Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence.

Abstract

Faecal incontinence (FI) is a debilitating condition, which affects approximately 2-17% of the population. Clinical assessment, physiological testing and imaging are usually used to evaluate the pathophysiology and guide management of FI. By analysing patient characteristics, symptoms and investigative findings, the aim of this study was to identify which patient characteristics and investigations influence patient management. Data was prospectively collected for all patients with FI presenting to a single surgeon at the Royal Prince Alfred Hospital, Sydney, between March 2002 and September 2013. Continuous data was analysed using the independent T-test. Categorical data was analysed using chi-square tests and logistic regression. Three hundred ninety-eight patients were reviewed; 96% were female and the mean age was 57years. Surgical intervention was recommended for 185 patients (47%) should biofeedback fail. Independent predictors for surgical recommendation were prolapse (p<0.001, adjusted OR=4.9 [CI 2.9-8.2]), a functional sphincter length <1cm (p=0.032, OR=1.7 [CI 1.1-2.8]), an external anal sphincter defect (p=0.028, OR=1.8 [CI 1.1-3.1]) and a Cleveland Clinic Incontinence Score ≥10 (p=0.029, OR=1.7 [CI 1.1-2.6]). Independent predictors of surgical recommendation included the presence of prolapse, a functional sphincter length <1cm, an external anal sphincter defect and a Cleveland Clinic Incontinence Score≥10. Pudendal neuropathy was not a predictor of surgical intervention, leading us to question the utility of this investigation.