Faecal incontinence associated with reduced pelvic sensation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Neurogastroenterology

Background:

• Faecal incontinence is a common condition impacting quality of life.
• While anal sphincter dysfunction is a known cause, other pathophysiological mechanisms may exist.
• Rectal sensation plays a crucial role in continence control.

Purpose of the Study:

• To investigate rectal sensory function in patients with faecal incontinence.
• To determine if an elevated threshold of rectal sensation is associated with faecal incontinence.
• To differentiate rectal sensation abnormalities from anal sphincter incompetence in incontinent patients.

Main Methods:

• Clinical and physiological assessment of anal sphincter function, including anal manometry, pudendal nerve latency, and single-fibre electromyography.
• Measurement of rectal sensory thresholds using controlled rectal distension.
• Comparison of rectal sensory parameters between patients with faecal incontinence and healthy controls.

Main Results:

• Eight patients with faecal incontinence exhibited significantly higher rectal sensory thresholds (143 +/- 33 ml) compared to controls (39 +/- 14 ml; P < 0.005).
• Anal sphincter function was normal in all incontinent patients.
• The recto-anal reflex and maximal tolerated rectal distension volumes were similar between groups.

Conclusions:

• A subgroup of patients with faecal incontinence may have impaired rectal sensation as a primary pathophysiological factor.
• This finding suggests that abnormal rectal sensation, rather than isolated sphincter incompetence, could underlie faecal incontinence in these individuals.
• Further research is warranted to explore the implications of rectal sensory dysfunction in faecal incontinence management.