Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry.

Retraining of the external sphincter response to rectal distention and improving the sensory threshold to balloon distention is documented as effective treatment for fecal incontinence in selected patients. Using anorectal manometric techniques, delayed conscious rectal sensation was demonstrated in 28% of 46 consecutive patients referred for fecal incontinence. In patients with delayed recognition of balloon distention, conscious rectal sensation seemed to correlate with a consistent level of internal sphincter relaxation rather than the primary stimulus of balloon distention of the rectum. Anorectal retraining techniques resulted in correction of sensory delay of 2-22 s, elimination of fecal incontinence, and improved sensory threshold in 10 of 13 patients. This previously unreported sensory abnormality represents a treatable manometric abnormality identified by anorectal motility in patients with fecal incontinence.