PATTERNS OF MALE FECAL INCONTINENCE

PURPOSE: This study sought to identify clinical and manometric charact eristics of male fecal incontinence. METHOD: Clinical charts of 25 men with a chief complaint of fecal incontinence were retrospectively rev iewed. Their anorectal physiology test results were compared with thos e from a group of 20 healthy men. RESULTS: Fourteen men (56 percent) w ere ''leakers,'' who complained of loss of liquid or solid stool smear s that stained their underclothes. Eleven men (44 percent) had true in continence, with loss of control over gas, liquid, and/or solid stool. Leakers had lower anal sphincter pressures than normal men (P < 0.05) but higher pressures than incontinent men (P < 0.05). In leakers the anal sphincter length at rest was longer than in incontinent (P < 0.01 ) and normal men (P < 0.05). All incontinent men had decreased manomet ric pressures, abnormal anorectal sensation or prolonged pudendal nerv e terminal motor latencies, whereas only one-half of the leakers had p hysiologic abnormalities. Treatment using dietary manipulation, consti pating agents or cleansing enemas was successful in nearly 90 percent of incontinent men but only 55 percent of the leakers, CONCLUSIONS: Wh ereas true incontinence in men is caused by a short, low pressure sphi ncter with altered sensation or innervation, leakage is associated wit h a long, intermediate pressure sphincter that frequently has normal s ensation and innervation. This long, intermediate pressure sphincter m ay predispose these men to leakage. Treatment of leakers is less succe ssful than treatment of incontinent men. Leakers and incontinent men h ave unique clinical and physiologic profiles that should be identified to help guide treatment and determine prognosis.