Developing a new electromyography-based algorithm to diagnose the etiology of fecal incontinence.

Michał Nowakowski,Krzysztof A Tomaszewski,Jerzy Sałówka,Michał Romaniszyn,Mateusz Rubinkiewicz,Roman M Herman,Jerzy A Walocha

doi:10.1007/s00384-014-1859-1

Michał Nowakowski, Krzysztof A Tomaszewski + Show 5 more

Open Access

https://doi.org/10.1007/s00384-014-1859-1

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Abstract

PurposeFor surface electromyography (sEMG) to become widely used in fecal incontinence (FI) etiology assessment, one would have to create a simple, step-by-step, computer-aided, electromyography-based algorithm that would become the basis for a computer-aided diagnosis (CAD) system. Thus, the aim of this work was to develop such an algorithm.MethodsEach patient included in the study underwent a structured medical interview, a general physical examination, and a proctological examination. Patients that scored more than 10 points on the fecal incontinence severity index (FISI) underwent further tests that included rectoscopy, anorectal manometry, transanal ultrasonography, multichannel sEMG, and assessment of anal reflexes. Patients with fully diagnosed FI were included into the study group. The control group consisted of healthy volunteers that scored five or less points on the FISI and had no known anal sphincters dysfunction.ResultsForty-nine patients were qualified to the study group (age ± SD 58.9 ± 13.8). The control group was number- and gender-matched (age ± SD 45.4 ± 15.1). The sensitivity and specificity of classification tree number I, to diagnose neurogenic FI, were 89.5 and 86 %, respectively. For patients with idiopathic FI, these values were 82 and 91 %, respectively. The sensitivity and specificity of classification tree number III, to diagnose neurogenic FI, were 84 and 78 %, respectively. For patients with idiopathic FI, these values were 78 and 87 %, respectively.ConclusionsThe relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology CAD system.

Highlights

The International Continence Society (ICS) has defined fecal incontinence (FI) as the involuntary loss of liquid or stool that is a social or hygiene problem [1]
The relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology computer-aided diagnosis (CAD) system
Study group exclusion criteria were the following: age below 18 or above 90; pregnancy; lack of consent to participate in the study; not being able to participate in all the necessary test from the study protocol; and conditions that influenced the fecal incontinence severity index (FISI) score

Summary

Introduction

The International Continence Society (ICS) has defined fecal incontinence (FI) as the involuntary loss of liquid or stool that is a social or hygiene problem [1]. FI prevalence, apart from being age related, is gender dependent, with over 60 % of affected elderly being women [1]. This last statement is not necessarily true for every population [6]. The many FI causes include trauma (obstetric, iatrogenic), radiation damage, rectal prolapse, inflammatory bowel diseases, neurological disorders, and cognitive impairment [1, 3]. FI etiology assessment can be divided into physiological and structural. Methods used for the physiological assessment of FI cause include anorectal manometry, needle and surface electromyography (sEMG), and pudendal nerve terminal latency [1].

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