Pudendal canal decompression for the treatment of fecal incontinence in complete rectal prolapse.

Our recent studies have attributed fecal incontinence (FI) when it is associated with complete rectal prolapse (CRP) to pudendal neuropathy caused by pudendal canal syndrome (PCS). Herein we present the results of pudendal canal decompression (PCD), performed for the treatment of FI in 21 patients whose CRP was corrected by Ivalon sponge rectopexy 5.2 years before presentation. Thirteen patients had partial and eight complete FI. Examination revealed perianal hypoesthesia, diminished rectal neck pressure, reduced electromyographic (EMG) activity of both the external anal sphincter (EAS) and levator ani (LA) muscle, as well as prolonged pudendal nerve terminal motor latency (PNTML). PCD was performed with a mean follow up of 14.8 months. Postoperatively, seven (53.8%) of the patients with partial FI showed full fecal control with normalization or improvement of the perianal hypoesthesia, rectal neck pressure, EMG of EAS and LA, as well as PNTML. The remaining six patients were failures. Five (62.5%) of the eight patients with complete FI showed full fecal control, two partial improvement, and one failure. The degree of response of FI to PCD seems to be related to the degree of pudendal nerve damage. Nonimprovement may be due to irreversible pudendal nerve damage or incomplete PCD. In conclusion, PCD is effective in the treatment of FI associated with CRP, provided it is performed before complete nerve damage occurs.