THE CLINICAL CONTRIBUTION OF INTEGRATED LABORATORY AND AMBULATORY ANORECTAL PHYSIOLOGY ASSESSMENT IN FECAL INCONTINENCE

To determine the clinical value of anorectal physiology testing, we ha ve assessed 73 patients with neurogenic incontinence (median age 55 ye ars, 60 female) and 115 controls (median age 48 years, 81 female). All the faecally incontinent patients displayed abnormal anal mucosal ele ctrosensitivity and prolonged pudendal nerve latencies. Rectal complia nce was poor in 14% of patients with neurogenic incontinence. Twenty-s even sphincter injuries were identified by endoanal ultrasonography in patients with neurogenic incontinence. Anal sphincter electromyograph ic abnormalities were demonstrated in all the incontinent patients. An al pressures were lower in the incontinent group. Frequent, abnormal i nternal sphincter relaxations were observed in patients with incontine nce during ambulatory assessment. These tests provide objective eviden ce of injury but do not frequently affect clinical decision making. En doanal ultrasonography and ambulatory assessment provided clinical inf ormation of the mechanism of incontinence in 60% of patients.