Skip to main content

Investigation of Fecal Incontinence

  • Chapter
Imaging Pelvic Floor Disorders

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Fecal incontinence (FI) is generally caused by altered bowel habit, predominantly diarrhoea, with or without pelvic floor dysfunction. Appropriate testing for diseases causing FI (e.g., spinal imaging for patients with suspected spinal cord lesions) should be guided by the clinical features. Similarly, changes in bowel habit should be investigated using conventional techniques (e.g., endoscopy, serological testing for celiac sprue, stool studies, breath tests for carbohydrate intolerance etc) dependent on the patient’s age and the clinical presentation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  • Agachan F, Pfeifer J, Wexner SD et al (1996) Defecography and proctography. Results of 744 patients. Dis Colon Rectum 39(8):899–905

    Article  CAS  PubMed  Google Scholar 

  • Altomare DF, Rinaldi M, Petrolino M et al (2004) Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence. Dis Colon Rectum 47(6):853–857

    Article  PubMed  Google Scholar 

  • Andrews C, Bharucha AE (2005) The etiology, assessment, and treatment of fecal incontinence. Nat Clin Pract Gastroenterol Hepatol 2(11):516–525

    Article  PubMed  Google Scholar 

  • Andrews C, Bharucha AE, Camilleri M et al (2007) Rectal sensorimotor dysfunction in women with fecal incontinence. Am J Physiol Gastrointest Liver Physiol 292(1):G282–289

    Article  CAS  Google Scholar 

  • Bannister JJ, Abouzekry L, Read NW (1987) Effect of aging on anorectal function. Gut 28(3):353–357

    Article  CAS  PubMed  Google Scholar 

  • Barnes PR, Lennard-Jones JE (1985) Balloon expulsion from the rectum in constipation of different types. Gut 26(10):1049–1052

    Article  CAS  PubMed  Google Scholar 

  • Bartolo DC, Jarratt JA, Read MG et al (1983) The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 70(11):664–667

    Article  CAS  PubMed  Google Scholar 

  • Bartram CI, Sultan AH (1995) Anal endosonography in faecal incontinence. Gut 37(1):4–6

    Article  CAS  PubMed  Google Scholar 

  • Bertschinger KM, Hetzer FH, Roos JE et al (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508

    Article  PubMed  Google Scholar 

  • Bharucha AE (2003) Fecal incontinence. Gastroenterology 124(6):1672–1685

    Article  PubMed  Google Scholar 

  • Bharucha AE (2004) Outcome measures for fecal incontinence: Anorectal structure and function. Gastroenterology 126:S90–S98

    Article  PubMed  Google Scholar 

  • Bharucha AE (2006a) Update of tests of colon and rectal structure function. J Clin Gastroenterol 40(2):96–103

    Article  PubMed  Google Scholar 

  • Bharuch AE (2006b) Anorectal manometry and imaging are necessary in patients with fecal incontinence. (Editorial) Am J Gastroenterol 101(12):2679–2681

    Article  Google Scholar 

  • Bharucha AE, Hubmayr RD, Ferber IJ et al (2001) Viscoelastic properties of the human colon. Am J Physiol Gastrointest Liver Physiol 281(2):G459–466

    CAS  PubMed  Google Scholar 

  • Bharucha AE, Seide B, Fox JC et al (2004) Day-to-day Reproducibility of Anorectal Sensorimotor Assessments in Healthy Subjects. Neurogastroenterol Motil 16:241–250

    Article  CAS  PubMed  Google Scholar 

  • Bharucha AE, Fletcher JG, Harper CM et al (2005a) Relationship between symptoms and disordered continence mechanisms in women with idiopathic fecal incontinence. Gut 54:546–555

    Article  CAS  PubMed  Google Scholar 

  • Bharucha AE, Fletcher JG, Seide B et al (2005b) Phenotypic variation in functional disorders of defecation. Gastroenterology 128:1199–1210

    Article  PubMed  Google Scholar 

  • Bharucha AE, Zinsmeister AR, Locke ER et al (2005c) Prevalence and burden of fecal incontinence: A population based study in women. Gastroenterology 129:42–49

    Article  PubMed  Google Scholar 

  • Briel JW, Stoker J, Rociu E et al (1999) External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg 86(10):1322–1327

    Article  CAS  PubMed  Google Scholar 

  • Buser WD, Miner BP (1986) Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry. Gastroenterology 91(5):1186–1191

    CAS  PubMed  Google Scholar 

  • Caruana BJ, Wald A, Hinds JP et al (1991) Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology 100(2):465–470

    CAS  PubMed  Google Scholar 

  • Chan CL, Lunniss PJ, Wang D et al (2005) Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies. Gut 54(9):1263–1272

    Article  CAS  PubMed  Google Scholar 

  • Cheung O, Wald A (2004) Review article: the management of pelvic floor disorders. Aliment Pharmacol Ther 19(5):481–495

    Article  CAS  PubMed  Google Scholar 

  • Chiarioni G, Bassotti G, Stanganini S et al (2002) Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97(1):109–117

    Article  CAS  PubMed  Google Scholar 

  • Denis P, Colin R, Galmiche JP et al (1979) Elastic properties of the rectal wall in normal adults and in the patients with ulcerative colitis. Gastroenterology 77(1):45–48

    CAS  PubMed  Google Scholar 

  • Deutekom M, Terra MP, Dobben AC et al (2006) Patients’ perception of tests in the assessment of faecal incontinence. Br J Radiol 79(938):94–100

    Article  CAS  PubMed  Google Scholar 

  • Deutekom M, Dobben AC, Terra MP et al (2007) Clinical presentation of fecal incontinence and anorectal function: what is the relationship? Am J Gastroenterol 102(2):351–361

    Article  PubMed  Google Scholar 

  • Diamant NE, Kamm MA, Wald A et al (1999) Am Gastroenterological Association Medical Position Statement on Anorectal Testing Techniques. Gastroenterology 116:732–760

    Article  Google Scholar 

  • Dobben AC, Wiersma TG, Janssen LW et al (2005) Prospective assessment of interobserver agreement for defecography in fecal incontinence. [see comment]. Am J Roentgenol 185(5):1166–1172

    Article  Google Scholar 

  • Dobben AC, Terra MP, Deutekom M et al (2007) The role of endoluminal imaging in clinical outcome of overlapping anterior anal sphincter repair in patients with fecal incontinence. Am J Roentgenology 189(2):W70–77

    Article  Google Scholar 

  • Fletcher JG, Busse RF, Riederer SJ et al (2003) Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 98(2):399–411

    Article  CAS  PubMed  Google Scholar 

  • Fox JC, Fletcher JG, Zinsmeister AR et al (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49(11):1726–1735

    Article  PubMed  Google Scholar 

  • Hallan RI, Marzouk DE, Waldron DJ et al (1989) Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 76(9):973–975

    Article  CAS  PubMed  Google Scholar 

  • Jones MP, Post J, Crowell MD et al (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102(4):850–855

    Article  PubMed  Google Scholar 

  • Jones OM, Ramalingam T, Lindsey I et al (2005) Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable. Dis Colon Rectum 48(2):349–352

    Article  PubMed  Google Scholar 

  • Law NM, Bharucha AE, Undale AS et al (2001) Cholinergic stimulation enhances colonic motor activity, transit and sensation in humans. Am J Physiol Gastrointest Liver Physiol 281(5):G1228–G1237

    CAS  PubMed  Google Scholar 

  • Liberman H, Faria J, Ternent CA et al (2001) A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence. Dis Colon Rectum 44(11):1567–1574

    Article  CAS  PubMed  Google Scholar 

  • Malouf AJ, Norton CS, Engel AF et al (2000) Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 355(9200):260–265

    Article  CAS  PubMed  Google Scholar 

  • Malouf AJ, Halligan S, Williams AB et al (2001) Prospective assessment of interobserver agreement for endoanal MRI in fecal incontinence. Abdom Imaging 26(1):76–78

    Article  CAS  PubMed  Google Scholar 

  • Minguez M, Herreros B, Sanchiz V et al (2004) Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 126(1):57–62

    Article  PubMed  Google Scholar 

  • Mushlin AI, Kern LM, Paris M et al (2005) The value of diagnostic information to patients with chest pain suggestive of coronary artery disease. [see comment]. Med Decis Making 25(2):149–157

    Article  PubMed  Google Scholar 

  • Rao SS, Patel RS (1997) How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 92(3):469–475

    Google Scholar 

  • Rao SS, Read NW, Davison PA et al (1987) Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology 93(6):1270–1275

    CAS  PubMed  Google Scholar 

  • Rao SS, Welcher KD, Leistikow JS (1998) Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 93(7):1042–1050

    Article  CAS  PubMed  Google Scholar 

  • Rao SS, Hatfield R, Soffer E et al (1999) Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 94(3):773–783

    Article  CAS  PubMed  Google Scholar 

  • Rao SS, Azpiroz F, Diamant N et al (2002) Minimum standards of anorectal manometry. Neurogastroenterol Motil. 14(5):553–559

    Article  CAS  PubMed  Google Scholar 

  • Rao SS, Mudipalli RS, Stessman M et al (2004a) Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 16(5):589–596

    Article  CAS  PubMed  Google Scholar 

  • Rao SS, Ozturk R, Stessman M et al (2004b) Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 99(11):2204–2209

    Article  PubMed  Google Scholar 

  • Read NW, Abouzekry L (1986) Why do patients with faecal impaction have faecal incontinence. Gut 27(3):283–287

    Article  CAS  PubMed  Google Scholar 

  • Ryhammer AM, Laurberg S, Bek KM (1997) Age and anorectal sensibility in normal women. Scand J Gastroenterol 32(3):278–284

    Article  CAS  PubMed  Google Scholar 

  • Salvioli B, Bharucha AE, Rath-Harvey D et al (2001) Rectal compliance, capacity and rectoanal sensation in fecal incontinence. Am J Gastroenterol 96(7):2158–2168

    Article  CAS  PubMed  Google Scholar 

  • Shorvon PJ, McHugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30(12):1737–1749

    Article  CAS  PubMed  Google Scholar 

  • Siproudhis L, Bellissant E, Pagenault M et al (1999) Fecal incontinence with normal anal canal pressures: where is the pitfall? Am J Gastroenterol 94(6):1556–1563

    Article  CAS  PubMed  Google Scholar 

  • Siproudhis L, El Abkari M, El Alaoui M et al (2005) Low rectal volumes in patients suffering from fecal incontinence: what does it mean? Aliment Pharmacol Ther 22(10):989–996

    Article  CAS  PubMed  Google Scholar 

  • Sloots CE, Felt-Bersma RJ, Cuesta MA et al (2000) Rectal visceral sensitivity in healthy volunteers: influences of gender, age and methods. Neurogastroenterol Motil 12(4):361–368

    Article  CAS  PubMed  Google Scholar 

  • Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218(3):621–641

    CAS  PubMed  Google Scholar 

  • Sun WM, Read NW, Donnelly TC (1990a) Anorectal function in incontinent patients with cerebrospinal disease. Gastroenterology 99(5):1372–1379

    CAS  PubMed  Google Scholar 

  • Sun WM, Read NW, Miner TB (1990b) Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut 31(9):1056–1061

    Article  CAS  PubMed  Google Scholar 

  • Sun WM, Read NW, Prior A et al (1990c) Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology 99(4):1008–1015

    Google Scholar 

  • Sun WM, Donnelly TC, Read NW (1992) Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of “idiopathic” faecal incontinence. Gut 33(6):807–813

    Article  Google Scholar 

  • Terra MP, Deutekom M, Beets-Tan TG et al (2006) Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum 49(5):668–678

    Article  Google Scholar 

  • Varma JS, Smith AN, Busuttil A et al (1985) Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 72(11):875–878

    Article  CAS  PubMed  Google Scholar 

  • Voderholzer WA, Neuhaus DA, Klauser AG et al (1997) Paradoxical sphincter contraction is rarely indicative of anismus. Gut 41(2):258–262

    CAS  PubMed  Google Scholar 

  • Wald A, Tunuguntla AK (1984) Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med 310(20):1282–1287

    Article  CAS  PubMed  Google Scholar 

  • Wexner SD, Marchetti F, Salanga VD et al (1991) Neurophysiologic assessment of the anal sphincters. Dis Colon Rectum 34(7):606–612

    Article  CAS  PubMed  Google Scholar 

  • Whitehead WE, Palsson OS (1998) Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception. Gastroenterology 115(5):1263–1271

    Article  CAS  PubMed  Google Scholar 

  • Yeoh EK, Russo A, Botten R et al (1998) Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut 43(1):123–127

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Bharucha, A.E. (2008). Investigation of Fecal Incontinence. In: Imaging Pelvic Floor Disorders. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-71968-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-71968-7_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-71966-3

  • Online ISBN: 978-3-540-71968-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics