Fecal incontinence in men

Coexistent constipation and impact of rectal hyposensitivity

Rebecca E. Burgell, Chetan Bhan, Peter J. Lunniss, S. Mark Scott

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)

Abstract

BACKGROUND: The pathophysiology of fecal incontinence in men is poorly established. OBJECTIVE: The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire. INTERVENTION: Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated. MAIN OUTCOME MEASURES: The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures. RESULTS: One hundred sixty patients met the inclusion criteria, and 47% of these patients described concurrent constipation. Fifty-four patients (34%) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18%) had rectal sensory dysfunction, 26 (93%) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77%) in comparison with patients with normal rectal sensation (44%; p = 0.001), allied with decreased bowel frequency (19% vs 2%; p = 0.003) and a sense of difficulty evacuating stool (27% vs 8%; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35% vs 10%; p = 0.024) and incomplete rectal evacuation (<55% of barium neostool expelled, 50% vs 20%; p = 0.02). LIMITATIONS: This study was limited by the retrospective analysis of prospectively collected data. CONCLUSIONS: Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.

Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalDiseases of the Colon and Rectum
Volume55
Issue number1
DOIs
Publication statusPublished - 1 Jan 2012
Externally publishedYes

Keywords

  • Constipation
  • Fecal incontinence
  • Rectal hyposensitivity

Cite this

Burgell, Rebecca E. ; Bhan, Chetan ; Lunniss, Peter J. ; Scott, S. Mark. / Fecal incontinence in men : Coexistent constipation and impact of rectal hyposensitivity. In: Diseases of the Colon and Rectum. 2012 ; Vol. 55, No. 1. pp. 18-25.
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title = "Fecal incontinence in men: Coexistent constipation and impact of rectal hyposensitivity",
abstract = "BACKGROUND: The pathophysiology of fecal incontinence in men is poorly established. OBJECTIVE: The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire. INTERVENTION: Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated. MAIN OUTCOME MEASURES: The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures. RESULTS: One hundred sixty patients met the inclusion criteria, and 47{\%} of these patients described concurrent constipation. Fifty-four patients (34{\%}) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18{\%}) had rectal sensory dysfunction, 26 (93{\%}) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77{\%}) in comparison with patients with normal rectal sensation (44{\%}; p = 0.001), allied with decreased bowel frequency (19{\%} vs 2{\%}; p = 0.003) and a sense of difficulty evacuating stool (27{\%} vs 8{\%}; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35{\%} vs 10{\%}; p = 0.024) and incomplete rectal evacuation (<55{\%} of barium neostool expelled, 50{\%} vs 20{\%}; p = 0.02). LIMITATIONS: This study was limited by the retrospective analysis of prospectively collected data. CONCLUSIONS: Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.",
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Fecal incontinence in men : Coexistent constipation and impact of rectal hyposensitivity. / Burgell, Rebecca E.; Bhan, Chetan; Lunniss, Peter J.; Scott, S. Mark.

In: Diseases of the Colon and Rectum, Vol. 55, No. 1, 01.01.2012, p. 18-25.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fecal incontinence in men

T2 - Coexistent constipation and impact of rectal hyposensitivity

AU - Burgell, Rebecca E.

AU - Bhan, Chetan

AU - Lunniss, Peter J.

AU - Scott, S. Mark

PY - 2012/1/1

Y1 - 2012/1/1

N2 - BACKGROUND: The pathophysiology of fecal incontinence in men is poorly established. OBJECTIVE: The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire. INTERVENTION: Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated. MAIN OUTCOME MEASURES: The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures. RESULTS: One hundred sixty patients met the inclusion criteria, and 47% of these patients described concurrent constipation. Fifty-four patients (34%) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18%) had rectal sensory dysfunction, 26 (93%) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77%) in comparison with patients with normal rectal sensation (44%; p = 0.001), allied with decreased bowel frequency (19% vs 2%; p = 0.003) and a sense of difficulty evacuating stool (27% vs 8%; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35% vs 10%; p = 0.024) and incomplete rectal evacuation (<55% of barium neostool expelled, 50% vs 20%; p = 0.02). LIMITATIONS: This study was limited by the retrospective analysis of prospectively collected data. CONCLUSIONS: Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.

AB - BACKGROUND: The pathophysiology of fecal incontinence in men is poorly established. OBJECTIVE: The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire. INTERVENTION: Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated. MAIN OUTCOME MEASURES: The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures. RESULTS: One hundred sixty patients met the inclusion criteria, and 47% of these patients described concurrent constipation. Fifty-four patients (34%) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18%) had rectal sensory dysfunction, 26 (93%) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77%) in comparison with patients with normal rectal sensation (44%; p = 0.001), allied with decreased bowel frequency (19% vs 2%; p = 0.003) and a sense of difficulty evacuating stool (27% vs 8%; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35% vs 10%; p = 0.024) and incomplete rectal evacuation (<55% of barium neostool expelled, 50% vs 20%; p = 0.02). LIMITATIONS: This study was limited by the retrospective analysis of prospectively collected data. CONCLUSIONS: Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.

KW - Constipation

KW - Fecal incontinence

KW - Rectal hyposensitivity

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DO - 10.1097/DCR.0b013e318237f37d

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VL - 55

SP - 18

EP - 25

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

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