Clinical parameters and symptom severity in males with fecal leakage and incontinence

Despite the commonality of fecal incontinence (FI) in men, few studies have been carried out in this patient group. The aim of the study was to determine the contributions of clinical and physiological factors to symptom severity in males with fecal leakage (FL) and FI.

The records of all male patients referred for evaluation of FI and FL over a 6-year period were analyzed. For each male case, the records of three age-matched female controls with FI or FL were retrieved. All patients completed symptom assessment questionnaires (Vaizey score) and standard anorectal manometry testing.

A total of 100 males and 300 age-matched female controls were included. Vaizey scores were similar between sexes. For all Vaizey strata, males had normal maximal resting pressures (MRP) as well as normal maximal squeeze pressure (MSP). Females had a significantly reduced MRP and MSP across all Vaizey strata. In the FL subgroup, males had higher MRP and MSP than females. A multivariable linear regression analysis in males did not identify any clinical factors predictive of symptoms severity. For females, increased symptom duration, abnormal Bristol score, and reduced MSP were associated with worsening in Vaizey score.

For females, FL represents one end of the severity spectrum of FI while in males FL has a distinct pathophysiology. Contributing factors to symptoms in males with FL are not identified by routine clinical tests; however, anorectal manometry may identify a subgroup of FL males with low anal sphincter pressures that may respond to targeted interventions.