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Survey of anal sphincter dysfunction using anal manometry in patients with fecal incontinence: a possible guide to therapy.

Mandaliya R, DiMarino AJ, Moleski S, Rattan S, Cohen S - Ann Gastroenterol (2015 Oct-Dec)

Bottom Line: Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001).Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026).Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, Abington Memorial Hospital (Rohan Mandaliya), PA, USA.

ABSTRACT

Background: Despite the surge of new medical and surgical approaches to treat fecal incontinence, the types of sphincter abnormalities in patients with incontinence have not been well characterized. We aimed to categorize anal sphincter dysfunction using anorectal manometry in patients with fecal incontinence as a potential guide for improved treatment.

Methods: A retrospective review of 162 consecutive patients with fecal incontinence referred for anorectal manometry was performed. Resting anal pressure and maximal squeeze pressure were considered as measures of internal anal sphincter and external anal sphincter function respectively.

Results: Mean age of the patients was 63 years (13-89); females (81.5%) and males (18.5%). 74% of the patients had sphincter dysfunction on anorectal manometry. Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001). Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026).

Conclusions: Overall, abnormal anorectal manometry studies revealed that internal anal sphincter dysfunction is the most common finding, alone or in combination with external anal sphincter dysfunction. We suggest that anorectal manometry may be important to delineate anal sphincter function prior to using newer therapeutic mechanical devices. Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance. Finally, the classification of fecal incontinence based on the type of sphincter dysfunction may be an improved guide in the selection of newer agents in treating fecal incontinence.

No MeSH data available.


Related in: MedlinePlus

Distribution of patients having normal and abnormal manometryNote that 21% of the patients did not have any sphincter or sensory dysfunction
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Figure 1: Distribution of patients having normal and abnormal manometryNote that 21% of the patients did not have any sphincter or sensory dysfunction

Mentions: The mean age of the patients was 63 years (range 13-89 years); females 81.5% (132/162) compared to males 18.5% (30/162). 74% (119/162) of the patients had sphincter dysfunction on manometric study, 17% (27/162) patients had impaired rectal sensation while 21% of the patients revealed no abnormality (Fig. 1). Abnormal manometry with sphincter dysfunction was further characterized based on the type of sphincter dysfunction present. Of 119 patients with sphincter dysfunction on manometry, only 15% (18) of the patients had isolated EAS dysfunction, while 40% (48) of the patients had isolated IAS dysfunction. 45% (53/119) of the patients had combined internal and external anal sphincter dysfunction (Fig. 2). Considering the overall involvement, EAS was involved in 44% of the total patients while IAS was involved in 62% patients.


Survey of anal sphincter dysfunction using anal manometry in patients with fecal incontinence: a possible guide to therapy.

Mandaliya R, DiMarino AJ, Moleski S, Rattan S, Cohen S - Ann Gastroenterol (2015 Oct-Dec)

Distribution of patients having normal and abnormal manometryNote that 21% of the patients did not have any sphincter or sensory dysfunction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585394&req=5

Figure 1: Distribution of patients having normal and abnormal manometryNote that 21% of the patients did not have any sphincter or sensory dysfunction
Mentions: The mean age of the patients was 63 years (range 13-89 years); females 81.5% (132/162) compared to males 18.5% (30/162). 74% (119/162) of the patients had sphincter dysfunction on manometric study, 17% (27/162) patients had impaired rectal sensation while 21% of the patients revealed no abnormality (Fig. 1). Abnormal manometry with sphincter dysfunction was further characterized based on the type of sphincter dysfunction present. Of 119 patients with sphincter dysfunction on manometry, only 15% (18) of the patients had isolated EAS dysfunction, while 40% (48) of the patients had isolated IAS dysfunction. 45% (53/119) of the patients had combined internal and external anal sphincter dysfunction (Fig. 2). Considering the overall involvement, EAS was involved in 44% of the total patients while IAS was involved in 62% patients.

Bottom Line: Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001).Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026).Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance.

View Article: PubMed Central - PubMed

Affiliation: Division of Internal Medicine, Abington Memorial Hospital (Rohan Mandaliya), PA, USA.

ABSTRACT

Background: Despite the surge of new medical and surgical approaches to treat fecal incontinence, the types of sphincter abnormalities in patients with incontinence have not been well characterized. We aimed to categorize anal sphincter dysfunction using anorectal manometry in patients with fecal incontinence as a potential guide for improved treatment.

Methods: A retrospective review of 162 consecutive patients with fecal incontinence referred for anorectal manometry was performed. Resting anal pressure and maximal squeeze pressure were considered as measures of internal anal sphincter and external anal sphincter function respectively.

Results: Mean age of the patients was 63 years (13-89); females (81.5%) and males (18.5%). 74% of the patients had sphincter dysfunction on anorectal manometry. Internal anal sphincter dysfunction was present in 62% patients vs. external anal sphincter dysfunction present in 44% patients. 80% females had abnormal manometry vs. 44% in males (P<0.0001). Internal anal sphincter dysfunction was present in 68% females vs. 37% in males (P=0.0026).

Conclusions: Overall, abnormal anorectal manometry studies revealed that internal anal sphincter dysfunction is the most common finding, alone or in combination with external anal sphincter dysfunction. We suggest that anorectal manometry may be important to delineate anal sphincter function prior to using newer therapeutic mechanical devices. Future studies using pharmacological agents to increase internal anal sphincter tone may be of clinical importance. Finally, the classification of fecal incontinence based on the type of sphincter dysfunction may be an improved guide in the selection of newer agents in treating fecal incontinence.

No MeSH data available.


Related in: MedlinePlus