Defecographic disorders in anal incontinent women: relation to symptoms and anal endosonographic patterns

The need for a defecography in incontinent women is still debatable. We prospectively evaluated the prevalence of defecographic abnormalities in incontinent women in order to determine whether any symptom or endosonographic findings could be associated with a particular defecographic pattern.

Fifty incontinent women (aged 30-87 years) underwent defecography and anal endosonography to look for pelvic floor descent, rectocele, intussusception, enterocele and the presence of anal sphincter defects. Other symptoms, i.e. straining at stools and pelvic pressure, were recorded.

Twenty-five cases of external sphincter defect (12 associated with an internal defect) and 4 cases of isolated internal defect were identified. Defecography identified 25 patients with perineal descent at rest, 28 with perineal descent at straining, 30 with rectocele, 30 with intussusception and 14 with enterocele. Three defecographies were normal. In the 29 women with sphincter defects, the prevalence of defecographic abnormalities did not differ from that observed in the 21 women without sphincter defects. In women complaining of straining at stools (n=26) or idiopathic pelvic pressure (n=32), the prevalence of defecographic abnormalities did not differ from that observed in women who did not have these symptoms.

The prevalence of pelvic floor disorders in incontinent women was similar whether associated symptoms or anal sphincter defects were present or not. When defecography has to be performed to investigate female anal incontinence, neither clinical nor endosonographic features can predict a higher diagnostic efficiency.