FECAL SEEPAGE AND SOILING - A PROBLEM OF RECTAL SENSATION

PURPOSE: To determine the physiologic alteration resulting in fecal se epage and soiling. results of anorectal manometric testing were evalua ted in patients with varying degrees of fecal incontinence. METHODS: A nal manometric studies performed on 170 patients with fecal incontinen ce were reviewed. Results of their studies, including mean resting pre ssure, maximum resting pressure, maximum squeezing pressure, minimum r ectal sensory volume, and minimum volume at which reflex relaxation fi rst occurs, were compared with those of 35 control group subjects with normal fecal continence. Manometric studies were performed using a fo ur-channel, water-perfused catheter. incontinent patients were divided into three groups based on presenting complaints: complete incontinen ce (incontinence of gas and Liquid and solid stool), partial incontine nce (incontinence of gas and Liquid), and seepage and soiling (inconti nence of small amounts of Liquid and solid stool without immediate awa reness). RESULTS: Resting pressures were significantly lower in comple te incontinence, partial incontinence, and seepage and soiling groups than in the controls <P < 0.001). Resting pressures of the complete in continence group were also significantly lower than those of the parti al incontinence and seepage and soiling groups (P = 0.03). Squeezing p ressures were lower for both the complete incontinence and partial inc ontinence groups than for those in the control group <P < 0.001) and i n the seepage and soiling group, which did not differ significantly fr om controls. The minimum rectal sensory volume was greater in ah incon tinent groups than in controls (P < 0.001). Sensory volume of the seep age and soiling group was significantly greater than that of the compl ete incontinence and partial incontinence groups (P < 0.01). The diffe rence between sensory volume and the volume producing reflex relaxatio n was greatest in the seepage and soiling group and differed from that of the partial incontinence and control groups. CONCLUSIONS: These fi ndings suggest that the mechanism of incontinence is different in seep age and soiling patients and involves a dyssynergy of rectal sensation and anal relaxation. Patients with the pattern of seepage and soiling may be successfully treated with stool bullring agents (e.g., psylliu m or bran).