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Faecal soiling: pathophysiology of post-defaecatory incontinence.
MedLine Citation:
PMID:  23570563     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: Passive post-defecatory incontinence is poorly understood and yet is an important clinical problem. The aim of this study was to characterize the pathophysiology of post-defecatory incontinence in patients affected by faecal soiling. METHOD: Seventy-two patients [30 women; age range, 49-79 years; 42 men; age range, 53-75 years] affected by faecal passive incontinence with faecal soiling were included in the study. Two patient groups were identified: Group 1 comprised 42 patients with post-defecatory incontinence and Group 2 had 30 patients without incontinence after bowel movements. After a preliminary clinical evaluation, including the Faecal Incontinence Severity Index (FISI) score and the Obstructed Defecation Syndrome (ODS) score, all patients of Groups 1 and 2 were studied by means of endoanal ultrasound (EU) and anorectal manometry (AM). The results were compared with those from 20 healthy control subjects. RESULTS: A significantly higher ODS score was found in Group 1 (P < 0.001). EU revealed a significantly diffuse thinning of the internal anal sphincter (IAS) in Group 2 (P < 0.02) with a linear relationship between signs of internal anal sphincter (IAS) atrophy and the FISI score (ps : 0.78; p< 0.03). Anal resting pressure (Pmax and Pm ) was significantly lower in Group 2 (p < 0.04). The straining test was considered positive in 30 (71.4%) patients in Group 1 significantly greater compared with Group 2 (p < 0.01). A significantly higher conscious rectal sensitivity threshold (CRST) was found in Group 1 patients (p < 0.01). CONCLUSION: The ODS score, a positive straining test, and high CRST values suggest that post-defaecatory incontinence is secondary to impaired daefecation. This article is protected by copyright. All rights reserved.
Authors:
Filippo Pucciani
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-9
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Affiliation:
Department of Surgery and Translational Medicine, University of Florence, Italy.
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