Fecal incontinence

Pelviperineology 2012; 31: 62-64 http://www.pelviperineology.org The fifth section of the book “Pelvic floor disordersImaging and Multidisciplinary Approach to Management” entitled “Fecal Incontinence” consists of twelve chapters divided into two subsections describing diagnostic modalities and management for this disorder. In the first chapter “Three-dimensional Endoluminal Ultrasonography” G. Di Falco and GA Santoro describe the role of endoanal ultrasonography in the patients with fecal incontinence. This technique is considered the gold standard in the assessment of anal sphincters and enables to differentiate between incontinent patients with intact anal sphincters and those with sphincter lesions (defects, scarring, thinning, thickening, and atrophy). High-resolution multiplanar reconstructions and rendering techniques available in 3D imaging (Figure 1a-b) enhance the accuracy of EAUS and its diagnostics value allowing for instance detection of occult sphincter tears. The technique also serves as a tool to establish the most appropriate therapy (sphincteroplasty, graciloplasty, injection of bulking agents, sacral nerve stimulation) and to monitor results following surgical treatment. In the second chapter entitled “Transperineal Ultra sono graphy”, B. Roche, G. Zufferey and J.R.Yap present the transperineal ultrasound as an easy to perform, fast examination in the assessment of rectoceles, intussusceptions, evacuatory apparatus lesions, and perineal muscle movement. This technique allows to evaluate this disorders quickly and accurately and prescribe appropriate therapy. Authors reported that measurement of displacement of the puborectal sling enables prediction of sphincter repair outcome as a treatment of fecal incontinence, which has an important clinical value. Moreover, the reproducibility of this test is rather good, and the technical training period quite short. In the third chapter “Magnetic Resonance Imaging” J. Stoker describes the technique, patient preparation and imaging findings in the patients with fecal incontinence. Endoanal MRI has been demonstrated to be comparable to endoanal ultrasound in the detection of external sphincter defects and could be used as an alternative, especially in cases with external sphincter atrophy. External sphincter atrophy at endoanal MRI has been demonstrated to be a negative predictor of the outcome of anterior anal repair. Thus, in candidates for anterior anal repair, endoluminal MRI should be considered, in order to identify patients with external sphincter atrophy. In the fourth chapter entitled “Anorectal Manometry”, F. Pucciani reviews information on anorectal manometry. Its clinical utility is limited by the relative absence of standardization of test protocols and normative data from a large number of healthy individuals, however anoretcal manometry is considered a valuable functional test for the diagnosis and management of fecal incontinence. When anorectal manometry is used in incontinent patients, its data suggest which continence mechanisms may be malfunctioning. However, manometric findings in incontinent paFecal incontinence