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Why do patients with faecal impaction have faecal incontinence.
Gut
|March 1, 1986
Summary
Faecal incontinence in elderly patients with impaction is linked to an obtuse anorectal angle and impaired sensation. These factors prevent conscious external sphincter control during internal sphincter relaxation, leading to soiling.
Area of Science:
- Gastroenterology
- Geriatrics
- Colorectal Surgery
Background:
- Faecal incontinence is a common and distressing condition in the elderly.
- Faecal impaction can lead to incontinence, but the underlying mechanisms are not fully understood.
Purpose of the Study:
- To investigate the physiological and sensory mechanisms underlying faecal incontinence in elderly patients with faecal impaction.
Main Methods:
- Manometric, radiological, and sensory testing were performed on 55 elderly patients with faecal impaction and incontinence.
- A control group of 36 elderly subjects without anorectal problems was included for comparison.
Main Results:
- Impacted patients exhibited an obtuse anorectal angle and impaired anal, perianal, and rectal sensation compared to controls.
- Sphincter pressures were not significantly different between impacted and control groups, nor did they change after disimpaction.
- Rectal sensation deficits included higher volumes for perception and desire to defecate, and lower volumes for anal relaxation.
Conclusions:
- Faecal soiling in impaction is likely due to a combination of an obtuse anorectal angle, age-related low anal pressures, and impaired anorectal sensation.
- Impaired sensation hinders the conscious contraction of the external anal sphincter when the internal sphincter relaxes, contributing to incontinence.
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