Importance of colonic transit evaluation in the management of fecal incontinence.

BACKGROUND AND AIMS

Fecal incontinence is common. The potential contribution of colon function to continence has not been studied. Treatment is poorly codified. To evaluate colonic transit time (CTT) and its importance in the management of fecal incontinence we analyzed in a retrospective study the CTT in patients with fecal incontinence, and on this basis in a prospective study used a treatment algorithm taking colonic transit into account.

PATIENTS AND METHODS

We studied 30 healthy subjects and 171 patients (110 in the retrospective and 61 in the prospective study). Anorectal manometry and CTT measurement using radio-opaque markers were performed. Patients were divided into three groups according to their CTT: rapid (<24 h), normal, and delayed (>65 h). In patients with abnormal CTT modifiers of transit time were used as first line of treatment. Biofeedback therapy was used alone in patients with normal transit and used in the other patients after 6 weeks of medication when there was no or only partial improvement.

RESULTS

Incontinent patients had less upper and lower anal pressure and maximal squeeze pressure and longer CTT than controls. Rapid and delayed transit times were found, respectively, in 17% and 32% of patients. After 6 weeks of treatment 77% of patients had recovered from fecal incontinence. Biofeedback therapy increased total improvement to 95%.

CONCLUSION

We conclude that evaluation of CTT is useful in the management of fecal incontinence, and that medical therapy is sufficient to treat most incontinent patients. This implies the use of a careful selection algorithm prior to surgery for fecal incontinence.