Anorectal incontinence: diagnosis and treatment

In correcting anorectal incontinence, the analysis of all known factors responsible for a lack of function is mandatory. Besides anamnestic and clinical data, manometric investigation is especially helpful. Continence may be improved by conservative measures (biofeedback training, muscle training, and drugs). The indication for surgical procedures depends on clinical and manometric findings: missed portions of the sphincteric muscle complex are reintegrated with a repull-through procedure. In some cases, Kottmeier's levatorplasty or a modification of it has led to some improvement of continence. Whenever a call to stool was present, gracilis transposition has markedly improved anorectal function in 22 of 27 operated patients. Free transplantation of palmaris longus muscle has not proven to be of functional advantage. Doubling the circular colonic musculature and an S-shaped anoplasty at the time of the primary pull-through procedure may lead to continence in the future.