FECAL INCONTINENCE 1994 - WHICH TEST AND WHICH TREATMENT

Faecal incontinence is a disabling condition caused by: (1) sphincter damage caused by childbirth, anorectal surgery, trauma, fistulae and a bcesses; (2) pudendal neuropathy (''idiopathic faecal incontinence'') caused by stretch injury by long-standing constipation or prolonged la bor; (3) diminished rectal compliance in proctitis, low anterior resec tion or small pouches; (4) faecal impaction causing paradoxal diarrhoe a; (5) neurological disease involving the pelvic floor and or the cent ral nervous system; (6) diarrhoea. Often several factors play a role i n a patient. A medical history and physical examination will generally provide a reasonable diagnosis. Anorectal function tests can show one or more abnormalities. Anal manometry can show low sphincter pressure s; rectal compliance can show a small Tectal volume; anal mucosal sens itivity measurement can show a high threshold and neurophysiological t ests can demonstrate diminished muscle activity and a delayed pudendal nerve motor latency. Anal endosonography and defaecography have a dir ect clinical impact. Anal endosonography is a promising diagnostic too l demonstrating sphincter defects, even those not previously suspected . A sphincter defect demonstrated by anal endosonography provides a so lid basis for a sphincter repair. Defaecography can reveal an intussus ception, which is an indication for performing a rectopexy in the inco ntinent patient. A suggested work-up of the incontinent patient is giv en in a table. Besides the classic surgical treatments such as sphinct er repair, rectopexy and post-anal repair new (surgical) options have been tried. The most promising new therapy seems the dynamic gracilis repair.