PELVIC FLOOR PROCEDURES PRODUCE NO CONSISTENT CHANGES IN ANATOMY OR PHYSIOLOGY

PURPOSE: Postanal repair was designed to restore both anatomy and func tion of the anal canal in neurogenic fecal incontinence. In most serie s, the degree of continence is improved in fewer than 50 percent of pa tients. Adding anterior levatorplasty and sphincter plication (total p elvic floor repair) is claimed to improve functional results. We perfo rmed a randomized trial comparing postanal and total pelvic floor repa ir for neurogenic incontinence. METHOD: Twenty female patients were st udied. All had Type D incontinence (Parks and Browning). Anal manometr y, defecography, and grading of the degree of continence were repeated 12 weeks after surgery to assess changes in clinical, manometric, and radiologic parameters. Statistical analysis was done using Wilcoxon's signed-rank test and Wilcoxon's two-sample test. RESULTS: Continence improved in eight patients. Differences among clinical, manometric, an d radiologic data were not statistically significant. CONCLUSION: Pelv ic floor repair procedures produce no consistent changes in anatomy or physiology. Clinical improvement is caused by creation of a local ste nosis or by the placebo effect rather than by improvement of muscle fu nction.