Anal ultrasound predicts the response to nonoperative treatment of fecal incontinence in men

Objective To assess the etiology, treatment, and utility of anal ultrasound in men with fecal incontinence and to review the outcomes of conservative (nonoperative) treatment. Summary Background Data The etiology of fecal incontinence in women is almo st exclusively from obstetric or iatrogenic surgical injuries resulting in damage to the anal sphincters and/or pudendal nerves. Corresponding data on men with fecal incontinence are sparse. Methods Between January 1995 and January 1998, 37 men with fecal incontinen ce were evaluated in the John Radcliffe Hospital anorectal ultrasound unit. Their clinical histories, anal ultrasound results, anorectal physiology st udies, and responses to conservative therapy were reviewed. Results Median age was 57 years. Major incontinence was present in 27% of t he patients. Anal ultrasound localized anal sphincter damage in nine patien ts, and the characteristics of these nine patients with sphincter damage we re then compared with the remaining 28 without sphincter damage. Prior anal surgery was more common in patients with sphincter damage. Hemorrhoids wer e more common in patients without sphincter damage. Anorectal physiology st udies revealed significantly lower mean Maximum resting and squeeze pressur es in patients with sphincter damage, confirming poor sphincter function. W ith 92% follow-up, patients without sphincter damage were more likely to im prove with nonoperative therapy. Conclusions Anal ultrasound is extremely useful in the evaluation of fecal incontinence in men. Unlike women, the majority of men do not have a sphinc ter defect by anal ultrasound, and conservative management is usually succe ssful in these patients. In contrast, in men with anal sphincter damage, al most all of these defects resulted from previous anal surgery. Conservative management rarely is successful in these cases, and surgical repair of the anal sphincter may be indicated. Therefore, because the presence or absenc e of sphincter damage on anal ultrasound usually predicts the response to n onoperative treatment, anal ultrasound should be used to guide the initial management of men with fecal incontinence.