Clinical anatomy of fecal incontinence in women.

Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901-911, 2017. © 2017 Wiley Periodicals, Inc.

Comparison of Anorectal Manometry Testing in Left Lateral and Lithotomy Positions.

OBJECTIVES: Anorectal manometry (ARM) is typically performed in left lateral position, but many practitioners are more familiar with the lithotomy position. We aimed to evaluate agreement between ARM performed in left lateral and lithotomy positions and patient preference for testing position. METHODS: We performed a prospective comparison study of left lateral versus lithotomy position for women undergoing ARM for the evaluation of fecal incontinence. Women were randomly assigned to undergo testing in either left lateral position first followed by lithotomy position, or vice versa. Women then completed a survey assessing preference of position. We performed Bland-Altman analysis to measure the level of agreement between anorectal measurements obtained in the 2 positions. RESULTS: Twenty-one women were enrolled (mean age, 65 ± 2.2 years). We noted an acceptable level of agreement between anal pressure values obtained in left lateral versus lithotomy positions: anal resting pressure (mean difference, 0.9 mm Hg; 95% limits of agreement, 30.2 and -28.5) and anal squeeze pressure (mean difference, 1.8 mm Hg; 95% limits of agreement, 54.3 and -50.7). The level of agreement for sensory values was outside the predetermined clinical acceptability range. Most women (17/21 [81%]) reported a "good" or "very good" experience in both positions. CONCLUSIONS: Anorectal manometry testing in the 2 positions can be used interchangeably for anal resting and squeeze pressures, but not for anorectal sensation. This modification can be introduced into clinical practice to accommodate the preference of women and practitioners who favor lithotomy position.

The Quality of Health Information Available on the Internet for Patients With Fecal Incontinence.

OBJECTIVE: The aim of this study was to assess the quality of information available through the Internet for a variety of search terms for fecal incontinence (FI). METHODS: Using the Google search engine, searches were performed for 4 terms: "bowel control problem," "accidental bowel leakage," "fecal incontinence," and "leaking stool." The DISCERN quality analysis tool and JAMA benchmark criteria were implemented by 2 independent reviewers to evaluate the first 20 search results for each term. To determine if 1 term provided higher-quality information, mean DISCERN and JAMA criteria scores as well as Web site category were compared using analysis of variance and Pearson χ tests. RESULTS: Mean DISCERN scores for all terms fell in the middle range of possible scores. DISCERN questions addressing risks of treatment options, effects of treatment on quality of life, and gaps in knowledge/differences in expert opinion had the lowest scores across all search terms (range of scores, 1.1-1.7/5). JAMA criteria on authorship and attribution were most frequently missing on average in 48 of 80 and 42 of 80 Web sites, respectively. There were significant differences in mean DISCERN scores among the terms, with "fecal incontinence" yielding the highest mean score. The term "accidental bowel leakage" yielded the highest number of marketing Web sites, whereas "leaking stool" had the highest proportion of social Web sites. CONCLUSIONS: The quality of available information about FI on the Internet is variable, and key components are often missing. The term "fecal incontinence" yielded the highest quality information of all search terms.