Stress, urge, and mixed types of partial fecal incontinence: pathogenesis, clinical presentation, and treatment
Author: Shafik A, El Sibai O, Shafik IA, Shafik
Source:
The American Surgeon, 73(1), 6-9.
The authors investigated the hypothesis that partial fecal incontinence (PFI) had
variable manifestations that can be categorized as different types of PFI with
different pathogeneses and treatment. Anal and rectal pressures as well as
external and internal anal sphincter electromyographic activity were recorded in
163 patients with PFI and in 25 healthy volunteers. Patients were treated with
biofeedback or surgically. Three types of PFI were encountered: stress fecal
incontinence (SFI; 55 patients), urge fecal incontinence (UFI; 72 patients), and
mixed fecal incontinence (MFI; 36 patients). Anal pressure decreased in three
groups in which MFI had the lowest pressure. A significant reduction in external
anal sphincter electromyographic activity occurred in SFI, in internal anal
sphincter electromyographic activity in UFI, and of both sphincters in MFI.
Biofeedback cured 36 of 55 patients and postanal repair cured 10 of 19 patients
with SFI. Forty-eight of 72 patients with UFI responded to biofeedback and 16 of
24 responded to internal anal sphincter repair. Biofeedback failed in MFI
patients. Twenty-four of 27 patients who consented to operative correction of the
sphincteric defect were cured. Three types of PFI could be identified: SFI, UFI,
and MFI. Each type has its own etiology and symptoms, and requires individual
treatment. Biofeedback succeeded in treating the majority of SFI and UFI
patients. Surgical correction of the anal sphincter was performed after
biofeedback failure.