The physiological evaluation of operative repair for incontinence and prolapse

Women with incontinence were divided into 30 with anorectal incontinence and 63 with complete rectal prolapse. The former group comprised 14 with a sphincter disruption and the remainder with intact sphincters. After anterior sphincter repair 70% were restored to acceptable continence. Success was associated with a rise in resting and voluntary contraction pressures and improved anal sensation. Patients with prolapse underwent either anterior and posterior rectopexy, or resection rectopexy. Continence was improved in both groups. Postoperatively, 90% following resection rectopexy and 80% following anterior and posterior rectopexy were restored to acceptable continence. Postoperative defaecatory straining and incomplete evacuation were reduced, with no significant differences between the two procedures. Restoration of continence was not associated with any change in sphincter pressures. However, rectal sensory threshold and anal sensation were both improved.