PUDENDAL CANAL DECOMPRESSION FOR THE TREATMENT OF FECAL INCONTINENCE IN COMPLETE RECTAL PROLAPSE

Our recent studies have attributed fecal incontinence (FI) when it is associated with complete rectal prolapse (CRP) to pudendal neuropathy caused by pudendal canal syndrome (PCS). Herein we present the results of pudendal canal decompression (PCD), performed for the treatment of Fl in 21 patients whose CRP was corrected by Ivalon sponge rectopexy 5.2 years before presentation. Thirteen patients had partial and eight complete Fl. Examination revealed perianal hypoesthesia, diminished r ectal neck pressure, reduced electromyographic (EMG) activity of both the external anal sphincter (EAS) and levator ani (LA) muscle, as well as prolonged pudendal nerve terminal motor latency (PNTML). PCD was p erformed with a mean follow up of 14.8 months. Postoperatively, seven (53.8%) of the 13 patients with partial Fl showed full fecal control w ith normalization or improvement of the perianal hypoesthesia, rectal neck pressure, EMG of EAS and LA, as well as PNTML. The remaining six patients were failures. Five (62.5%) of the eight patients with comple te Fl showed full fecal control, two partial improvement, and one fail ure. The degree of response of Fl to PCD seems to be related to the de gree of pudendal nerve damage. Nonimprovement may be due to irreversib le pudendal nerve damage or incomplete PCD. In conclusion, PCD is effe ctive in the treatment of Fl associated with CRP, provided it is perfo rmed before complete nerve damage occurs.