Electrodiagnostic evaluation of fecal incontinence

The aim of this study was to assess the utility of electrodiagnostic testing (EDT) for the evaluation of fecal incontinence (FI). Over a 5-year period, 225 patients (174 females) with FI were prospectively studied with anal manometry, anal ultrasonography, anal electromyography (AEMG), and pudendal nerve terminal motor latency (PNTML) assessment. The mean age was 60 (range 12-94) years. Causes of FI identified by clinical evaluation were obstetric injuries (45), rectal prolapse (43), iatrogenic or other trauma (42), neurologic disease (23), and idiopathic (72). EDT revealed abnormalities in 76% of patients. The incidence of pudendal neuropathy (PN) was 36% (bilateral 21%, unilateral 15%). Patients with PN were older than were those with normal PNTML (mean 71 vs. 63 years; P < 0.002). No relationship between squeeze pressure and PN could be demonstrated (P = 0.9). Reduced motor unit potential (MUP) recruitment on AEMG was present in 60% and was associated with decreased squeeze pressure (P < 0.001) and increased MUP polyphasia (P < 0.001). Concurrence of AEMG and anal ultrasonographic findings was observed in 35 of 41 patients (84%). Defects were overlooked in one study but identified by the other on three occasions, each. Moreover, 8 of 22 patients with demonstrated sphincter defects had unsuspected PN or extensive sphincter injury on AEMG that precluded sphincter repair. In conclusion, EDT proved to be a valuable tool in the evaluation and subsequent treatment of patients with FI.