Abstract
We aimed to determine if the type of clinical presentation in patients with faecal incontinence correlated with the underlying sphincter pathology. One hundred fifty one consecutive patients (129 female) with faecal incotinence were classified as having either passive (faecal incontinence without the patient's knowledge) or urge incontinence (incontinence occuring with the patient's awareness, against their will because of lack of voluntary control), and were investigated by routine anorectal physiological testing and anal endosonography. Sixty six patients had passive incontinence (PI) only, 42 patients had urge incontinence (UI) only, 38 patients had combined passive and urge incontinence, and 5 patients had soiling after defaecation only. Patients with PI alone (n=66) were significantly older than those with UI alone (PI vs UI, 60 vs 42 yr, p<0.001), had a lower maximum resting anal pressure (51 vs 64 cm H2O, means, p=0.02) and had a significantly (p<0.001) greater prevalence of internal anal sphincter (IAS) defects. Patients with UI alone (n=42) had a significantly lower maximum voluntary contraction pressure (PI v UI, 72 v 42 cm H2O, p<0.001), and a significantly (p<0.001) greater prevalence of external anal sphincter (EAS) defects. The clinical classification of faecal incontinence into passive and urge incontinence relates to specific patterns of abnormality of the internal and external anal sphincters.
Résumé
Le but de ce travail est de déterminer si le mode de présentation clinique des patients avec incontinence fécale peut étre corrélé avec la pathologie sphinctérienne sous-jacente. Cent-cinquante-et-un patients consécutifs (129 femmes) avec incontinence fécale ont été classifiés comme ayant une incontinence passive (sans que le patient n'en ait conscience), une incontinence de stress (incontinence dont le patient est conscient mais à laquelle il ne peut pas s'opposer en raison de l'absence de contraction colontaire). Ces patients ont été investigués par des épreuves physiologiques ano-rectales de routine et par une échographie endo-anale. Soixante-six patients étaient porteurs d'une incontinence passive (PI), 42 patients avaient une incontinence de stress (UI), 38 patients avaient une combinaison d'incontinence passive et d'incontinence de stress et 5 patients avaient une incontinence et un soiling aprés exonération uniquement. Les patients avec incontinence passive seule (n=66) étaient plus âgés, de manière significative, que ceux porteurs d'une incontinence de stress seule (PI vs UI, 60 vs 42 ans, p<0.001) et avaient une pression maximale de repos du canal anal plus basse (51 vs 64 cm d'H2O, moyenne, p<0.02) et présentaient une prévalence plus importante de lésions du sphincter interne (p<0.001). Les patients avec incontinence de stress (n=42) avaient une pression de contraction volontaire maximale abaissée (PI vs UI, 72 vs 42 cm d'H2O, p<0.001) et une prévalence plus grande de lésions du sphincter externe (P<0.001). La classification clinique des incontinences en incontinences passives et incontinences de stress correspond à des anomalies spécifiques du sphincter interne et du sphincter externe.
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Engel, A.F., Kamm, M.A., Bartram, C.I. et al. Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorect Dis 10, 152–155 (1995). https://doi.org/10.1007/BF00298538
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DOI: https://doi.org/10.1007/BF00298538