Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4000-4005
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4000
Rectal tone and compliance affected in patients with fecal incontinence after fistulotomy
Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García
Richard Alexander Awad, Santiago Camacho, Francisco Flores, Evelyn Altamirano, Mario Antonio García, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico DF06726, Mexico
Author contributions: Awad RA was involved in creating the protocol, evaluation of data, recruitment of patients, acquisition of results, statistical analysis, and drafting of the manuscript; Camacho S was involved in recruitment of patients, acquisition of results, and statistical analysis; Flores F, Altamirano E and García MA were involved in recruitment of patients and acquisition of results; all authors have seen and approved the final version of the report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Richard Alexander Awad, MD, MSc, Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Dr. Balmis #148, Col. Doctores, México DF06726, Mexico. awadrichardalexander@prodigy.net.mx
Telephone: +52-55-50043806 Fax: +52-55-50043806
Received: September 9, 2014
Peer-review started: September 9, 2014
First decision: September 27, 2014
Revised: October 15, 2014
Accepted: November 18, 2014
Article in press: November 19, 2014
Published online: April 7, 2015
Abstract

AIM: To investigate the anal sphincter and rectal factors that may be involved in fecal incontinence that develops following fistulotomy (FIAF).

METHODS: Eleven patients with FIAF were compared with 11 patients with idiopathic fecal incontinence and with 11 asymptomatic healthy subjects (HS). All of the study participants underwent anorectal manometry and a barostat study (rectal sensitivity, tone, compliance and capacity). The mean time since surgery was 28 ± 26 mo. The postoperative continence score was 14 ± 2.5 (95%CI: 12.4-15.5, St Mark’s fecal incontinence grading system).

RESULTS: Compared with the HS, the FIAF patients showed increased rectal tone (42.63 ± 27.69 vs 103.5 ± 51.13, P = 0.002) and less rectal compliance (4.95 ± 3.43 vs 11.77 ± 6.9, P = 0.009). No significant differences were found between the FIAF patients and the HS with respect to the rectal capacity; thresholds for the non-noxious stimuli of first sensation, gas sensation and urge-to-defecate sensation or the noxious stimulus of pain; anal resting pressure or squeeze pressure; or the frequency or percentage of relaxation of the rectoanal inhibitory reflex. No significant differences were found between the FIAF patients and the patients with idiopathic fecal incontinence.

CONCLUSION: In patients with FIAF, normal motor anal sphincter function and rectal sensitivity are preserved, but rectal tone and compliance are impaired. The results suggest that FIAF is not due to alterations in rectal sensitivity and that the rectum is more involved than the anal sphincters in the genesis of FIAF.

Keywords: Fecal incontinence, Anorectal surgery, Fistulotomy, Visceral sensitivity, Barostat

Core tip: Fistula and anorectal abscess are common, and 40% of such abscesses result in fistulas. Postoperative fecal incontinence (FI) is frequent. It has been reported that rectal distensibility and thresholds for sensations decrease after hemorrhoidopexy, and that the perception of rectal distension is not always reduced in FI. In our patients with FI after fistulotomy (FIAF), anal sphincter function and rectal sensitivity are preserved, but rectal tone and compliance are impaired. The results suggest that FIAF is not due to alterations in rectal sensitivity and that the rectum is more involved than the anal sphincters in the genesis of FIAF.