Academic Surgical Unit, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, United Kingdom.
Dis Colon Rectum. 2012 Jan;55(1):18-25. doi: 10.1097/DCR.0b013e318237f37d.
The pathophysiology of fecal incontinence in men is poorly established.
The aim of this study was to assess the coexistence of constipation and determine the impact of rectal sensorimotor dysfunction in males with fecal incontinence.
This study was conducted at a tertiary referral center.
Included were adult male patients referred for the investigation of fecal incontinence over a 5-year period who underwent full anorectal physiology testing and completed a standardized symptom questionnaire.
Standardized symptom questionnaires were fully completed, and anorectal physiologic test results (including evacuation proctography) were evaluated.
: The primary outcomes measured were the frequency of symptoms of associated constipation, the association of blunted rectal sensation (rectal hyposensitivity) with symptoms, and other physiologic measures.
One hundred sixty patients met the inclusion criteria, and 47% of these patients described concurrent constipation. Fifty-four patients (34%) had sphincter dysfunction on manometry, only 19 of whom had structural abnormalities on ultrasound. Overall, 28 patients (18%) had rectal sensory dysfunction, 26 (93%) of whom had rectal hyposensitivity. Patients with rectal hyposensitivity were more likely to subjectively report constipation (77%) in comparison with patients with normal rectal sensation (44%; p = 0.001), allied with decreased bowel frequency (19% vs 2%; p = 0.003) and a sense of difficulty evacuating stool (27% vs 8%; p = 0.008). Cleveland Clinic constipation scores were higher in patients with rectal hyposensitivity (median score, 13 (interquartile range: 8-17) vs normosensate, 9 (5-13); p = 0.004). On proctography, a higher proportion of patients with rectal hyposensitivity had protracted defecation (>180 s; 35% vs 10%; p = 0.024) and incomplete rectal evacuation (<55% of barium neostool expelled, 50% vs 20%; p = 0.02).
: This study was limited by the retrospective analysis of prospectively collected data.
Only one-third of incontinent men had sphincteric dysfunction. Other pathophysiologies must therefore be considered. Nearly half of patients reported concurrent constipation, and one-sixth had rectal hyposensitivity, which was associated with higher frequencies of both symptomatic and objective measures of rectal evacuatory dysfunction. In the majority of adult males, fecal incontinence may represent a secondary phenomenon.
男性粪便失禁的病理生理学尚未明确。
本研究旨在评估便秘的共存情况，并确定直肠感觉运动功能障碍对男性粪便失禁的影响。
该研究在三级转诊中心进行。
研究纳入了 5 年内因粪便失禁接受调查的成年男性患者，他们接受了完整的肛门直肠生理检查，并完成了标准化症状问卷。
完成了标准化症状问卷，评估了肛门直肠生理测试结果（包括排空直肠造影）。
主要结局指标为相关便秘症状的发生频率、直肠感觉迟钝（直肠感觉减退）与症状的关系以及其他生理指标。
160 例患者符合纳入标准，其中 47%的患者同时存在便秘。54 例（34%）患者在测压时存在括约肌功能障碍，仅 19 例患者在超声检查时存在结构异常。总的来说，28 例（18%）患者存在直肠感觉功能障碍，其中 26 例（93%）存在直肠感觉减退。直肠感觉减退的患者更有可能主观报告便秘（77%），而直肠感觉正常的患者为 44%（p=0.001），同时伴有排便频率降低（19%比 2%；p=0.003）和排便困难感（27%比 8%；p=0.008）。直肠感觉减退患者的克利夫兰便秘评分更高（中位数 13 分（四分位距：8-17）比感觉正常患者的 9 分（5-13）；p=0.004）。在排粪造影中，直肠感觉减退患者的排便时间延长（>180 秒）的比例更高（35%比 10%；p=0.024），直肠排空不全（钡剂新便排出量<55%）的比例也更高（50%比 20%；p=0.02）。
本研究受到前瞻性收集数据的回顾性分析的限制。
仅有三分之一的失禁男性存在括约肌功能障碍。因此，必须考虑其他病理生理学。近一半的患者报告同时存在便秘，六分之一的患者存在直肠感觉迟钝，这与症状和直肠排空功能障碍的客观指标的发生频率均更高有关。在大多数成年男性中，粪便失禁可能是继发现象。
