RESUMEN
INTRODUCTION: Colorectal transport in idiopathic fecal incontinence has scarcely been studied, and it remains to be investigated in patients with fecal incontinence and anal sphincter lesion. The aim of the present study was to compare colorectal transport during defecation in patients with idiopathic fecal incontinence and patients with fecal incontinence due to anal sphincter lesions with transport in healthy volunteers. METHOD: Five women with idiopathic fecal incontinence (median age 72 years, range: 58-78 years) and five women with an obstetric sphincter lesion (median age 42 years, range: 28-63 years), four of whom had had previous anal sphincter repair, were compared with nine healthy female volunteers (median age 53 years, range 32-57 years). Colorectal scintigraphy was performed to assess colorectal emptying at defecation as well as segmental antegrade and retrograde transport during defecation. Segmental colorectal transit times were determined using radio-opaque markers. RESULTS: Median colorectal emptying time at defecation was significantly lower in the sphincter lesion group compared with the healthy volunteers (P = 0.009). At defecation, median antegrade transport time from the ascending colon was significantly lower in the sphincter lesion group than in the healthy group (P = 0.02). The median segmental transit time from the rectosigmoid colon was higher in the group with a sphincter lesion than in the healthy group (P = 0.05). There were no statistically significant differences between the group with idiopathic fecal incontinence and the healthy volunteers. CONCLUSION: Patients with fecal incontinence due to sphincter lesions, but not those with idiopathic fecal incontinence, have reduced transport from the cecum/ascending colon and from the rectosigmoid colon at defecation.
Asunto(s)
Canal Anal/lesiones , Defecación/fisiología , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Tránsito Gastrointestinal/fisiología , Adulto , Anciano , Canal Anal/cirugía , Colon/diagnóstico por imagen , Colon/fisiopatología , Parto Obstétrico/efectos adversos , Incontinencia Fecal/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Cintigrafía , Recto/diagnóstico por imagen , Recto/fisiopatología , Factores de Tiempo , Adulto JovenRESUMEN
INTRODUCTION: Most patients with fecal incontinence have poor anal sphincter function. In patients with idiopathic fecal incontinence no structural abnormality can be identified. The aim of the present study was to compare rectal motility patterns in patients with idiopathic fecal incontinence and in healthy controls. METHODS: Rectal impedance planimetry provides simultaneous measurement of rectal pressure, anal pressure, and rectal cross-sectional area at 5 levels. This allows highly detailed description of rectoanal motility. In 12 female patients with idiopathic fecal incontinence (mean age, 64.5) and 12 healthy controls (mean age, 47; 12 females) rectal phasic activity and tone were studied at a distension pressure 10 cm H2O above basic rectal pressure for one hour during fast and one hour after the meal. RESULTS: The median rectal cross-sectional area during fast was 3178 mm2 (range, 1905-4095) in patients with fecal incontinence and 2907 mm2 (range, 1832-4195) in the control group (P = .42). The postprandial decrease in rectal cross-sectional area was significantly more pronounced in patients (median postprandial reduction 462 mm2 (range, 3124 reduction to 7 increase)) than in the control group (median postprandial change 33 mm2 (range, 844 reduction to 974 increase)) (P = .007). The number of anal sampling reflexes during fast was reduced in patients (P = .03) and rectal wall tension during anal sampling reflexes also tended to be lower (P = .07). No differences in other phasic rectal motility patterns were found. CONCLUSION: Idiopathic fecal incontinence is associated with enhanced postprandial increase in rectal tone and a reduced frequency of anal sampling reflexes.
Asunto(s)
Canal Anal/fisiopatología , Incontinencia Fecal/fisiopatología , Manometría/métodos , Recto/fisiopatología , Adulto , Anciano , Estudios de Casos y Controles , Impedancia Eléctrica , Femenino , Humanos , Persona de Mediana Edad , Periodo Posprandial , Presión , Estadísticas no ParamétricasRESUMEN
Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33-73 (mean 58), with faecal incontinence of various aetiologies were examined. Before and during SNS, rectal cross-sectional area (CSA) and ano-rectal pressures were determined with impedance planimetry and manometry for 1 h during fast and 1 h postprandially. Neither in the fasting state nor postprandially did SNS affect the number of single rectal contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS (P < 0.02). Before SNS, median rectal CSA was 2999 mm(2) (range: 1481-3822) during fast and 2697 mm(2) (range: 1227-3310) postprandially (P < 0.01). During SNS, median rectal CSA was 2990 mm(2) (1823-3678) during fast and 2547 mm(2) (1831-3468) postprandially (P = 0.22). SNS for faecal incontinence does not affect phasic rectal motility but it impairs postprandial changes in rectal tone.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Plexo Lumbosacro/fisiología , Recto , Nervios Espinales/fisiología , Adulto , Anciano , Femenino , Humanos , Manometría/métodos , Persona de Mediana Edad , Contracción Muscular/fisiología , Periodo Posprandial , Recto/inervación , Recto/fisiologíaRESUMEN
BACKGROUND: Sacral nerve stimulation reduces the frequency of defaecation in patients with faecal incontinence. The aim of this study was to examine the mechanism behind the reduced number of bowel movements in incontinent patients treated with sacral nerve stimulation. METHODS: The study included 20 patients with faecal incontinence and a positive percutaneous nerve evaluation test: 19 women and one man, with a median age of 63 (range 28-78) years. Colorectal scintigraphy was performed to assess colorectal emptying at defaecation before and after implantation. Segmental colorectal transit times were determined using radio-opaque markers. RESULTS: The median frequency of defaecation per 3 weeks decreased from 56 (range 19-136) to 26 (range 12-78) (P < 0.002). At defaecation, antegrade transport from the ascending colon decreased from a median score of 8 (range 0-23) to 0 (range 0-11) per cent (P = 0.001), while retrograde transport from the descending colon increased from a median score of 0 (range 0-14) to 2 (range 0-30) per cent (P = 0.039). The median defaecation score was unchanged. There was a non-significant increase in median total gastrointestinal transit time from 2.5 (range 0.9-6.2) to 3.3 (range 0.8-6.2) days (P = 0.079). CONCLUSION: Sacral nerve stimulation reduces antegrade transport from the ascending colon and increases retrograde transport from the descending colon at defaecation. This may prolong colonic transit time and increase the storage capacity of the colon.