal sensation, anal sphincter manometry and postoperative pain and function. Br J Surg 1987;74:948–51.

    PubMed  CAS  Google Scholar 

  99. Lord PH. A new regime for the treatment of haemorrhoids. J R Soc Med 1968;61:935.

    CAS  Google Scholar 

  100. Goligher JC, Graham NG, Clark CG, de Dombal FT, Giles G. The value of stretching the sphincters in relief of post haemorrhoidectomy pain. Br J Surg 1969;64:609.

    Google Scholar 

  101. Hancock BD. Lord's procedure for haemorrhoids: a prospective anal pressure study. Br J Surg 1981;68:729–30.

    PubMed  CAS  Google Scholar 

  102. Snooks SJ, Henry MM, Swash M. Faecal incontinence after anal dilatation. Br J Surg 1984;71:617–8.

    PubMed  CAS  Google Scholar 

  103. Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg 1991;78:1429–30.

    PubMed  CAS  Google Scholar 

  104. Snooks SJ, Henry MM, Swash M. Faecal incontinence due to external anal sphincter division in childbirth is associated with damage to the innervation of the pelvic floor musculature: a double pathology. Br J Obstet Gynaecol 1985;92:824–8.

    PubMed  CAS  Google Scholar 

  105. Thacker SB, Banta HD. Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980. Obstet Gynecol Surv 1983;38:322–38.

    PubMed  CAS  Google Scholar 

  106. Haadem K, Dahlstrom JA, Ling L, Ohrlander S. Anal sphincter function after delivery rupture. Obstet Gynecol 1987;70:53–6.

    PubMed  CAS  Google Scholar 

  107. Harris RE. An evaluation of the median episiotomy. Am J Obstet Gynecol 1970;106:660–5.

    PubMed  CAS  Google Scholar 

  108. Venkatesh KS, Ramanujam PS, Larson DM, Haywood MA. Anorectal complications of vaginal delivery. Dis Colon Rectum 1989;32:1039–41.

    PubMed  CAS  Google Scholar 

  109. Kaltreider DF, Dixon DM. Study of 710 complete lacerations following central episiotomy. South Med J 1948;41:814–20.

    PubMed  CAS  Google Scholar 

  110. Roberts PL, Coller JA, Schoetz DJ Jr, Veidenheimer MC. Manometric assessment of patients with obstetric injuries and fecal incontinence. Dis Colon Rectum 1990;33:16–20.

    Article  PubMed  CAS  Google Scholar 

  111. Coats PM, Chan KK, Wilkins M, Beard RJ. A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 1980;87:408–12.

    PubMed  CAS  Google Scholar 

  112. Jacobs PP, Scheuer M, Kuijpers JH, Vingerhoets MH. Obstetric fecal incontinence: role of pelvic floor denervation and results of delayed sphincter repair. Dis Colon Rectum 1990;33:494–7.

    Article  PubMed  CAS  Google Scholar 

  113. Neill ME, Swash M. Increased motor unit fibre density in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.

    PubMed  CAS  Google Scholar 

  114. Henry MM, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg 1982;69:470–2.

    PubMed  CAS  Google Scholar 

  115. Bartolo DC, Jarrat T, Read MG, Donnelly TC, Read NW. The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 1983;70:664–7.

    PubMed  CAS  Google Scholar 

  116. Beersiek F, Parks AG, Swash M. Pathogenesis of anorectal incontinence: a histometric study of the anal sphincter musculature. J Neurol Sci 1979;42:111–27.

    Article  PubMed  CAS  Google Scholar 

  117. Snooks SJ, Barnes PR, Swash M. Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence. J Neurol Neurosurg Psychiatry 1984;47:1269–73.

    PubMed  CAS  Google Scholar 

  118. Jones PN, Lubowski DZ, Swash S, Henry MM. Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence. Int J Colorectal Dis 1987;2:93–5.

    Article  PubMed  CAS  Google Scholar 

  119. Kiff ES, Barnes PR, Swash M. Evidence of pudendal neuropathy in patients with perineal descent and chronic straining at stool. Gut 1984;25:1279–82.

    PubMed  CAS  Google Scholar 

  120. Read NW, Bartolo DC, Read MG. Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 1984;71:39–42.

    PubMed  CAS  Google Scholar 

  121. Jorge JM, Wexner SD, Ehrenpreis E, Nogueras JJ, Jagelman DG. Does perineal descent correlate with pudendal neuropathy? (Meeting abstr) Dis Colon Rectum 1992;35:P11–2.

    Article  Google Scholar 

  122. Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989;32:737–42.

    PubMed  CAS  Google Scholar 

  123. Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.

    PubMed  CAS  Google Scholar 

  124. McHugh SM, Diamant NE. Effect of age, gender and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 1987;32:726–36.

    Article  PubMed  CAS  Google Scholar 

  125. Matheson DM, Keighley MR. Manometric evaluation of rectal prolapse and faecal incontinence. Gut 1981;22:126–9.

    PubMed  CAS  Google Scholar 

  126. Burnett SJ, Bartram CI. Endosonographic variations in the normal internal anal sphincter. Int J Colorectal Dis 1991;6:2–4.

    Article  PubMed  CAS  Google Scholar 

  127. Klosterhalfen B, Offner F, Topf N, Vogel P, Mittermayer C. Sclerosis of the internal anal sphincter—a process of aging. Dis Colon Rectum 1990;33:606–9.

    PubMed  CAS  Google Scholar 

  128. Gardner E. Decrease in human motor neurones with age. Anat Rec 1940;77:529–36.

    Article  Google Scholar 

  129. Percy JP, Neill ME, Kandiah TK, Swash M. A neurogenic factor in faecal incontinence in the elderly. Age Ageing 1982;11:175–9.

    PubMed  CAS  Google Scholar 

  130. Broden G, Dolk A, Holmstrom B. Recovery of the internal anal sphincter following rectopexy: a possible explanation for incontinence improvement. Int J Colorectal Dis 1988;3;23–8.

    Article  PubMed  CAS  Google Scholar 

  131. Yoshioka K, Heyen F, Keighley MR. Functional results after posterior abdominal rectopexy for rectal prolapse. Dis Colon Rectum 1989;32:835–8.

    PubMed  CAS  Google Scholar 

  132. Williams JG, Wong WD, Jensen L, Rothenberger DA, Goldberg SM. Incontinence and rectal prolapse: a prospective manometric study. Dis Colon Rectum 1991;34:209–16.

    PubMed  CAS  Google Scholar 

  133. Frenckner B, Ihre T. Function of the anal sphincters in patients with intussusception of the rectum. Gut 1976;17:147–55.

    PubMed  CAS  Google Scholar 

  134. Holmstrom B, Broden G, Dolk A, Frenckner B. Increased anal resting pressure following the Ripstein operation: a contribution to continence? Dis Colon Rectum 1986;29:485–7.

    PubMed  CAS  Google Scholar 

  135. Ihre T, Seligson U. Intussusception of the rectum—internal procidentia: treatment and results in 90 patients. Dis Colon Rectum 1975;18:391–6.

    PubMed  CAS  Google Scholar 

  136. Parks AG, Swash M, Urich H. Sphincter denervation in ano-rectal incontinence and rectal prolapse. Gut 1977;18:656–65.

    PubMed  CAS  Google Scholar 

  137. Snooks SJ, Henry MM, Swash M. Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut 1985;26:470–6.

    PubMed  CAS  Google Scholar 

  138. Habr-Gama A, Engler-Pinto P Jr, Jatoba P, Gama-Rodrigues J, Goffi F. Rectal prolapse. Results of treatment. Coloproctology 1983;5:4–7.

    Google Scholar 

  139. Schiller LR, Santa Ana CA, Schmulen AC, Hendler RS, Harford WV, Fordtran JS. Pathogenesis of fecal incontinence in diabetes mellitus. Evidence for internal-anal-sphincter dysfunction. N Engl J Med 1982;307:1666–71.

    Article  PubMed  CAS  Google Scholar 

  140. Rogers J, Levy DM, Henry MM, Misiewicz JJ. Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut 1988;29:756–61.

    PubMed  CAS  Google Scholar 

  141. Longo WE, Ballantyne GH, Modlin IM. The colon, anorectum, and spinal cord patient: functional alterations of the denervated hindgut. Dis Colon Rectum 1989;32:261–7.

    PubMed  CAS  Google Scholar 

  142. Schoetz DJ Jr. Operative therapy for anal incontinence. Surg Clin North Am 1985;65:35–46.

    PubMed  Google Scholar 

  143. Chantraine A, Lloyd K, Swinyard CA. The sphincter ani externus in spina bifida and myelomeningocele. J Urol 1966;95:250–6.

    PubMed  CAS  Google Scholar 

  144. Miller R, Bartolo DC, Locke-Edmunds JC, Mortensen NJ. Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 1988;75:101–5.

    PubMed  CAS  Google Scholar 

  145. Rothenberger DA. Anal incontinence. In: Cameron JL, ed. Current surgical therapy—3. Philadelphia: BC Decker, 1986:185–94.

    Google Scholar 

  146. Karulf RE, Coller JA, Bartolo DC,et al. Anorectal physiology testing: a survey of availability and use. Dis Colon Rectum 1991;34:464–8.

    Article  PubMed  CAS  Google Scholar 

  147. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987;16:17–33.

    PubMed  CAS  Google Scholar 

  148. Schouten WR, van Vroonhoven TJ. A simple method of anorectal manometry. Dis Colon Rectum 1983;26:721–4.

    PubMed  CAS  Google Scholar 

  149. Varma JS, Smith AN. Anorectal profilimetry with the microtransducer. Br J Surg 1984;71:867–9.

    PubMed  CAS  Google Scholar 

  150. Hiltunen K-M. Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 1985;28:925–8.

    PubMed  CAS  Google Scholar 

  151. Enck P, Kuhlbusch R, Lubke H, Frieling T, Erckenbrecht JF. Age and sex and anorectal manometry in incontinence. Dis Colon Rectum 1989;32:1026–30.

    PubMed  CAS  Google Scholar 

  152. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Anorectal function investigations in incontinent and continent patients: differences and discriminatory value. Dis Colon Rectum 1990;33:479–86.

    Article  PubMed  CAS  Google Scholar 

  153. Taylor BM, Beart RW Jr, Phillips SF. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology 1984;86:693–7.

    PubMed  CAS  Google Scholar 

  154. Perry RE, Blatchford GJ, Christensen MA, Thorson AG, Attwood SE. Manometric diagnosis of anal sphincter injuries. Am J Surg 1990;159:112–7.

    PubMed  CAS  Google Scholar 

  155. Bartolo DC, Jarrat JA, Read NW. The use of conventional electromyography to assess external sphincter neuropathy in man. J Neurol Neurosurg Psychiatry 1983;46:1115–8.

    PubMed  CAS  Google Scholar 

  156. Wexner SD, Marchetti F, Salanga VD, Corredor C, Jagelman DG. Neurophysiologic assessment of the anal sphincters. Dis Colon Rectum 1991;34:606–12.

    Article  PubMed  CAS  Google Scholar 

  157. Binnie NR, Kawimbe BM, Papachrysostomou M, Clare N, Smith AN. The importance of the orientation of the electrode plates in recording the external anal sphincter EMG by non-invasive anal plug electrodes. Int J Colorectal Dis 1991;6:5–8.

    Article  PubMed  CAS  Google Scholar 

  158. Pinho M, Hosie K, Bielecki K, Keighley MR. Assessment of noninvasive intra-anal electromyography to evaluate sphincter function. Dis Colon Rectum 1991;34:69–71.

    Article  PubMed  CAS  Google Scholar 

  159. Kiff ES, Swash M. Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry 1984;47:820–3.

    Article  PubMed  CAS  Google Scholar 

  160. Snooks SJ, Swash M. Nerve stimulation techniques. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor. London: Butterworths, 1985:112–28.

    Google Scholar 

  161. Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.

    Article  PubMed  CAS  Google Scholar 

  162. Laurberg S, Swash M, Henry MM. Delayed external sphincter repair for obstetric tear. Br J Surg 1988;75:786–8.

    PubMed  CAS  Google Scholar 

  163. Wunderlich M, Swash M. The overlapping innervation of the two sides of the external anal sphincter by the pudendal nerve. J Neurol Sci 1983;59:97–109.

    Article  PubMed  CAS  Google Scholar 

  164. Swash M, Snooks SJ, Henry MM. Unifying concept of pelvic floor disorders and incontinence. J R Soc Med 1985;78:906–11.

    PubMed  CAS  Google Scholar 

  165. Snooks SJ, Henry MM, Swash M. Abnormalities in central and peripheral nerve conduction in anorectal incontinence. J R Soc Med 1985;78:294–300.

    PubMed  CAS  Google Scholar 

  166. Mahieu P, Pringot J, Bodart P. Defecography I: description of a new procedure and results in normal patients. Gastrointest Radiol 1984;9:247–51.

    Article  PubMed  CAS  Google Scholar 

  167. Hardcastle DJ, Parks AG. A study of anal incontinence and some principles of surgical treatment. J R Soc Med 1970;63(suppl):116–18.

    Google Scholar 

  168. Kuijpers J. Fecal incontinence and the anorectal angle. Neth J Surg 1971;36:20–3.

    Google Scholar 

  169. Womack NR, Morrison JF, Williams NS. Prospective study of the effects of post anal repair in neurogenic faecal incontinence. Br J Surg 1988;75:48–52.

    PubMed  CAS  Google Scholar 

  170. Preston DM, Lennard-Jones JE, Thomas BM. The balloon proctogram. Br J Surg 1984;71:29–32.

    PubMed  CAS  Google Scholar 

  171. Lahr CJ, Rothenberger DA, Jensen LL, Goldberg SM. Balloon topography: a simple method of evaluating anal function. Dis Colon Rectum 1986;29:1–5.

    PubMed  CAS  Google Scholar 

  172. Jorge JM, Wexner SD, Marchetti F, Rosato GO, Sullivan ML, Jagelman DG. How reliable are currently available methods of measuring the anorectal angle? Dis Colon Rectum 1992;35:332–8.

    Article  PubMed  CAS  Google Scholar 

  173. Law PJ, Kamm MA, Bartram CI. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum 1990;33:370–3.

    PubMed  CAS  Google Scholar 

  174. Cuesta MA, Meijer S, Derksen EJ, Boutkan H, Meuwissen SG. Anal sphincter imaging in fecal incontinence using endosonography. Dis Colon Rectum 1992;35:59–63.

    PubMed  CAS  Google Scholar 

  175. Burnett SJ, Speakman CT, Kamm MA, Bartram CI. Confirmation of endosonographic detection of external anal sphincter defects by simultaneous electromyographic mapping. Br J Surg 1991;78:448–50.

    PubMed  CAS  Google Scholar 

  176. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal temperature sensation: a comparison of normal and incontinent patients. Br J Surg 1987;74:511–5.

    PubMed  CAS  Google Scholar 

  177. Schmitt SL, Wexner SD. Anterior and posterior sphincter repair. Semin Colon Rectal Surg 1992;3:92–7.

    Google Scholar 

  178. Harford WV, Krejs GJ, Santa Ana CA, Fordtran JS. Acute effect of diphenoxylate with atropine (Lomotil) in patients with chronic diarrhea and fecal incontinence. Gastroenterology 1980;78:440–3.

    PubMed  CAS  Google Scholar 

  179. Read M, Read MW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 1982;27:807–14.

    Article  PubMed  CAS  Google Scholar 

  180. Keighley MR, Fielding JW. Management of faecal incontinence and results of surgical treatment. Br J Surg 1983;70:463–8.

    PubMed  CAS  Google Scholar 

  181. Binnie NR, Kawimbe BM, Papachrysostomou M, Smith AN. Use of the pudendoanal reflex in the treatment of neurogenic fecal incontinence. Gut 1990;31:1051–5.

    PubMed  CAS  Google Scholar 

  182. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning to rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med 1974;29:646–9.

    Article  Google Scholar 

  183. Cerulli MA, Nikoomanesh P, Schuster MM. Progress in biofeedback conditioning for fecal incontinence. Gastroenterology 1979;76:742–6.

    PubMed  CAS  Google Scholar 

  184. Wald A. Biofeedback for neurogenic fecal incontinence: rectal sensation is a determinant of outcome. J Pediatr Gastroenterol Nutr 1983;2:302–6.

    PubMed  CAS  Google Scholar 

  185. Constantinides CG, Cywes S. Fecal incontinence: a simple pneumatic device for home biofeedback training. J Pediatr Surg 1983;18:276–7.

    PubMed  CAS  Google Scholar 

  186. Whitehead WE, Burgio KL, Engel BT. Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc 1985;33:320–4.

    PubMed  CAS  Google Scholar 

  187. MacLeod JH. Management of anal incontinence by biofeedback. Gastroenterology 1987;93:291–4.

    PubMed  CAS  Google Scholar 

  188. Ruiboli EB, Francio M, Pitto G, Reboa G, Zanolla R. Biofeedback conditioning for fecal incontinence. Arch Phys Med Rehabil 1988;69:29–31.

    PubMed  Google Scholar 

  189. Jensen LL, Lowry AC. Biofeedback: a viable treatment option for anal incontinence. (Meeting abstr) Dis Colon Rectum 1991;34:P6.

    Google Scholar 

  190. Ferguson GH, Redford J, Barrett JA, Kiff ES. The appreciation of rectal distension in fecal incontinence. Dis Colon Rectum 1989;32:964–7.

    PubMed  CAS  Google Scholar 

  191. Corman ML. Anal incontinence. In: Corman ML, ed. Colon and rectal surgery. 2nd ed. Philadelphia: JB Lippincott, 1989;171–207.

    Google Scholar 

  192. Browning GG, Parks AG. Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 1983;70:101–4.

    PubMed  CAS  Google Scholar 

  193. Browning GG, Motson RW. Anal sphincter injury: management and results of Parks sphincter repair. Ann Surg 1984;199:351–7.

    PubMed  CAS  Google Scholar 

  194. Arnaud A, Sarles JC, Sielezneff I, Orsoni P, Joly A. Sphincter repair without overlapping for fecal incontinence. Dis Colon Rectum 1991;34:744–7.

    Article  PubMed  CAS  Google Scholar 

  195. Nesselrod JP. Proctology in general practice. Philadelphia: WB Saunders, 1950.

    Google Scholar 

  196. Scheuer M, Kuijpers HC, Jacobs PP. Postanal repair restores anatomy rather than function. Dis Colon Rectum 1989;32:960–3.

    PubMed  CAS  Google Scholar 

  197. Orrom WJ, Miller R, Cornes H, Duthie G, Mortensen NJ, Bartolo DC. Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic fecal incontinence. Dis Colon Rectum 1991;34:305–10.

    Article  PubMed  CAS  Google Scholar 

  198. Laurberg S, Swash M, Henry MM. Effect of post anal repair on progress of neurogenic damage to the pelvic floor. Br J Surg 1990;77:519–22.

    PubMed  CAS  Google Scholar 

  199. Ferguson EF. Puborectalis sphincteroplasty for anal incontinence. South Med J 1984;77:423–5.

    PubMed  Google Scholar 

  200. Habr-Gama A, Alves PA, da Silva e Souza AH, Femenia Vieira MJ, Brunetti-Netto C. Treatment of faecal incontinence by postanal repair. Coloproctology 1986;8:244–6.

    Google Scholar 

  201. Keighley MR, Oya M, Oritz J, Pinho M, Asperer J, Chattaphaday G. What is the optimum pelvic floor repair for neuropathic fecal incontinence? (Meeting abstr) Dis Colon Rectum 1991;34:P6.

    Google Scholar 

  202. Parks AG, McPartlin JF. Later repair of injuries of the anal sphincter. J R Soc Med 1971;64:1187–9.

    CAS  Google Scholar 

  203. Slade MS, Goldberg SM, Schottler JL, Balcos EG, Christenson CE. Sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 1977;20:33–5.

    PubMed  CAS  Google Scholar 

  204. Christiansen J, Pedersen IK. Traumatic anal incontinence: results of surgical repair. Dis Colon Rectum 1987;30:189–91.

    PubMed  CAS  Google Scholar 

  205. Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA. Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 1984;27:720–2.

    PubMed  CAS  Google Scholar 

  206. Fleshman JW, Peters WR, Shemesh EI, Fry RD, Kodner IJ. Anal sphincter reconstruction: anterior overlapping muscle repair. Dis Colon Rectum 1991;34:739–43.

    Article  PubMed  CAS  Google Scholar 

  207. Ctercteko GC, Fazio VW, Jagelman DG, Lavery IC, Weakley FL, Melia M. Anal sphincter repair: a report of 60 cases and a review of the literature. Aust N Z J Surg 1988;58:703–10.

    PubMed  CAS  Google Scholar 

  208. Motson RW. Sphincter injuries: indications for, and results of sphincter repair. Br J Surg 1985;72:519–21.

    PubMed  Google Scholar 

  209. Pezim ME, Spencer RJ, Stanhope CR, Beart RW Jr, Ready RL, Ilstrup DM. Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury. Dis Colon Rectum 1987;30:521–5.

    PubMed  CAS  Google Scholar 

  210. Abcarian H, Orsay CP, Pearl RK, Nelson RL, Briley SC. Traumatic cloaca. Dis Colon Rectum 1989;32:783–7.

    PubMed  CAS  Google Scholar 

  211. Stern H, Gallinger S, Rabau M, Ross T. Surgical treatment of anal incontinence. Can J Surg 1987;30:348–50.

    PubMed  CAS  Google Scholar 

  212. Yoshioka K, Keighley MR. Sphincter repair for fecal incontinence. Dis Colon Rectum 1989;32:39–42.

    PubMed  CAS  Google Scholar 

  213. Fleshman JW, Dreznick Z, Fry RD, Kodner IJ. Anal sphincter repair for obstetric injury: manometric evaluation of functional results. Dis Colon Rectum 1991;34:1061–7.

    Article  PubMed  CAS  Google Scholar 

  214. Labow S, Rubin RJ, Hoexter B, Salvati EP. Perineal repair of rectal procidentia with an elastic fabric sling. Dis Colon Rectum 1980;23:467–9.

    Article  PubMed  CAS  Google Scholar 

  215. Horn HR, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Sphincter repair with a Silastic® sling for anal incontinence and rectal procidentia. Dis Colon Rectum 1985;28:868–72.

    PubMed  CAS  Google Scholar 

  216. Pickrell KL, Broadbent IR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle. A report of four cases in children. Ann Surg 1952;135:853–62.

    PubMed  CAS  Google Scholar 

  217. Corman ML. Gracilis muscle transposition. Contemp Surg 1978;13:9–16.

    PubMed  Google Scholar 

  218. Simonsen OS, Stolf NA, Aun F, Raia A, Habr-Gama A. Rectal sphincter reconstruction in perineal colostomies after abdominoperineal resection for cancer. Br J Surg 1976;63:389–91.

    PubMed  CAS  Google Scholar 

  219. Corman ML. Follow-up evaluation of gracilis muscle transposition for fecal incontinence. Dis Colon Rectum 1980;23:552–5.

    PubMed  CAS  Google Scholar 

  220. Corman ML. Gracilis muscle transposition for anal incontinence: late results. Br J Surg 1985;72:521–2.

    Google Scholar 

  221. Leguit P Jr, van Baal JG, Brummelkamp WH. Gracilis muscle transposition in the treatment of fecal incontinence: long-term follow-up and evaluation of anal pressure recordings. Dis Colon Rectum 1985;28:1–4.

    PubMed  Google Scholar 

  222. Yoshioka K, Keighley MR. Clinical and manometric assessment of gracilis muscle transplant for fecal incontinence. Dis Colon Rectum 1988;31:767–9.

    PubMed  CAS  Google Scholar 

  223. Chittenden AS. Reconstruction of the anal sphincter by muscle slips from the glutei. Ann Surg 1930;92:152–4.

    Google Scholar 

  224. Hentz VR. Construction of a rectal sphincter using the origin of the gluteus maximus muscle. Plast Reconstr Surg 1982;70:82–5.

    PubMed  CAS  Google Scholar 

  225. Iwai N, Kaneda H, Tsuto T, Yanagihara J, Takahashi T. Objective assessment of anorectal function after sphincter reconstruction using the gluteus maximus muscle: report of a case. Dis Colon Rectum 1985;28:973–7.

    PubMed  CAS  Google Scholar 

  226. Pearl RK, Prasad ML, Nelson RL, Orsay CP, Abcarian H. Bilateral gluteus maximus transportation for anal incontinence. Dis Colon Rectum 1991;34:478–81.

    Article  PubMed  CAS  Google Scholar 

  227. Stone HB, Plastic operation for anal incontinence. Trans South Surg Assoc 1928;41:235–40.

    Google Scholar 

  228. Stone HB. Plastic operation for anal incontinence. Arch Surg 1929;18:845–85.

    Google Scholar 

  229. Stone HB, McLanahan S. Results with the fascia plastic operation for anal incontinence. Ann Surg 1941;114:73–7.

    PubMed  CAS  Google Scholar 

  230. Ingelman-Sundberg A. Plastic repair for extensive defects of the anal sphincter. Acta Chir Scand 1951;101:155–7.

    PubMed  CAS  Google Scholar 

  231. State D, Katz A. The use of the superficial transverse perineal muscles in the treatment of post surgical anal incontinence. Ann Surg 1955;142:262–5.

    PubMed  CAS  Google Scholar 

  232. Hakelius L. Free autogenous muscle transplantation in two cases of total anal incontinence. Acta Chir Scand 1975;141:69–75.

    Google Scholar 

  233. Caldwell KP. The electrical control of sphincter incompetence. Lancet 1963;2:174–5.

    Article  PubMed  CAS  Google Scholar 

  234. Williams NS, Hallan RI, Koeze TH, Watkins ES. Restoration of gastrointestinal continuity and continence after abdominoperineal excision of the rectum using an electrically stimulated neoanal sphincter. Dis Colon Rectum 1990;33:561–5.

    PubMed  CAS  Google Scholar 

  235. Hallan RI, Williams NS, Hutton MR,et al. Electrically stimulated sartorius neosphincter: canine model of activation and skeletal muscle transformation. Br J Surg 1990;77:208–13.

    PubMed  CAS  Google Scholar 

  236. Salmons S, Henriksson J. The adoptive response of skeletal muscle to increased use. Muscle Nerve 1981;4:94–105.

    Article  PubMed  CAS  Google Scholar 

  237. Matzel KE, Schmidt RA, Tanagho EA. Neuroanatomy of the striated muscular anal continence mechanism: implications for the use of neurostimulation. Dis Colon Rectum 1990;33:666–73.

    PubMed  CAS  Google Scholar 

  238. George BD, Williams NS. Electrically stimulated gracilis neoanal sphincter. Semin Colorect Surg 1992;3:104–9.

    Google Scholar 

  239. Christiansen J, Lorentzen M. Implantation of artificial sphincter for anal incontinence. Lancet 1987;2:244–5.

    Article  PubMed  CAS  Google Scholar 

  240. Christiansen J, Lorentzen M. Implantation of artificial sphincter for anal incontinence: report of five cases. Dis Colon Rectum 1989;32:432–6.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida

    J. Marcio N. Jorge M.D. & Steven D. Wexner M.D.

Authors
  1. J. Marcio N. Jorge M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven D. Wexner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Jorge, J.M.N., Wexner, S.D. Etiology and management of fecal incontinence. Dis Colon Rectum 36, 77–97 (1993). https://doi.org/10.1007/BF02050307

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02050307

Key words

Search

Navigation