Rationale for medical or surgical therapy in anal incontinence

Seventy patients with anal incontinence referred to a colorectal service over a two-year period were evaluated and treated. In each case, a comprehensive history and physical examination as well as anal manometry were performed. Anorectal angle measurement was done when indicated. Patients were separated into groups of the four major causes of incontinence: 1) external/internal sphincter dysfunction, 2) puborectalis and anorectal angle, 3) alterations in rectal compliance, and 4) sensory deficits. Treatment was dictated by categorization of the patients. All patients were followed for a minimum of one year and, with the exception of patients with profound sensory loss, each believed that their symptoms had decreased substantially, enabling them to return to normal occupational and social activities.