Effect of age, patient's sex, and type of trauma on the correlation between size of sphincter defect and anal pressures in posttraumatic fecal incontinence

Abstract

The physiologic assessment of anal sphincters in cases of posttraumatic fecal incontinence is a fundamental step in planning operative treatment. In this study, we evaluate the correlation between size of anal sphincter defect, anal pressures, and clinical symptoms in patients with posttraumatic fecal incontinence. We also investigate the impact of patients' age, sex, and type of trauma on this correlation. Records of 70 patients fitting the study's eligibility criteria were collected retrospectively from the archives of Mansoura University Hospitals' colorectal surgery unit. Demographic data of patients, causes of fecal incontinence, images of sphincter defects on endorectal ultrasonography, anal resting and squeeze pressures, and Wexner continence scores were collected, and correlation analysis was performed. Seventy patients (54 males and 16 females) with a mean (±standard deviation) age of 36±16years were studied. Mean maximal resting anal pressure was 42±16mm Hg, and mean maximal squeeze anal pressure was 80±35mm Hg. Size of external anal sphincter defect was negatively correlated with mean maximal squeeze (r=-0.4298). Mean Wexner continence score was correlated positively with size of external anal sphincter defect (r=0.3743). Both correlations became significantly stronger in female patients, patients greater than 50years, postfistulectomy patients, and patients with obstetric injuries. Size of external anal sphincter defect correlates negatively with mean maximal squeeze and positively with symptoms score. This correlation is stronger in females, patients greater than 50years, and patients with postfistulectomy or obstetric injuries. These findings suggest that this group of patients requires additional assessment before surgical repair.