Background
Fecal incontinence is frequently associated with rectal prolapse, but little is known
about recovery after treatment of the prolapse.
Objective
We therefore aimed to investigate the long-term outcome of fecal incontinence in a
cohort of patients suffering from full-thickness rectal prolapse.
Design
A database of 145 patients diagnosed with full-thickness rectal prolapse was compiled
prospectively over a 7-year period (2003–2010).
Main outcome measures
Patients were referred to a single institution and assessed by standardized questionnaires,
anorectal manometry, endosonography, and evacuation proctography. Fecal incontinence
was evaluated according to the Cleveland Clinic Score; continence improvement was
defined by ≥50% improvement of the Cleveland Clinic Score.
Results
Among the population studied (134 women, 11 men; median follow-up, 38.9 months [range,
21.2–67.2]), 103 patients (71%) underwent operation for their prolapse and 42 (29%)
did not. According to the Cleveland Clinic Score, 139 patients (96%) suffered from
fecal incontinence before treatment and 64 (46%) reported improvement at the end of
the follow-up. Pretreatment history of incontinence symptoms for >2 years (hazard
ratio [HR], 1.99; 95% CI, 1.14–3.46; P = .015) and ventral rectopexy (HR, 1.86; 95% CI, 1.026–3.326; P = .04) were associated with continence improvement. Patients who underwent an operative
procedure other than ventral rectopexy had similar outcome as compared with nonoperated
patients. Conversely, chronic pelvic pain precluded fecal incontinence improvement
(HR, 0.32; 95% CI, 0.135–0.668; P = .0017).
Limitations
Follow-up, returned questionnaires, and the heterogeneous reasons put forth for declining
surgery may introduce some methodologic bias.
Conclusion
Fecal incontinence in patients suffering from rectal prolapse is improved when ventral
rectopexy is performed compared with other operative or medical therapies.
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References
- Epidemiologic aspects of complete rectal prolapse.Scand J Surg. 2005; 94: 207-210
- Surgical management of rectal prolapse.Nat Clin Pract Gastroenterol Hepatol. 2007; 4: 552-561
- Overt rectal prolapse and fecal incontinence.Dis Colon Rectum. 2008; 51: 1356-1360
- No surgery for full-thickness rectal prolapse: what happens with continence?.World J Surg. 2013; 37: 1297-1302
- Surgery for faecal incontinence in adults.Cochrane Database Syst Rev. 2013; : CD001757
- Systematic review on ventral rectopexy for rectal prolapse and intussusception.Colorectal Dis. 2010; 12: 504-512
- Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation.Colorectal Dis. 2010; 12: 526-532
- Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases.Dis Colon Rectum. 1984; 27: 356-359
- Symptoms and anal sphincter morphology following primary repair of third-degree tears.Br J Surg. 2003; 90: 1573-1579
- Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy.Colorectal Dis. 2013; 15: 470-476
- The surgical anatomy of rectocele and anterior rectal wall intussusception.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 705-710
- Underlying functional bowel disorder may explain patient dissatisfaction after haemorrhoidal surgery.Colorectal Dis. 2012; 14: 356-361
- Improvement in irritable bowel syndrome following ano-rectal surgery.Int J Colorectal Dis. 2002; 17: 402-411
- Etiology and management of fecal incontinence.Dis Colon Rectum. 1993; 36: 77-97
- Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS).Dis Colon Rectum. 2000; 43: 1419-1426
- Validation of the French version of the Fecal Incontinence Quality-of-Life (FIQL) scale.Gastroenterol Clin Biol. 2004; 28: 562-568
- Gastrointestinal Quality of Life Index: development, validation and application of a new instrument.Br J Surg. 1995; 82: 216-222
- Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group.Neurourol Urodyn. 1995; 14: 131-139
- A specific evaluation of the perturbation of life quality during voiding disorders: the Ditrovie scale.Ann Readapt Med Phys. 1997; 40: 21-26
- Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients.Int J Colorectal Dis. 1992; 7: 102-107
- Defecography in normal volunteers: results and implications.Gut. 1989; 30: 1737-1749
- Enterocele revealed by simultaneous evacuation proctography and peritoneography: does “defecation block” exist?.Am J Roentgenol. 1996; 167: 461-466
- Anal incontinence in adults. Guidelines for clinical practice. National French Gastroenterology Society.Gastroenterol Clin Biol. 2000; 24: 299-314
- Treatment of faecal incontinence: recommendations from the French National Society of Coloproctology.Colorectal Dis. 2014; 16: 159-166
- Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome of 109 patients.Surg Endosc. 2006; 20: 1919-1923
- Rectal adaptation to distension in patients with overt rectal prolapse.Br J Surg. 1998; 85: 1527-1532
Article info
Publication history
Published online: April 10, 2015
Accepted:
March 7,
2015
Footnotes
All authors have no financial disclosure to be acknowledged. This work did not receive any financial support.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
