Outcome measures for fecal incontinence: anorectal structure and function

Area of Science:

• Gastroenterology
• Pelvic Floor Disorders
• Clinical Trials

Background:

• Fecal incontinence stems from various disorders affecting continence mechanisms.
• Objective assessments are vital for outcome measures in therapeutic trials.
• Standardized assessments may predict treatment response.

Purpose of the Study:

• To highlight the importance of objective assessments in fecal incontinence trials.
• To recommend specific outcome variables for evaluating continence mechanisms.
• To discuss newer approaches for assessing factors maintaining continence.

Main Methods:

• Incorporating anal sphincter pressures and rectal sensation measurements.
• Utilizing barostat for rectal compliance and sensation assessment.
• Employing endoanal ultrasound and magnetic resonance imaging (MRI) for sphincter integrity.
• Using dynamic MRI for puborectalis and pelvic floor motion.
• Performing needle electromyography for nerve and muscle damage assessment.

Main Results:

• Biofeedback therapy can improve rectal sensation in fecal incontinence.
• The predictive value of improved anal pressures post-biofeedback is not well-established.
• MRI demonstrates comparable or superior efficacy to ultrasound in assessing the external sphincter.
• Needle electromyography is sensitive for detecting denervation and muscle damage.

Conclusions:

• Standardized, reproducible assessments of continence mechanisms are essential for fecal incontinence trials.
• These objective measures should be incorporated as outcome variables.
• Accurate assessment of underlying mechanisms can guide therapeutic strategies and predict outcomes.