Efficacy of Kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

Table 1 Modified Vaizey’s incontinence scores

Factor	Never	Rarely	Sometimes	Weekly	Daily
Incontinence for solid stool	0	1	2	3	4
Incontinence for liquid stool	0	1	2	3	4
Incontinence for gas	0	1	2	3	4
Alteration in lifestyle	0	1	2	3	4
Need to wear a pad	No = 0
	Yes = 2
Taking constipating medicines	No = 0
	Yes = 2
Urge incontinence (inability to defer defection by 15 min)	0	1	2	3	4

Never: No episodes in the past 4 wk; Rarely: 1 episode in the past 4 wk; Sometimes: > 1 episode in the past 4 wk but < 1 a week; Weekly: ≥ 1 a week, < 1 daily; Daily: ≥ 1 a day. In Vaizey’s scores, Urge incontinence had only two categories (no = 0, yes = 4). In modified Vaizey’s scores, Urge incontinence was given five score categories (0-4) as shown in the table above.

Table 2 Patient parameters

Parameter	Data, n = 102
Age	42.3 ± 12.8
Males	90 (88.2)
Follow-up, median (range), mo	30 (18-42)
Fistula characteristics
High	102 (100)
Recurrent fistulas	65 (63.7)
Multiple tracts	92 (90.2)
Associated abscess	42 (41.7)
Horseshoe fistula	46 (45.1)
Supralevator fistulas	34 (33.3)
Parks classification	Grade I-8
	Grade II-61
	Grade III-33
	Grade IV-0

Data are presented as n (%), unless otherwise indicated.

Table 3 Overall incontinence

n = 99	Immediate postoperative (before Kegel exercises)	Long-term (after Kegel exercises)	P value
Number of patients	31	13	0.00001, t-test
Total score	118	26
Mean score	1.19 ± 1.96	0.26 ± 0.77

Table 4 Distribution of incontinence types in affected patients

Type of incontinence	Total patients, n = 31 (urge = 24, gas = 8, liquid = 7, solid = 0)
Urge	19
Gas	2
Liquid	3
Urge + gas	3
Urge + liquid	1
Gas + liquid	2
Urge + gas + liquid	1
Total	31

Table 5 Sub-group analysis

n = 99		Immediate postoperative (before Kegel exercises)	Long-term (after Kegel exercises)	P value
Urge	Number of patients	24	10	0.00007, t-test
	Mean scores	0.88 ± 1.62	0.20 ± 0.66
	Total score	88	20
Gas	Number of patients	8	3	0.03, t-test
	Mean scores	0.16 ± 0.60	0.04 ± 0.24
	Total score	16	4
Liquid	Number of patients	7	2	0.03, t-test
	Mean scores	0.14 ± 0.58	0.02 ± 0.14
	Total score	14	2
Solid	Number of patients	0	0

Table 6 Males vs females

n = 99		Males, n = 87	Females, n = 12	Significance, P value
Patients		29 (33.3%)	2 (16.7%)	0.33, Fisher exact test
Total scores	Immediate postoperative (before Kegel exercises)	112	6	0.59, Fisher exact test
	Long-term (after Kegel exercises)	26	0
Mean scores	Immediate postoperative (before Kegel exercises)	1.28 ± 2.0	0.5 ± 1.24	0.09, t-test
	Long-term (after Kegel exercises)	0.29 ± 0.82	0