How correlate the manometry pressures with fecal incontinence severity index and presence of sphincter defects?

Background: Fecal incontinence is a common health care problem affecting 1–7% of the population. The aim of this study was to determine the relatonship between anorectal manometry, fecal incontinence severity and findings at endoanal ultrasound.

Patients and methods: 28 consecutive patients (21 females and 7 males) was enrolled in the program. The severity of incontinence was determinate by the Cleveland score system. Endoanal ultrasound were performed to exclude or proved structural damage. Anorectal manometry was performed to detect the perception tresholds and measure sphincter function. Cleveland score and manometry pressures in 18 patients with intact sphincters on ultrasound were compared in 10 patients with sphincter defects. We detect the relationships between resting and squeeze pressures, maximal tolerable volume and severity index.

Results: Mean severity score in patients with and without sphincter defect were 19±0,47 vs. 13,8±0,56 (NS=not significant). The resting pressure and maximal tolerable volume correlated with the Cleveland score. Resting pressures patients with and without sphincter defect were 22,6±4,41 vs. 32,2±4,63mmHg (NS), maximal tolerable volume were 138±30,1ml vs. 190±25,59ml (NS). Significant difference were observed in squeezing pressure between the patients with and without sphincter defect (45,2±10,7mmHg vs. 67,4±7,45mmHg, p<0,05).

Conclusions: All patients had similar severity score and resting pressure, but patients with sphincter defects had lower squeezing pressures. Both manometry and ultrasound should be offered to patients with history of sphincter trauma.