Patterns of male fecal incontinence

This study sought to identify clinical and manometric characteristics of male fecal incontinence.

Clinical charts of 25 men with a chief complaint of fecal incontinence were retrospectively reviewed. Their anorectal physiology test results were compared with those from a group of 20 healthy men.

Fourteen men (56 percent) were "leakers," who complained of loss of liquid or solid stool smears that stained their underclothes. Eleven men (44 percent) had true incontinence, with loss of control over gas, liquid, and/or solid stool. Leakers had lower anal sphincter pressures than normal men (P < 0.05) but higher pressures than incontinent men (P < 0.05). In leakers the anal sphincter length at rest was longer than in incontinent (P < 0.01) and normal men (P < 0.05). All incontinent men had decreased manometric pressures, abnormal anorectal sensation or prolonged pudendal nerve terminal motor latencies, whereas only one-half of the leakers had physiologic abnormalities. Treatment using dietary manipulation, constipating agents or cleansing enemas was successful in nearly 90 percent of incontinent men but only 55 percent of the leakers.

Whereas true incontinence in men is caused by a short, low pressure sphincter with altered sensation or innervation, leakage is associated with a long, intermediate pressure sphincter that frequently has normal sensation and innervation. This long, intermediate pressure sphincter may predispose these men to leakage. Treatment of leakers is less successful than treatment of incontinent men. Leakers and incontinent men have unique clinical and physiologic profiles that should be identified to help guide treatment and determine prognosis.