Gastroenterology
Volume 124, Issue 6 , Pages 1672-1685 , June 2003

Fecal incontinence1, 2

  • Adil E. Bharucha

      Affiliations

    • Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program, Division of Gastroenterology and Hepatology, Department of Medicine Mayo Clinic, Rochester, Minnesota, USA
    • Corresponding Author InformationAddress requests for reprints to: Adil E. Bharucha, M.D., Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905, USA; fax: (507) 538-5820

Received 26 December 2002 ,Accepted 26 February 2003.

References 

  1. Whitehead WE, Wald A, Norton NJ. Treatment options for fecal incontinence. Dis Colon Rectum. 2001;44:131–142 discussion 142–144
  2. Crowell M, Schettler-Duncan V, Brookhart K, Barofsky I. Fecal incontinence (impact on psychosocial function and health-related quality of life). Gastroenterology. 1998;114:A738; (abstr)
  3. O’Keefe EA, Talley NJ, Zinsmeister AR, Jacobsen SJ. Bowel disorders impair functional status and quality of life in the elderly (a population-based study). Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 1995;50:M184–M189
  4. Rockwood TH, Church JM, Fleshman JW. Fecal incontinence quality of life scale (quality of life instrument for patients with fecal incontinence). Dis Colon Rectum. 2000;43:9–16 discussion 16–17
  5. Perry S, Shaw C, McGrother C, et al.  Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut. 2002;50:480–484
  6. Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes (prevalence and associations). Dis Colon Rectum. 1998;41:1226–1229
  7. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA. 1995;274:559–561
  8. Frenckner B, Ihre T. Influence of autonomic nerves on the internal and sphincter in man. Gut. 1976;17:306–312
  9. Bartolo DC, Jarratt JA, Read MG, Donnelly TC, Read NW. The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg. 1983;70:664–667
  10. Fernandez-Fraga X, Azpiroz F, Malagelada JR. Significance of pelvic floor muscles in anal incontinence. Gastroenterology. 2002;123:1441–1450
  11. Bartolo DC, Read NW, Jarratt JA, Read MG, Donnelly TC, Johnson AG. Differences in anal sphincter function and clinical presentation in patients with pelvic floor descent. Gastroenterology. 1983;85:68–75
  12. Harewood GC, Coulie B, Camilleri M, Rath-Harvey D, Pemberton JH. Descending perineum syndrome (audit of clinical and laboratory features and outcome of pelvic floor retraining). Am J Gastroenterol. 1999;94:126–130
  13. Bassotti G, Crowell MD, Whitehead WE. Contractile activity of the human colon (lessons from 24 hour studies). Gut. 1993;34:129–133
  14. Sun WM, Read NW, Miner PB. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut. 1990;31:1056–1061
  15. Sun WM, Donnelly TC, Read NW. Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of idiopathic faecal incontinence. Gut. 1992;33:807–813
  16. Allen ML, Orr WC, Robinson MG. Anorectal functioning in fecal incontinence. Dig Dis Sci. 1988;33:36–40
  17. Buser WD, Miner PB. Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry. Gastroenterology. 1986;91:1186–1191
  18. Whitehead WE, Palsson OS. Is rectal pain sensitivity a biological marker for irritable bowel syndrome? Psychological influences on pain perception. Gastroenterology. 1998;115:1263–1271
  19. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal sampling (a comparison of normal and incontinent patients). Br J Surg. 1988;75:44–47
  20. Devroede G. Functions of the anorectum (defecation and continence). In:  Phillips S,  Pemberton J,  Shorter R editor. The large intestine: physiology and disease. New York: Raven; 1991;p. 115
  21. Samuelsson E, Ladfors L, Wennerholm UB, Gareberg B, Nyberg K, Hagberg H. Anal sphincter tears (prospective study of obstetric risk factors). BJOG: Int J Obstet Gynaecol. 2000;107:926–931
  22. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. [see comments] N Engl J Med. 1993;329:1905–1911
  23. Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–314
  24. Williams AB, Bartram CI, Halligan S, Spencer JA, Nicholls RJ, Kmiot WA. Anal sphincter damage after vaginal delivery using three-dimensional endosonography. Obstetr Gynecol. 2001;97:770–775
  25. Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS. Obstetric anal sphincter injury (prospective evaluation of incidence). Dis Colon Rectum. 1999;42:1537–1542
  26. Abramowitz L, Sobhani I, Ganansia R. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum. 2000;43:590–596 discussion 596–598
  27. Chaliha C, Sultan AH, Bland JM, Monga AK, Stanton SL. Anal function (effect of pregnancy and delivery). Am J Obstet Gynecol. 2001;185:427–432
  28. Reilly W, Talley N, Pemberton J. Fecal incontinence (prevalence and risk factors in the community). Gastroenterology. 1995;108:A32; (abstr)
  29. Chen H, Humphreys MS, Kettlewell MG, Bulkley GB, Mortensen N, George BD. Anal ultrasound predicts the response to nonoperative treatment of fecal incontinence in men. Ann Surg. 1999;229:739–743 discussion 743–744
  30. Parellada CM, Miller AS, Williamson ME, Johnston D. Paradoxical high anal resting pressures in men with idiopathic fecal seepage. Dis Colon Rectum. 1998;41:593–597
  31. Hayne D, Vaizey CJ, Boulos PB. Anorectal injury following pelvic radiotherapy. Br J Surg. 2001;88:1037–1048
  32. Nyam DC, Pemberton JH. Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum. 1999;42:1306–1310
  33. Del Pino A, Nelson RL, Pearl RK, Abcarian H. Island flap anoplasty for treatment of transsphincteric fistula-in-ano. Dis Colon Rectum. 1996;39:224–226
  34. Epanomeritakis E, Koutsoumbi P, Tsiaoussis I, et al.  Impairment of anorectal function in diabetes mellitus parallels duration of disease. Dis Colon Rectum. 1999;42:1394–1400
  35. Maleki D, Locke GR, Camilleri M, et al.  Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med. 2000;160:2808–2816
  36. Wiesel PH, Norton C, Glickman S, Kamm MA. Pathophysiology and management of bowel dysfunction in multiple sclerosis. Eur J Gastroenterol Hepatol. 2001;13:441–448
  37. Sun WM, Read NW, Donnelly TC. Anorectal function in incontinent patients with cerebrospinal disease. Gastroenterology. 1990;99:1372–1379
  38. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80
  39. Rockwood TH, Church JM, Fleshman JW, et al.  Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence (the fecal incontinence severity index). Dis Colon Rectum. 1999;42:1525–1532
  40. Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992;35:482–487
  41. Byrne CM, Pager CK, Rex JR, Roberts RBN, Solomon MJ. Assessment of quality of life in the treatment of patients with neuropathic fecal incontinence. Dis Colon Rectum. 2002;45:1431–1436
  42. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–924
  43. Engel AF, Kamm MA, Bartram CI, Nicholls RJ. Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorectal Dis. 1995;10:152–155
  44. Chiarioni G, Scattolini C, Bonfante F, Vantini I. Liquid stool incontinence with severe urgency (anorectal function and effective biofeedback treatment). Gut. 1993;34:1576–1580
  45. Hill J, Corson RJ, Brandon H, Redford J, Faragher EB, Kiff ES. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37:473–477
  46. Jameson JS, Chia YW, Kamm MA, Speakman CT, Chye YH, Henry MM. Effect of age, sex and parity on anorectal function. Br J Surg. 1994;81:1689–1692
  47. McHugh SM, Diamant NE. Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci. 1987;32:726–736
  48. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value. Dis Colon Rectum. 1990;33:479–485 discussion 485–486
  49. Siproudhis L, Bellissant E, Pagenault M, et al.  Fecal incontinence with normal anal canal pressures (where is the pitfall?). Am J Gastroenterol. 1999;94:1556–1563
  50. Bartram CI, Sultan AH. Anal endosonography in faecal incontinence. Gut. 1995;37:4–6
  51. Nielsen MB, Hauge C, Pedersen JF, Christiansen J. Endosonographic evaluation of patients with anal incontinence (findings and influence on surgical management). Am J Roentgenol. 1993;160:771–775
  52. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81:463–465
  53. Vaizey CJ, Kamm MA, Bartram CI. Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence. Lancet. 1997;349:612–615
  54. Heyer T, Enck P, Gantke B, Schmitt A, Frieling T, Haussinger D. Anal endosonography (are morphometric measurements of the anal sphincter reproducible). Gastroenterology. 1995;108:A613; (abstr)?
  55. Gold DM, Halligan S, Kmiot WA, Bartram CI. Intraobserver and interobserver agreement in anal endosonography. Br J Surg. 1999;86:371–375
  56. Enck P, Heyer T, Gantke B, et al.  How reproducible are measures of the anal sphincter muscle diameter by endoanal ultrasound?. Am J Gastroenterol. 1997;92:293–296
  57. Hussain SM, Stoker J, Lameris JS. Anal sphincter complex (endoanal MR imaging of normal anatomy). Radiology. 1995;197:671–677
  58. Agachan F, Pfeifer J, Wexner SD. Defecography and proctography. Results of 744 patients. Dis Colon Rectum. 1996;39:899–905
  59. Diamant NE, Kamm MA, Wald A, Whitehead WE. American Gastroenterological Association medical position statement on anorectal testing techniques. Gastroenterology. 1999;116:732–760
  60. Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers (results and implications). Gut. 1989;30:1737–1749
  61. Fletcher JG, Busse RF, Riederer SJ, et al.  Imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol. 2003;98:399–411
  62. deSouza NM, Puni R, Zbar A, Gilderdale DJ, Coutts GA, Krausz T. MR imaging of the anal sphincter in multiparous women using an endoanal coil (correlation with in vitro anatomy and appearances in fecal incontinence). Am J Roentgenol. 1996;167:1465–1471
  63. Malouf AJ, Halligan S, Williams AB, Bartram CI, Dhillon S, Kamm MA. Prospective assessment of interobserver agreement for endoanal MRI in fecal incontinence. Abdom Imaging. 2001;26:76–78
  64. Rociu E, Stoker J, Eijkemans MJ, Schouten WR, Lameris JS. Fecal incontinence (endoanal US vs. endoanal MR imaging). Radiology. 1999;212:453–458
  65. Briel JW, Zimmerman DD, Stoker J, et al.  Relationship between sphincter morphology on endoanal MRI and histopathological aspects of the external anal sphincter. Int J Colorectal Dis. 2000;15:87–90
  66. Briel JW, Stoker J, Rociu E, Lameris JS, Hop WC, Schouten WR. External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg. 1999;86:1322–1327
  67. Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR. Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit vs. with patient supine in a closed-magnet unit. Radiology. 2002;223:501–508
  68. Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Furst A. Dynamic magnetic resonance imaging defecography (a diagnostic alternative in the assessment of pelvic floor disorders in proctology). Dis Colon Rectum. 2001;44:999–1007
  69. Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet. 2000;355:260–265
  70. Cheong DM, Vaccaro CA, Salanga VD, et al.  Electrodiagnostic evaluation of fecal incontinence. Muscle Nerve. 1995;18:612–619
  71. Daube JR. In: Clinical neurophysiology contemporary neurology series. Vol. 46:Philadelphia, PA: FA Davis; 1996;p. 257–281
  72. Law NM, Bharucha AE, Undale AS, Zinsmeister AR. Cholinergic stimulation enhances colonic motor activity, transit and sensation in humans. Am J Physiol. 2001;281:G1228–G1237
  73. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal temperature sensation (a comparison of normal and incontinent patients). Br J Surg. 1987;74:511–515
  74. Salvioli B, Bharucha AE, Rath-Harvey D, Pemberton JH, Phillips SF. Rectal compliance, capacity and rectoanal sensation in fecal incontinence. Am J Gastroenterol. 2001;96:2158–2168
  75. Meagher AP, Kennedy ML, Lubowski DZ. Rectal mucosal electrosensitivity-what is being tested?. Int J Colorectal Dis. 1996;11:29–33
  76. Fox JC, Rath-Harvey DM, Helwig PS, Zinsmeister AR, Bharucha AE. Anal sphincter pressures and rectal compliance decline with aging in asymptomatic women. Gastroenterology. 2002;122:A69; (abstr)
  77. Bharucha AE, Hubmayr RD, Ferber IJ, Zinsmeister AR. Viscoelastic properties of the human colon. Am J Physiol Gastrointest Liver Physiol. 2001;281:G459–G466
  78. Hammer H, Phillips S, Camilleri M, Hanson R, Zinsmeister A. Day to day variability and the effect of repeated distensions on symptom thresholds during rectal distension. Gastroenterology. 1995;108:A610; (abstr)
  79. Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807–814
  80. Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272–1275
  81. Locke GR, Pemberton JH, Phillips SF. AGA technical review on constipation. Gastroenterology. 2000;119:1766–1778
  82. Locke GR, Pemberton JH, Phillips SF. American Gastroenterological Association medical position statement (guidelines on constipation). Gastroenterology. 2000;119:1761–1766
  83. Cheetham MJ, Kamm MA, Phillips RK. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut. 2001;48:356–359
  84. Carapeti EA, Kamm MA, Phillips RK. Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence. Br J Surg. 2000;87:38–42
  85. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med. 1974;290:646–649
  86. Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE. Biofeedback treatment of fecal incontinence (a critical review). Dis Colon Rectum. 2001;44:728–736
  87. Rao SS, Welcher KD, Happel J. Can biofeedback therapy improve anorectal function in fecal incontinence?. Am J Gastroenterol. 1996;91:2360–2366
  88. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med. 1984;310:1282–1287
  89. Miner PB, Donnelly TC, Read NW. Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci. 1990;35:1291–1298
  90. Norton C, Chelvanayagam S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2002;122:A607; (abstr)
  91. Halverson ALMD, Hull TLMD. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45:345–348
  92. Karoui SMD, Leroi AMPD, Koning EMD, Menard JFMD, Michot FPD, Denis PPD. Results of sphincteroplasty in 86 patients with anal incontinence. Dis Colon Rectum. 2000;43:813–820
  93. Chapman AE, Geerdes B, Hewett P, et al.  Systematic review of dynamic graciloplasty in the treatment of faecal incontinence. Br J Surg. 2002;89:138–153
  94. Wong WD, Congliosi SM, Spencer MP, et al.  The safety and efficacy of the artificial bowel sphincter for fecal incontinence (results from a multicenter cohort study). Dis Colon Rectum. 2002;45:1139–1153
  95. Ganio E, Ratto C, Masin A, et al.  Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience. Dis Colon Rectum. 2001;44:965–970
  96. Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology. 2001;121:536–541
  97. Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J. Effects of short-term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut. 1999;44:407–412
  98. Takahashi T, Garcia-Osogobio S, Valdovinos MA, et al.  Radio-frequency energy delivery to the anal canal for the treatment of fecal incontinence. Dis Colon Rectum. 2002;45:915–922
  99. Drossman DA, Li Z, Andruzzi E, et al.  U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–1580
  100. Talley NJ, O’Keefe EA, Zinsmeister AR, Melton LJD. Prevalence of gastrointestinal symptoms in the elderly (a population-based study). Gastroenterology. 1992;102:895–901
  101. Caruana BJ, Wald A, Hinds JP, Eidelman BH. Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology. 1991;100:465–470
  102. Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence?. Gut. 1986;27:283–287
  103. Yeoh EK, Russo A, Botten R, et al.  Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut. 1998;43:123–127
  104. Varma JS, Smith AN, Busuttil A. Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg. 1985;72:875–878
  105. Rao SS, Read NW, Davison PA, Bannister JJ, Holdsworth CD. Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology. 1987;93:1270–1275
  106. Denis P, Colin R, Galmiche JP, et al.  Elastic properties of the rectal wall in normal adults and in the patients with ulcerative colitis. Gastroenterology. 1979;77:45–48
  107. Roberts RO, Jacobsen SJ, Reilly WT, Pemberton JH, Lieber MM, Talley NJ. Prevalence of combined fecal and urinary incontinence (a community-based study). J Am Geriatr Soc. 1999;47:837–841
  108. Shirran E, Brazzelli M. Absorbent products for containing urinary and/or faecal incontinence in adults. [Systematic Review] Cochrane Database of Systematic Reviews. 2000;2: CD001406
  109. Bachoo P, Brazzelli M, Grant A. Surgery for faecal incontinence in adults. [Systematic Review] Cochrane Database of Systematic Reviews. 2000;2: CD001757

 Supported in part by USPHS NIH grants RO1 HD 38666 and HD 41129.

PII: S0016-5085(03)00329-9

doi: 10.1016/S0016-5085(03)00329-9

Gastroenterology
Volume 124, Issue 6 , Pages 1672-1685 , June 2003

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