PERINEAL DESCENT AT DEFECOGRAPHY IN WOMEN WITH STRAINING AT STOOL - ALACK OF SPECIFICITY OR PREDICTIVE VALUE FOR FUTURE ANAL INCONTINENCE

Objective: To determine (1) whether patients complaining of straining at stool have pelvic floor descent and anal abnormalities similar to t hose of patients with anal incontinence and (2) whether these patients are prone to develop anal incontinence. Methods: To answer the first question we used defecography to study perineal floor position at rest , during maximal contraction of the anal sphincter and during strainin g, and we performed anorectal manometry in 46 women with straining at stool but without anal incontinence at the beginning of the study, and in 46 women with idiopathic anal incontinence, matched for age. To an swer the second question, we performed a 5-year follow-up study to det ermine whether anal incontinence had developed in those women with str aining at stool. Results: Perineal floor position at rest, during maxi mal contraction of the sphincter and during straining, resting pressur e in the upper part of the anal canal, maximal amplitude and duration of the voluntary contraction were similar in the 46 women with straini ng at stool and the 46 women with idiopathic anal incontinence. In the follow-up study, 24 of the 46 women with straining at stool were cont acted. The incidence of anal incontinence after 5 years was higher amo ng these 24 women than in a control group of 20 women (13 out of 24 ve rsus three out of 20, for women with straining at stool versus control s, respectively; P<0.01). The 13 patients with straining at stool who became incontinent had, at the initial investigation, a tower maximal amplitude of voluntary contraction, greater perineal descent at rest a nd less elevation of the pelvic floor during maximal contraction of th e anal sphincter than the other women (P<0.05). Conclusion: Women with chronic straining at stool have perineal descent at rest and during s training similar to that of incontinent women. Women with chronic stra ining are also prone to develop anal incontinence, suggesting that per ineal descent at defecography in women with straining at stool may pre dict future anal incontinence.