Diagnostic Evaluation of Patients with Faecal Incontinence at a Specialist Institution

Toshiki Mimura, Michio Kaminishi and Michael A Kamm*

Department of Gastrointestinal Surgery, University of Tokyo Physiology Unit, St Mark's Hospital*

Background: Evaluation of anorectal function clinically, structurally and functionally in patients with faecal incontinence should ensure appropriate and individual treatment. Methods: Two hundred and twenty-six patients with faecal incontinence were reviewed regarding disease history, results of anorectal physiological tests and anal ultrasonography. Results: The mean age was 54 and 191 patients (85%) were female. Sixty-two had passive faecal incontinence only (PI); 49 urge faecal incontinence only (UI); and 115 had both passive and urge faecal incontinence (PUI). Patients with PI had a significantly higher voluntary contraction pressure and less external sphincter abnormalities than UI or PUI. The structural abnormalities of the internal and external anal sphincters identified on anal ultrasonography were significantly associated with a low maximum resting pressure and a low voluntary contraction pressure, respectively. The causes identified for this faecal incontinence were: 90 idiopathic; 76 obstetric injury; 36 internal anal sphincter degeneration; 20 anal surgical injury; 6 rectal prolapse; and 9 miscellaneous. Conclusion: The anal sphincter structure as demonstrated by ultrasonography was closely related to the anorectal function as determined by anorectal physiological tests and the observations from these were reflected in the range of patient reported symptoms. Anal ultrasonography and anorectal physiological tests are useful tools, enabling us to identify the mechanisms and causes of faecal incontinence in at least 60% of the patients.

Key words
faecal incontinence, anorectal physiological examinations, anal ultrasonography

Reprint requests
Toshiki Mimura Department of Surgery, Teikyo University, School of Medicine
2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 JAPAN

Accepted
November 30, 2004

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