EXERCISE-INDUCED URINARY AND FECAL INCONTINENCE - AN EXCEEDINGLY UNUSUAL PRESENTATION OF AORTOILIAC OCCLUSIVE DISEASE

Fecal and urinary incontinence is an exceedingly unusual manifestation of aortoiliac occlusive disease, with only 4 previous cases having be en reported in the literature. The authors report the case of a sixty- two-year-old woman with a long history of bilateral lower extremity cl audication and exercise-induced urinary and fecal incontinence. Angiog raphy demonstrated a complete infrarenal aortic occlusion. Following a ortofemoral bypass, peripheral perfusion normalized and the patient ex perienced complete relief of claudication and incontinence. The author s propose that the patient's incontinence was due to intermittent pelv ic ischemia as a consequence of her aortoiliac disease. In contrast to the cauda equina syndrome, a ''steal'' mechanism is the most likely e xplanation for the pathophysiology of exercise-induced pelvic ischemia , which may be completely eradicated by aortoiliac revascularization.