ANAL INCONTINENCE - ROLE OR PERINEAL NEUROPATHY

The pathophysiological debate: Transanal ultrasonography and neurophys iological examinations have greatly contributed to a better understand ing of anal incontinence, a frequent and debilitating condition. Since the demonstration of post partum sphincter ruptures, debate has focus ed on the importance of perineal neuropathy. Perineal neuropathy: The demonstration of anal sphincter rupture has been greatly facilitated b y transanal ultrasonography, a simple and safe procedure, but it is di fficult to confirm perineal dennervation as several factors limit func tional explorations First, prior medical and surgical treatments invol ving the pelvis may have stretched the pudential nerves. Secondly the conditions of the anatomic exploration of the somatic nervous system i s difficult acid our approach to the autonomous system is still quite superficial. However the effect of perineal neuropathy on prognosis af ter surgery far anal incontinence has been documented in several studi es. Treatment: Schematically, sphincter repair is indicated in case of rupture. Posterior myorraphia is often insufficient either because of underlying neuropathy or because of insufficient or defective sphinct er repair. Other proposed procedures such as total reconstruction of t he pelvic floor have been advocated as possible remedies.