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Subtypes of Anal Incontinence Associated With Bowel Dysfunction: Clinical, Physiologic, and Psychosocial Characterization

  • Original Contributions
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Diseases of the Colon & Rectum

BACKGROUND

We hypothesized that functional anal incontinence with no structural explanation comprises distinct pathophysiologic subgroups that could be identified on the basis of the predominant presenting bowel pattern.

METHODS

Consecutive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incontinence only, 2) incontinence + constipation, 3) incontinence + diarrhea, and 4) incontinence + alternating bowel symptoms. The Hopkins Bowel Symptom Questionnaire, the Symptom Checklist 90-R, and anorectal manometry were completed.

RESULTS

Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the highest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressures were significantly higher in alternating patients (P = 0.03). Contractile pressures in the distal anal canal were diminished in the incontinent-only and diarrhea groups (P = 0.004). Constipated patients with incontinence exhibited elevated thresholds for the urge to defecate (P = 0.027). Dyssynergia was significantly more frequent in patients with incontinence and constipation or alternating bowel patterns.

CONCLUSIONS

Distinct patterns of pelvic floor dysfunction were identified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different pathophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.

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REFERENCES

  1. R Nelson N Norton E Cautley S Furner (1995) ArticleTitleCommunity-based prevalence of anal incontinence JAMA 274 559–61 Occurrence Handle10.1001/jama.274.7.559 Occurrence Handle1:STN:280:ByqA2MnjsVM%3D Occurrence Handle7629985

    Article  CAS  PubMed  Google Scholar 

  2. MJ Cheetham AJ Malouf MA Kamm (2001) ArticleTitleFecal incontinence Gastroenterol Clin North Am 30 115–30 Occurrence Handle1:STN:280:DC%2BD3Mzis12lsg%3D%3D Occurrence Handle11394026

    CAS  PubMed  Google Scholar 

  3. Van Nostrand JF, Zappolo A, Hing E, Bloom B, Hirsch B, Foley DJ. The national nursing home survey: 1977 summary for the United States (DHEW Publication No. PHS 79-1794).

  4. DM Matheson MR Keighley (1981) ArticleTitleManometric evaluation of rectal prolapse and faecal incontinence Gut 22 126–9 Occurrence Handle1:STN:280:Bi6C28rnsVM%3D Occurrence Handle7215942

    CAS  PubMed  Google Scholar 

  5. M Wells (1996) ArticleTitleContinence following childbirth Br J Nurs 5 353–4 Occurrence Handle1:STN:280:BymA2cvotVY%3D Occurrence Handle8704463

    CAS  PubMed  Google Scholar 

  6. C MacArthur DE Bick MR Keighley (1997) ArticleTitleFaecal incontinence after childbirth Br J Obst Gynaecol 104 46–50 Occurrence Handle1:STN:280:ByiC2c3mslA%3D

    CAS  Google Scholar 

  7. CJ Walsh EF Mooney GJ Upton RW Motson (1996) ArticleTitleIncidence of third-degree tears in labour and outcome after primary repair Br J Surg 83 218–21 Occurrence Handle10.1046/j.1365-2168.1996.02043.x Occurrence Handle1:STN:280:BymB2cnpslQ%3D Occurrence Handle8689168

    Article  CAS  PubMed  Google Scholar 

  8. MD Levine (1975) ArticleTitleChildren with encopresis: a descriptive analysis Pediatrics 56 412–6 Occurrence Handle1:STN:280:CSmD3M7lslE%3D Occurrence Handle1161398

    CAS  PubMed  Google Scholar 

  9. Whitehead WE, Schuster MM. Gastrointestinal disorders: behavioral and physiological basis for treatment. New York: Academic Press, 1985;229–75.

  10. WE Whitehead A Wald NE Diamant P Enck JH Pemberton SS Rao (1999) ArticleTitleFunctional disorders of the anus and rectum Gut 45 1155–9

    Google Scholar 

  11. V Loening-baucke (1989) ArticleTitleFactors determining outcome in children with chronic constipation and faecal soiling Gut 5 346–51

    Google Scholar 

  12. NW Read L Abouzekry (1986) ArticleTitleWhy do patients with faecal impaction have faecal incontinence? Gut 27 283–7 Occurrence Handle1:STN:280:BimC1MzntFA%3D Occurrence Handle3699548

    CAS  PubMed  Google Scholar 

  13. DA Drossman RS Sandler CM Broom DC McKee (1986) ArticleTitleUrgency and fecal soiling in people with bowel dysfunction Dig Dis Sci 31 1221–5 Occurrence Handle1:STN:280:BiiD38bns1A%3D Occurrence Handle3769707

    CAS  PubMed  Google Scholar 

  14. MD Crowell NH Dubin JC Robinson et al. (1994) ArticleTitleFunctional bowel disorders in women with dysmenorrhea Am J Gastroenterol 89 1973–7 Occurrence Handle1:STN:280:ByqD38bitlA%3D Occurrence Handle7942720

    CAS  PubMed  Google Scholar 

  15. WE Whitehead MD Crowell JC Robinson et al. (1992) ArticleTitleEffects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction Gut 33 825–30 Occurrence Handle1:STN:280:By2A38vmsFI%3D Occurrence Handle1624167

    CAS  PubMed  Google Scholar 

  16. LR Derogatis K Rickels AF Rock (1976) ArticleTitleThe SCL-90 and the MMPI: a step in the validation of a new self-report scale Br J Psychiatry 128 280–9 Occurrence Handle1:STN:280:CSmC3sjgtVI%3D Occurrence Handle1252693

    CAS  PubMed  Google Scholar 

  17. AJ Malouf MG Chambers MA Kamm (2001) ArticleTitleClinical and economic evaluation of surgical treatments for fecal incontinence Br J Surg 88 1029–36 Occurrence Handle10.1046/j.0007-1323.2001.01807.x Occurrence Handle1:STN:280:DC%2BD3MvktlWhsw%3D%3D Occurrence Handle11488786

    Article  CAS  PubMed  Google Scholar 

  18. JS Milne (1976) Prevalence of incontinence in the elderly age groups EL Willing (Eds) Incontinence in the elderly Academic Press London

    Google Scholar 

  19. WE Whitehead A Wald NJ Norton (2001) ArticleTitleTreatment options for fecal incontinence Dis Colon Rectum 44 131–42 Occurrence Handle1:STN:280:DC%2BD38%2FosVyquw%3D%3D Occurrence Handle11805574

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical Enteric Neuroscience Translational and Epidemiologic Research (CENTER) Program, Mayo Foundation and Mayo Clinic, Rochester, Minnesota

    M. D. Crowell Ph.D., T. N. Dineen M.D., K. W. Olden M.D. & N. J. Talley M.D., Ph.D.

  2. Marvin M. Schuster Center for Digestive and Motility Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland

    M. D. Crowell Ph.D., B. E. Lacy M.D., Ph.D. & V. A. Schettler B.S.N.

Authors
  1. M. D. Crowell Ph.D.
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  2. B. E. Lacy M.D., Ph.D.
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  3. V. A. Schettler B.S.N.
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  4. T. N. Dineen M.D.
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  5. K. W. Olden M.D.
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  6. N. J. Talley M.D., Ph.D.
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Correspondence to M. D. Crowell Ph.D..

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Crowell, M., Lacy, B., Schettler, V. et al. Subtypes of Anal Incontinence Associated With Bowel Dysfunction: Clinical, Physiologic, and Psychosocial Characterization. Dis Colon Rectum 47, 1627–1635 (2004). https://doi.org/10.1007/s10350-004-0646-4

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  • DOI: https://doi.org/10.1007/s10350-004-0646-4

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