HISTORY AND EXAMINATION IN THE ASSESSMENT OF PATIENTS WITH IDIOPATHICFECAL INCONTINENCE

PURPOSE: This study was undertaken to identify those factors from the history and examination which might predict the pathophysiologic basis of idiopathic fecal incontinence. METHODS: In a prospective study of 237 patients with idiopathic fecal incontinence (female to male, 7:1.7 ; mean age, 54.8 years; median history, 3 years), history, examination , and anorectal physiology studies findings have been analyzed using c ontingency table analysis. RESULTS: In patients with idiopathic fecal incontinence, anorectal physiology studies have shown that a low maxim um basal pressure (<45 cm H2O) is predominantly attributable to intern al anal sphincter weakness, and low maximum squeezing pressure (<76 cm H2O) is indicative of voluntary sphincter deficiency. In this study, a low maximum basal pressure is correlated with leakage, gaping of the anus on traction of the anal verge, and decreased resting tone on dig ital examination (all P < 0.05). A low maximum squeezing pressure is c orrelated with incontinence en route to the lavatory, urgency, both st ress and urge incontinence of urine, reduced voluntary contraction in the external anal sphincter and puborectalis on digital examination, a nd a reduced or absent anorectal angle (all P < 0.05). CONCLUSION: Thi s study has shown that an informed history and digital examination can predict the manometric findings of specialist anorectal physiology st udies.