RELATIONSHIP OF SYMPTOMS IN FECAL INCONTINENCE TO SPECIFIC SPHINCTER ABNORMALITIES

We aimed to determine if the type of clinical presentation in patients with faecal incontinence correlated with the underlying sphincter pat hology. One hundred fifty one consecutive patients (129 female) with f aecal incontinence were classified as having either passive (faecal in continence without the patient's knowledge) or urge incontinence (inco ntinence occurring with the patient's awareness, against their will be cause of lack of voluntary control), and were investigated by routine anorectal physiological testing and anal endosonography. Sixty six pat ients had passive incontinence (PI) only, 42 patients had urge inconti nence (UI) only, 38 patients had combined passive and urge incontinenc e, and 5 patients had soiling after defaecation only. Patients with PI alone (n = 66) were significantly older than those with UI alone (PI vs UI, 60 vs 42 yr, p < 0.001), had a lower max imum resting anal pres sure (51 vs 64 cm H2O, means, p = 0.02) and had a significantly (p < 0 .00 1) greater prevalence of internal anal sphincter (IAS) defects. Pa tients with UI alone (It = 42) had a significantly lower maximum volun tary contraction pressure (PI v UI, 72 v 42 cm H2O, p < 0.001), and a significantly (p < 0.001) greater prevalence of external anal sphincte r (EAS) defects. The clinical classification of faecal incontinence in to passive and urge incontinence relates to specific patterns of abnor mality of the internal and external anal sphincters.