Disorders of impaired fecal control. A clinical and manometric study

Two hundred eight patients with retention disorders have been studied. Most frequent causes were idiopathic (107), iatrogenic (57), and obstetric (33). Twenty-five patients experienced soiling, 31 had insufficient function, and 152 complained of incontinence. Seventy percent of patients with idiopathic incontinence did not experience urge, compared with 38 percent with iatrogenic and only 3 percent with obstetric incontinence. The incidence of prolapse was 58 percent in patients with idiopathic incontinence, 20 percent in patients with iatrogenic incontinence, and only 3 percent in patients with obstetric incontinence. The authors conclude that the function of the puborectalis sling is to create the anorectal angle to evoke the feeling of urge and to support intra-abdominal contents and, furthermore, that fecal incontinence after anorectal surgery was likely caused by denervation. Anal resting and squeeze pressures varied widely. There was a huge overlap in the different groups. Mean resting and squeeze pressures were 9.5 kPa and 9.4 kPa, respectively, in controls, 4.8 kPa and 10.3 kPa, respectively, in the soiling group, 7.1 and 6.1 kPa, respectively, in the insufficient group, and 5.1 and 2.7 kPa, respectively, in the incontinent group. An incontinent external sphincter function could be defined as a function of the external sphincter causing a pressure increase of 5 kPa or less during straining. The ability to retain feces, therefore, is based on external sphincter function. Anal manometry is, indeed, a suitable technique to determine anal sphincter functions, but the presence of a retention disorder cannot definitely be determined. Its clinical application remains under discussion.