Pathophysiology of fecal incontinence differs between men and women

a case-matched study in 200 patients

D. C. Townsend, E. V. Carrington, U. Grossi, R. E. Burgell, J. Y.J. Wong, C. H. Knowles, S. M. Scott

Research output: Contribution to journalArticleResearchpeer-review

14 Citations (Scopus)

Abstract

Background: Fecal incontinence (FI) is a common and socially disabling condition with obstetric trauma considered the principal etiological factor. This study aimed to systematically evaluate symptom presentation and anorectal function in both females and males with FI. Methods: One hundred males (M) and 100 age-matched females (F) with FI presenting between 2012 and 2014 were identified from a prospectively collected database. Comparison of clinical (history, symptom profile, and severity using validated questionnaires) and anorectal physiological (manometry, rectal sensory testing, endoanal ultrasonography, and evacuation proctography) data between M and F was performed. Key Results: Incidence of prior anal surgery (M: 28% vs F: 18%, p = 0.13) and abdominal surgery (M: 25% vs F: 26%, p = 0.90) was similar between sexes, but females had a higher incidence of previous pelvic surgery (M: 4% vs F: 47%, p < 0.001). Eighty-five females were parous and 75% reported history of traumatic vaginal delivery. There was a trend toward higher St Mark's incontinence scores in females (mean ± SD; M: 13 ± 4 vs F: 14 ± 5, p = 0.06). In men, structural sphincter abnormalities were uncommon (M: 37% vs F: 77%, p < 0.001), while impaired rectal sensation (M: 24% vs F: 7%, p = 0.001) and functional disturbances of evacuation (M: 36% vs F: 13%, p = 0.001) were more common than in women. No abnormality on all tests performed was observed in twice as many males (M: 18% vs F: 9%, p = 0.10). Conclusions & Inferences: Pathophysiological mechanisms of FI differ between sexes. Anal sphincter dysfunction was an uncommon finding in males, with impaired rectal sensation and functional disturbances of evacuation much more prominent than in the female cohort. These findings are likely to impact options for symptom management.

Original languageEnglish
Pages (from-to)1580-1588
Number of pages9
JournalNeurogastroenterology and Motility
Volume28
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016
Externally publishedYes

Keywords

  • anorectal physiology
  • fecal incontinence
  • females
  • males
  • rectal hyposensitivity
  • sex differences

Cite this

Townsend, D. C., Carrington, E. V., Grossi, U., Burgell, R. E., Wong, J. Y. J., Knowles, C. H., & Scott, S. M. (2016). Pathophysiology of fecal incontinence differs between men and women: a case-matched study in 200 patients. Neurogastroenterology and Motility, 28(10), 1580-1588. https://doi.org/10.1111/nmo.12858
Townsend, D. C. ; Carrington, E. V. ; Grossi, U. ; Burgell, R. E. ; Wong, J. Y.J. ; Knowles, C. H. ; Scott, S. M. / Pathophysiology of fecal incontinence differs between men and women : a case-matched study in 200 patients. In: Neurogastroenterology and Motility. 2016 ; Vol. 28, No. 10. pp. 1580-1588.
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abstract = "Background: Fecal incontinence (FI) is a common and socially disabling condition with obstetric trauma considered the principal etiological factor. This study aimed to systematically evaluate symptom presentation and anorectal function in both females and males with FI. Methods: One hundred males (M) and 100 age-matched females (F) with FI presenting between 2012 and 2014 were identified from a prospectively collected database. Comparison of clinical (history, symptom profile, and severity using validated questionnaires) and anorectal physiological (manometry, rectal sensory testing, endoanal ultrasonography, and evacuation proctography) data between M and F was performed. Key Results: Incidence of prior anal surgery (M: 28{\%} vs F: 18{\%}, p = 0.13) and abdominal surgery (M: 25{\%} vs F: 26{\%}, p = 0.90) was similar between sexes, but females had a higher incidence of previous pelvic surgery (M: 4{\%} vs F: 47{\%}, p < 0.001). Eighty-five females were parous and 75{\%} reported history of traumatic vaginal delivery. There was a trend toward higher St Mark's incontinence scores in females (mean ± SD; M: 13 ± 4 vs F: 14 ± 5, p = 0.06). In men, structural sphincter abnormalities were uncommon (M: 37{\%} vs F: 77{\%}, p < 0.001), while impaired rectal sensation (M: 24{\%} vs F: 7{\%}, p = 0.001) and functional disturbances of evacuation (M: 36{\%} vs F: 13{\%}, p = 0.001) were more common than in women. No abnormality on all tests performed was observed in twice as many males (M: 18{\%} vs F: 9{\%}, p = 0.10). Conclusions & Inferences: Pathophysiological mechanisms of FI differ between sexes. Anal sphincter dysfunction was an uncommon finding in males, with impaired rectal sensation and functional disturbances of evacuation much more prominent than in the female cohort. These findings are likely to impact options for symptom management.",
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Pathophysiology of fecal incontinence differs between men and women : a case-matched study in 200 patients. / Townsend, D. C.; Carrington, E. V.; Grossi, U.; Burgell, R. E.; Wong, J. Y.J.; Knowles, C. H.; Scott, S. M.

In: Neurogastroenterology and Motility, Vol. 28, No. 10, 01.10.2016, p. 1580-1588.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Pathophysiology of fecal incontinence differs between men and women

T2 - a case-matched study in 200 patients

AU - Townsend, D. C.

AU - Carrington, E. V.

AU - Grossi, U.

AU - Burgell, R. E.

AU - Wong, J. Y.J.

AU - Knowles, C. H.

AU - Scott, S. M.

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N2 - Background: Fecal incontinence (FI) is a common and socially disabling condition with obstetric trauma considered the principal etiological factor. This study aimed to systematically evaluate symptom presentation and anorectal function in both females and males with FI. Methods: One hundred males (M) and 100 age-matched females (F) with FI presenting between 2012 and 2014 were identified from a prospectively collected database. Comparison of clinical (history, symptom profile, and severity using validated questionnaires) and anorectal physiological (manometry, rectal sensory testing, endoanal ultrasonography, and evacuation proctography) data between M and F was performed. Key Results: Incidence of prior anal surgery (M: 28% vs F: 18%, p = 0.13) and abdominal surgery (M: 25% vs F: 26%, p = 0.90) was similar between sexes, but females had a higher incidence of previous pelvic surgery (M: 4% vs F: 47%, p < 0.001). Eighty-five females were parous and 75% reported history of traumatic vaginal delivery. There was a trend toward higher St Mark's incontinence scores in females (mean ± SD; M: 13 ± 4 vs F: 14 ± 5, p = 0.06). In men, structural sphincter abnormalities were uncommon (M: 37% vs F: 77%, p < 0.001), while impaired rectal sensation (M: 24% vs F: 7%, p = 0.001) and functional disturbances of evacuation (M: 36% vs F: 13%, p = 0.001) were more common than in women. No abnormality on all tests performed was observed in twice as many males (M: 18% vs F: 9%, p = 0.10). Conclusions & Inferences: Pathophysiological mechanisms of FI differ between sexes. Anal sphincter dysfunction was an uncommon finding in males, with impaired rectal sensation and functional disturbances of evacuation much more prominent than in the female cohort. These findings are likely to impact options for symptom management.

AB - Background: Fecal incontinence (FI) is a common and socially disabling condition with obstetric trauma considered the principal etiological factor. This study aimed to systematically evaluate symptom presentation and anorectal function in both females and males with FI. Methods: One hundred males (M) and 100 age-matched females (F) with FI presenting between 2012 and 2014 were identified from a prospectively collected database. Comparison of clinical (history, symptom profile, and severity using validated questionnaires) and anorectal physiological (manometry, rectal sensory testing, endoanal ultrasonography, and evacuation proctography) data between M and F was performed. Key Results: Incidence of prior anal surgery (M: 28% vs F: 18%, p = 0.13) and abdominal surgery (M: 25% vs F: 26%, p = 0.90) was similar between sexes, but females had a higher incidence of previous pelvic surgery (M: 4% vs F: 47%, p < 0.001). Eighty-five females were parous and 75% reported history of traumatic vaginal delivery. There was a trend toward higher St Mark's incontinence scores in females (mean ± SD; M: 13 ± 4 vs F: 14 ± 5, p = 0.06). In men, structural sphincter abnormalities were uncommon (M: 37% vs F: 77%, p < 0.001), while impaired rectal sensation (M: 24% vs F: 7%, p = 0.001) and functional disturbances of evacuation (M: 36% vs F: 13%, p = 0.001) were more common than in women. No abnormality on all tests performed was observed in twice as many males (M: 18% vs F: 9%, p = 0.10). Conclusions & Inferences: Pathophysiological mechanisms of FI differ between sexes. Anal sphincter dysfunction was an uncommon finding in males, with impaired rectal sensation and functional disturbances of evacuation much more prominent than in the female cohort. These findings are likely to impact options for symptom management.

KW - anorectal physiology

KW - fecal incontinence

KW - females

KW - males

KW - rectal hyposensitivity

KW - sex differences

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U2 - 10.1111/nmo.12858

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