Anal Incontinence


anal region

Anal Incontinence

The incidence of anal incontinence is generally felt to be higher than surveys reveal and may affect in excess of 5% of the elderly population. Loss of control of flatus and liquid or solid faeces is the key symptom but also the frequency of this control loss is important in planning treatment.

Associated urinary incontinence is common in women and in those with a cerebral(brain) cause.

Causes include:

  • Obstetric Trauma (damage of the muscle or nerve during childbirth).
  • Neuropathy - pudendal, spinal cord, cerebral control
  • Post Surgical -anal surgery, rectal surgery
  • Post-radiotherapy
  • Anorectal trauma
  • Secondary to rectal prolapse

Investigation:

  • Bedside examination including digital rectal examination & sigmoidoscopy
  • Anal manometry - measure of muscle pressure
  • EMG - measure of muscle fibre innervation
  • Pudendal nerve terminal motor latency - stroke measure of nerve conduction speed
  • Anal USS - picture of anal sphincter muscle integrity
  • Colonoscopy: often recommended
  • MRI may be used in special cases or in trial setting

Treatment:

  • Constipating agents- may be all that’s required if incontinence is mild and infrequent. 
  • Biofeedback- has been shown to be beneficial in treatment of incontinence Surgery
  • Anal sphincter repair: for a clearly damaged anal sphincter
  • Internal anal sphincter injection of silicone for isolated IAS weakness
  • Dynamic Gracilloplasty for sphincter loss or damage not amenable to overlap sphincter repair
  • Artificial anal sphincter for sphincter loss or damage not amenable to      overlap sphincter repair
  • Sacral nerve stimulation for predominantly neuropathic faecal           incontinence.
  • End Colostomy is still offered to patients as a solution

Success rates for surgery in expert hands generally approach 80%

Related Links:

www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=5