INVESTIGATION OF FECAL INCONTINENCE WITH ENDOANAL ULTRASOUND

PURPOSE: This study was undertaken to audit the results of endoanal ul trasound in patients with fecal incontinence. METHODS: Endoanal ultras ound was used to investigate 53 patients with fecal incontinence. Data for endoanal ultrasound were collected prospectively. Results were co mpared with clinical and obstetric history, obtained retrospectively c ly from case notes, and were compared with manometric and operative fi ndings. RESULTS: Sphincter abnormalities were identified in 42 of 53 p atients. A total of 28 anterior defects were thought to be obstetric i n origin. Fourteen other defects were secondary to anal pathology or s urgery. Patients with anterior external sphincter defects either had c omplete defects (4 patients; mean age, 31 years) or proximal defects ( 24 patients; mean age, 55 years). For patients with a proximal defect, 38 percent gave a history of obstetric tear, episiotomy, or forceps d elivery, and the rest declared having had an apparently normal deliver y. Only 50 percent had a sphincter weakness that was evident on clinic al examination. Of those studied with manometry, only 21 percent had l ow squeeze pressures consistent with an external sphincter defect. CON CLUSIONS: Sphincter defects seen on ultrasound may not have a history of obstetric trauma or abnormal clinical and manometric findings. Endo anal ultrasound is recommended in all patients with fecal incontinence to detect occult sphincter defects.