Fecal incontinence in men: Causes and clinical and manometric features

Table 1 Previous medical history of patients with fecal incontinence n (%)

	Ano-rectal Surgery	Chronic Diarrhea					Hemorrhoids
		Total	IBD	Irritable Intestine syndrome	Others1	Radiotherapy
Total (n = 764)	190 (24.9)	339 (44.4)	72 (9.4)	107 (14.0)	138 (18.1)	22 (2.9)	35 (4.6)
Men (n = 119)	46 (38.6)	50 (42.0)	10 (8.4)	11 (9.2)	24 (20.2)	5 (4.2)	7 (5.9)
Women (n = 645)	144 (22.3)	289 (44.8)	62 (9.6)	96 (14.9)	114 (17.7)	17 (2.6)	28 (4.3)
χ2 (P value)	5.72 (< 0.001)	0.16 (NS)	0.09 (NS)	1.99 (NS)	0.96 (NS)	0.39 (NS)	0.26 (NS)
	Epidermoid Carcinoma	Constipation	Prolapse	Obstetric	None	Several risk factors	Neurological disease
Total (n = 764)	1 (0.4)	138 (18.1)	12 (1.6)	375 (49.1)	75 (9.8)	401 (52.5)	39 (5.1)
Men (n = 119)	1 (0.8)	20 (16.8)	2 (1.7)	0 ( 0.0)	8 (6.7)	34 (28.6)	16 (13.4)
Women (n = 645)	0 (0.0)	118 (18.3)	10 (1.5)	375 (58.1)	67 (10.4)	367 (56.9)	23 (3.6)
χ2 (P value)	0.8 (NS)	0.08 (NS)	0.01 (NS)	81.9 (< 0.001)	0.87 (NS)	16.36 (< 0.0001)	6.17 (< 0.01)

¹Other causes of chronic diarrhea (men, women): Billroth II gastrectomy (2, 11); Cholecystectomy (3, 26); Small bowel resection (0, 2); Celiac disease (3, 13); Whipple’s disease (0, 1); Giardia lamblia (1, 8); Pancreatic insufficiency (2, 9); Collagenous colitis (2, 5); Food intolerance (1, 4); Small intestinal bacterial overgrowth (7, 12); Undetermined cause (3, 23). NS: Not significant; IBD: Inflammatory bowel disease.

Table 2 Previous ano-rectal surgery in patients with fecal incontinence n (%)

Indications for ano-rectal surgery	Men	Women	χ2	P
Hemorrhoids	9 (7.6)	26 (4.0)	1.18	NS
Ulcerative colitis	2 (1.7)	9 (1.4)	0.03	NS
Crohn’s disease	2 (1.7)	12 (1.8)	0.003	NS
Rectal cancer	12 (10.1)	16 (2.4)	5.06	< 0.05
(Low anterior resection)
Abscess	8 (6.7)	23 (3.5)	1.06	NS
Anal atresia	3 (2.5)	15 (2.3)	0.001	NS
Colorectal cancer	2 (1.7)	9 (1.4)	0.03	NS
Fistula	4 (3.4)	19 (1.4)	0.854	NS
Fissure	2 (1.7)	6 (0.9)	0.006	NS
Rectal prolapse	1 (0.8)	3 (0.5)	0.07	NS
Prostate cancer	1 (0.8)	0 (0.0)	0.8	NS
Anal dilatation	0 (0.0)	6 (0.9)	0.9	NS
Total	46 (38.6)	144 (22.3)	5.72	< 0.05

NS: Not significant.

Table 3 Ano-rectal manometry n (%)

Resting pressure	Normal (60-80 mmHg)	Decreased (< 50 mmHg)	Increased (> 80 mmHg)
Total (n = 763)	333 (43.6)	373 (48.9)	57 (7.5)
Men (n = 118)	65 (55.1)	42 (35.6)	11 (9.3)
Women (n = 645)	268 (41.5)	331 (51.3)	46 (7.1)
χ2 (P value)	3.70 (NS)	5.02 (< 0.05)	0.32 (NS)
External anal sphincter pressure	Normal (> 120 mmHg)	Decreased (< 120 mmHg)
Total (n = 763)	322 (42.2)	441 (57.8)
Men (n = 118)	92 (78.0)	26 (22.0)
Women (n = 645)	230 (35.6)	415 (64.3)
χ2 (P value)	64.4 (< 0.001)	35.7 (< 0.001)
Rectal sensitivity	Normal	Decreased	Increased
Total (n = 763)	393 (51.5)	97 (12.7)	273 (35.8)
Men (n = 118)	54 (45.8)	29 (24.6)	35 (29.7)
Women (n = 645)	339 (52.6)	68 (10.5)	238 (36.9)
χ2 (P value)	0.92 (NS)	6.87 (<0.01)	1.17 (NS)
Recto-anal inhibitory reflex	Normal (20-30 mL)	Decreased or absent (> 60 mL)	Increased (< 10 mL)
Total (n = 763)	614 (80.5)	69 (9.0)	80 (10.5)
Men (n = 118)	102 (86.4)	10 (8.5)	6 (5.1)
Women (n = 645)	515 (79.8)	59 (9.1)	71 (11.0)
χ2 (P value)	1.55 (NS)	0.02 (NS)	2.35 (NS)

NS: Not significant.

Table 4 Response to treatment n (%)

	No follow-up	Follow-up	Response to treatment
				Wexner score after treatment
				0-1 WS	2- 5 WS	6-9 WS	≥10 WS
Total (n = 764)	145 (19.0)	619 (81.0)		257 (41.5)	241 (38.9)	92 (14.8)	29 (4.7)
Men (n = 119)	36 (30.3)	83 (69.7)	Treatments:	28 (33.7)	39 (46.9)	10 (12.8)	6 (7.2)
n = 50	21 (42.0)	29 (58.0)	Chronic diarrhea1	4 (13.8)	22 (75.9)	2 (6.9)	1 (3.4)
n = 20	8 (40.0)	12 (60.0)	Constipation2	4 (33.3)	6 (50.0)	2 (16.6)	0 (0.0)
n = 12	5 (41.7)	7 (58.3)	Incomplete evacuation3	2 (28.6)	4 (57.1)	1 (14.3)	0 (0.0)
n = 25	0 (0.0)	25 (100.0)	Soiling4	18 (72.0)	6 (24.0)	1 (4.0)	0 (0.0)
n = 12	2 (16.7)	10 (83.3)	Others5	0 (00.0)	1 (10.0)	4 (40.0)	5 (50.0)
Women (n = 645)	109 (16.9)	536 (83.1)	Treatments:	229 (42.7)	202 (37.7)	82 (15.3)	23 (4.3)
n = 289	51 (17.6)	238 (82.3)	Chronic diarrhea1	129 (54.2)	88 (37.0)	21 (8.8)	0 (0.0)
n = 118	28 (23.7)	90 (76.3)	Constipation2	48 (53.3)	35 (38.9)	7 (7.8)	0 (0.0)
n = 74	18 (24.3)	56 (75.7)	Incomplete evacuation3	18 (32.1)	34 (60.7)	4 (7.1)	0 (0.0)
n = 32	2 (6.3)	30 (93.7)	Soiling4	22 (73.3)	6 (23.3)	2 (3.3)	0 (0.0)
n = 132	10 (7.6)	122 (92.4)	Others5	12 (9.8)	39 (31.9)	48 (39.3)	23 (18.8)
χ2 (P) (men vs women)	4.98 (< 0.05)	4.98 (< 0.05)		1.72 (NS)	1.73 (NS)	0.26 (NS)	0.78 (NS)

¹Patients with chronic diarrhea were treated in a stepwise approach according to the response: (1) dietary modification and loperamide; (2) resin-cholysteramine or codeine phosphate; (3) otilonium bromide; and (4) amitriptyline;

²Patients with constipation were treated with: (1) a fiber-rich diet and a bulking agent; (2) osmotic laxative; and (3) glycerol suppositories or enemas;

³Patients with incomplete evacuation were treated with bulking agents with or without glycerol suppositories or enema;

⁴Patients with soiling started with fiber-rich diet and bulking agents; glycerol suppositories or enema;

⁵Patients with inflammatory bowel disease, prolapses, neurological diseases required special treatment including specific therapy, surgery, anal plugs, sacral nerve electrostimulation, or a combination of several measures. NS: Not significant; WS: Wexner score.