Abstract
Anorectal function was prospectively evaluated in 43 consecutive patients with fecal incontinence and in 19 healthy volunteers using manometry and electrical stimulation of the anoderm. Both anorectal motor and sensory function was impaired in incontinent patients as compared with healthy controls. Further statistical analysis identified four subgroups of patients showing different pathomechanisms of fecal incontinence: severe combined anorectal motor and sensory dysfunction, isolated anal sphincter dysfunction, isolated anorectal sensory dysfunction, and combined dysfunction of the internal anal sphincter and impaired anorectal sensitivity. These data support the hypothesis that sensory function of both the rectum and the anal canal is an important and independent factor in the preservation of continence.
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References
Goligher JC, Hughes ES. Sensibility of the rectum and the colon—its role in the mechanism of anal continence. Lancet 1951;1:543–8.
Duthie HL. Defecation and the anal sphincters. Clin Gastroenterol 1982;11:621–31.
Schiller LR. Fecal incontinence. Clin Gastroenterol 1986;15:687–704.
Bielefeldt K, Enck P, Wienbeck M. Diagnosis and treatment of fecal incontinence. Dig Dis Sci 1990;8:179–88.
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.
Hiltunen KM. Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 1985;28:925–8.
Rogers J, Henry MM, Misiewicz JJ. Combined sensory and motor deficit in primary faecal incontinence. Gut 1988;29:5–9.
Sun WM, Read NW, Donnelly TC. Impaired internal anal sphincter function in a subgroup of patients with idiopathic fecal incontinence. Gastroenterology 1989;97:130–5.
Duthie HL, Bennett RC. The relation of sensation in the anal canal to the functional anal sphicter: a possible factor in anal continence. Gut 1963;4:179–82.
Ihre T. Studies on anal function in continent and incontinent patients. Scand J Gastroenterol 1974;9:suppl 24:7–55.
Schiller LR, Santa Ana C, Schmulen AC, Hendler RS, Harford WV, Fordtran JS. Pathogenesis of fecal incontinence in diabetes mellitus. N Engl J Med 1982;307:1666–71.
Buser WA, Miner PB. Delayed rectal sensation with fecal incontinence—successful treatment usind anorectal manometry. Gastroenterology 1986;91:1186–91.
Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence? Gut 1986;27:283–7.
Miller R, Bartolo DC, Roe A, Cervero F, Mortensen NJ. Anal sensation and the continence mechanism. Dis Colon Rectum 1988;31:433–8.
Wood B. Anatomy of the anal sphincters and the pelvic floor In: Henry MM, Swash M. Coloproctology and the pelvic floor. London: Butterworths, 1985:3–21.
Kiff ES, Swash M. Slowed conduction in the pundendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 1984;71:614–6.
Neil ME, Swash M. Increased motor unit fibre densitiy in the external anal sphincter muscle in anorectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry 1980;43:343–7.
Frieling T, Enck P, Wienbeck M. Cerebral responses evoked by electrical stimulation of the rectosigmoid in normal subjects. Dig Dis Sci 1989;34:202–5.
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Supported by a grant from the “Deutsche Forschungsgemeinschaft” (Er 142/1-1).
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Bielefeldt, K., Enck, P. & Erckenbrecht, J.F. Sensory and motor function in the maintenance of anal continence. Dis Colon Rectum 33, 674–678 (1990). https://doi.org/10.1007/BF02150743
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DOI: https://doi.org/10.1007/BF02150743