Rectal compliance, capacity, and rectoanal sensation in fecal incontinence

Beatrice Salvioli, Adil Eddie Bharucha, Doris Rath-Harvey, John H. Pemberton, Sidney F. Phillips

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Assessments of the pathophysiology of fecal incontinence are skewed toward anal sphincter function; however, rectal compliance, rectoanal sensation and capacity may also be relevant. The aim of this study was to evaluate the usual and some novel diagnostic approaches in fecal incontinence. METHODS: In 22 unselected patients with fecal incontinence (21 F, 33-75 yr), we quantified: 1) symptoms, anorectal manometry, and anal ultrasound; 2) anal perception of temperature and light touch; 3) rectal sensitivity and compliance to distension; and 4) rectal reservoir function. Control values were obtained from two groups of 11 (seven F, 32-53 yr), and 32 (18 F, 19-44 yr) volunteers. RESULTS: Patients had urge (14), passive (four), or combined (four) fecal incontinence; symptoms were mild in three, moderate in nine, and severe in 10 patients. Most had low sphincteric pressures and ultrasonic abnormalities. Temperature perception was impaired (p < 0.05) in incontinent patients, to a greater extent in the proximal anal canal and in patients with passive, as opposed to urge, incontinence. Intraluminal pressures for sensations of rectal distension were lower in incontinent patients (p = 0.02). Artificial stools elicited sensations of rectal filling at lower volumes than did a barostat bag, and in patients with urge, as opposed to passive, incontinence. In patients and controls, the sensation of urgency was associated (r2 = 0.2,p < 0.01) with rectal compliance. CONCLUSIONS: We confirm that temperature sensation is impaired, and perception of rectal distension is not always reduced in fecal incontinence. Artificial stool tended to induce sensations at lower volumes than did balloon inflation. Altered sensory mechanisms may contribute to the pathophysiology of fecal incontinence.

Original languageEnglish (US)
Pages (from-to)2158-2168
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume96
Issue number7
DOIs
StatePublished - 2001

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Fecal Incontinence
Compliance
Anal Canal
Temperature
Urge Urinary Incontinence
Pressure
Hypesthesia
Economic Inflation
Manometry
Touch
Ultrasonics
Volunteers

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rectal compliance, capacity, and rectoanal sensation in fecal incontinence. / Salvioli, Beatrice; Bharucha, Adil Eddie; Rath-Harvey, Doris; Pemberton, John H.; Phillips, Sidney F.

In: American Journal of Gastroenterology, Vol. 96, No. 7, 2001, p. 2158-2168.

Research output: Contribution to journalArticle

Salvioli, Beatrice ; Bharucha, Adil Eddie ; Rath-Harvey, Doris ; Pemberton, John H. ; Phillips, Sidney F. / Rectal compliance, capacity, and rectoanal sensation in fecal incontinence. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 7. pp. 2158-2168.
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