Patients with rectal intussusception and fecal incontinence without rectocele may have reduced anal sphincter function, according to research published in the International Journal of Colorectal Disease.

Recent evidence suggests that a reduction in internal sphincter tone may be an important cause of fecal incontinence, which becomes notable with increasing rectal intussusception levels, yet it is still unclear the roles of other anatomical abnormalities in anal function.

In this study, the investigators sought to determine the effect of anatomical abnormalities — including rectocele, enterocoele, and pelvic floor descent — on anal sphincter function in women with rectal intussusception and fecal incontinence.


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Patients underwent evaluation proctography, and participants with rectal intussusception and fecal incontinence, who underwent both manometric study and endo-anal ultrasound, were included in the study. Laboratory studies of anal sphincter function were also conducted.

The total cohort included 802 patients who underwent evaluation proctography; 49.5% of those patients were found to have rectal intussusception, including 194 with fecal incontinence. From this group, a final cohort of 85 patients (median age 74) was included in the study (68 with rectoanal intussusception and 17 with rectorectal intussusception). Median fecal incontinence severity index score was 24 (range 8-59), with 78% of patients experiencing passive fecal incontinence, 11% experiencing urgent fecal incontinence, and 12% experiencing both.

No significant difference in the incidence of rectocele or enterocele between patients with rectorectal and rectoanal intussusception was noted.

Patients with rectoanal intussusception experienced significantly lower maximum resting pressure compared with patients with rectorectal intussusception. (51.1 vs 70.7 cmH₂0; P =.007); maximum squeeze pressure “tended to be significantly lower” in these patients as well (146.9 vs 188.3 cmH₂0; P =.052). No significant between-group difference in defactory desire volume or maximum tolerated volume was noted, although both maximum resting pressure and maximum squeeze pressure were significantly lower in patients with rectal intussusception without rectocele than in those with rectal intussusception and rectocele.

The investigators found that age, the presence of rectocele, and the level of rectal intussusception were all significantly associated with maximum resting pressure, although fecal incontinence severity index was not correlated.

A stepwise multivariate regression analysis found that rectoanal intussusception and the absence of rectocele were significantly associated with decreased maximum resting pressure.

Study limitations included the small, retrospective nature of the study, as well as the potential of fecal incontinence severity being affected by factors not evaluated such as health status and physical limitations. Additionally, information bias may be present due to the self-reported nature of symptom scores.

“This study demonstrated that a reduction in [internal anal sphincter] function was more common not only in patients with rectoanal intussusception, but also in those without rectocele,” the investigators concluded. “Further studies are necessary to confirm the results of this study.”

Reference

Tsunoda A, Takahashi T, Kusanagi H. Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence [published online August 30, 2019]. Int J Colorectal Dis. doi: 10.1007/s00384-019-03382-3