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KMID : 0356720000160030156
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Journal of the Korean Society of Coloproctology
2000 Volume.16 No. 3 p.156 ~ p.162
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Etiology and Surgery Management of Fecal Incontinence
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Kim Chang-Nam
Park Sang-Kyu
Yu Chang-Sik
Kim Suk-Young
Kim Jin-Cheon
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Abstract
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Purpose: Fecal incontinence is a disabling condition with devastating psychosocial due to diverse etiology. This study was performed to assess various causes of fecal incontinence, clinical evaluation, and adequate surgical treatment.
Methods: Eighty patients presenting fecal incontinence during July 1989 and June 1997 were included. They were evaluated by clinical parameters and physiologic tests including the defecography, electromyography, transanal ultrasonography, and anorectal manometry. Surgery was performed in 31 patients based on those evaluation. Pre- and post-operative comparison of manometric finding, clinical assessment, incontinence score, and the outcome of surgery were assessed. Mean postoperative follow-up was 22 (2∼84) months.
Results: Inappropriate anal surgery was the most common cause, and then injuries during delivery, trauma, rectal prolapse, and hysterectomy in descending order. Defecography was performed in 21 patients and mean values of anorectal angles were 115 15°at rest, 98 18°during squeezing, and 136 10°during push. Electromyography
was performed in 8 patients showing pudendal neuropathy in 2, bilateral lumbosacral polyradiculopathy in 4, and normal finding in 2 patients, respectively. Transanal ultrasonography was performed in 33 patients and 22 among them showed finding of an injury of the anal sphincters. Surgery was performed in 31 patients due to anal sphincter damage, rectovaginal fistula, and anal stricture in descending order. Type of surgery was determined by respective cause: plication, triple repair (sphincteroplasty, anoplasty, perineorrhaphy), and posterior rectopexy in descending order. Nerve preserving graciloplasty performed in a 12 year-old girl who had severe defect of the anal sphincters by traffic accident, showing sound recovery with a good functional outcome. Although there was no significant difference of manometric variables between pre-and post-operative periods, sphincter length, and maximum resting and squeezing pressure, revealed an increasing tendency postoperatively. According to the clinical assessment between pre- and post-operative periods, urgency to evacuate, soiling, sensation on defecation, and quality discrimination were significantly improved postoperatively (p<0.01). Incontinence score was markedly decreased from 10.6 6.1 during preoperative period 2.9 4.7 during postoperative period (p<0.01). Eighty one percent of the patients undergone surgery experienced a significant symptomatic improvement.
Conclusion: According to the analysis of the cause of fecal incontinence, inappropriate anal surgery,
injuries during delivery, and trauma were main cause. Adequate application of physiologic tests, such as, defecography, electromyography, transanal ultrasonography, and anorectal manometry, were helpful in determining treatment modality and types surgery. We got satisfactory results with adequate surgery based on the physiologic
tests.
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KEYWORD
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Feces, Incontinence, Etiology, Surgery
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