Document Detail

Patterns of fecal incontinence after anal surgery.
MedLine Citation:
PMID:  15540293     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Conservative anal surgery, with maximum preservation of the anal sphincters and continence, is becoming increasingly possible with the emergence of new sphincter-sparing treatments. Many surgeons remain skeptical, however, of the nature and impact of incontinence after anal surgery. We aimed to characterize the patterns of anal sphincter injury in patients with fecal incontinence after anal surgery. METHODS: We reviewed our fecal incontinence database and studied a subset developing incontinence after anal surgery. Maximum resting and squeeze pressures and the distal high-pressure zone to mid-anal canal resting pressure gradient were evaluated. Anal ultrasounds were evaluated and specific postoperative lesions were characterized. RESULTS: Patterns of sphincter injury in 93 patients with fecal incontinence after manual dilation, internal sphincterotomy, fistulotomy, and hemorrhoidectomy were studied. The internal sphincter was almost universally injured, in a pattern specific to the underlying procedure. One-third of patients had a related surgical external sphincter injury. Two-thirds of women had an unrelated obstetric external sphincter injury. The distal resting pressure was typically reduced, with reversal of the normal resting pressure gradient of the anal canal in 89 percent of patients. Maximum squeeze pressure was normal in 52 percent. CONCLUSION: Incontinence after anal surgery is characterized by the virtually universal presence of an internal sphincter injury, which is distal in the high-pressure zone, resulting in a reversal of the normal resting pressure gradient in the anal canal. These data support concerns that non-sphincter-sparing anal surgery leads to fecal incontinence and is increasingly difficult to justify given the availability of modern sphincter-sparing approaches.
Ian Lindsey; Oliver M Jones; M M Smilgin-Humphreys; Chris Cunningham; Neil J Mortensen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  47     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-11-11     Completed Date:  2004-11-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1643-9     Citation Subset:  IM    
Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
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MeSH Terms
Aged, 80 and over
Anal Canal / injuries*,  surgery*
Anus Diseases / surgery*
Databases, Factual
Digestive System Surgical Procedures / adverse effects*
Fecal Incontinence / etiology*
Middle Aged
Retrospective Studies
Sex Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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