Anorectal incontinence: aetiology, pathophysiology and evaluation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Faecal incontinence (FI) is a complex, multifactorial condition affecting all age groups, not just the elderly.
• Prevalence varies widely, impacting approximately 2% of the general population and up to 60% in specific cohorts.
• Despite advances, understanding and evaluation of FI remain limited, necessitating comprehensive assessments.

Purpose of the Study:

• To emphasize the importance of complete functional and anatomical assessments in managing faecal incontinence.
• To highlight key diagnostic tools for identifying the cause and type of incontinence.
• To guide therapeutic decision-making through objective physiological investigations.

Main Methods:

• Detailed patient history and physical examination.
• Anorectal physiological investigations, including anorectal manometry to assess sphincter muscle strength (resting and squeeze pressures).
• Anal endosonography for anatomical evaluation and surgical planning, complemented by electromyography for functional abnormalities.

Main Results:

• Comprehensive assessments are mandatory for accurate diagnosis and treatment planning in faecal incontinence.
• Anorectal manometry provides objective measures of sphincter function.
• Anal endosonography and electromyography are valuable, complementary tools for evaluating structural and functional deficits.

Conclusions:

• Accurate diagnosis of faecal incontinence relies on a combination of clinical evaluation and specialized anorectal investigations.
• The choice of diagnostic tests should be individualized based on patient history and symptoms.
• Objective physiological testing is crucial for guiding effective management strategies for faecal incontinence.