Resting and Squeeze Anal Pull-Through Assessments by Fecobionics Demonstrate Weak Anal Sphincters in Patients With Fecal Incontinence.

BACKGROUND

Many fecal incontinence (FI) patients have low anal sphincter pressure, which is thought to be a major pathophysiological mechanism. This is assessed either by stationary or pull-through manometry techniques. Fecobionics is a new device for comprehensive assessment of anorectal function.

AIM: To evaluate anal pressure profiles during rest and squeeze pull-through maneuvers in FI patients and normal subjects (NS) using Fecobionics and to compare with current technology.

METHODS

Patients with FI (Rome IV criteria) and healthy controls were recruited. FI severity was assessed with FISI questionnaire. Anal pull-through maneuvers were performed using Fecobionics and anorectal manometry (ARM) during rest and maximum anal squeeze, and the pull-through pressures were measured and compared. Data were expressed as median and quartiles. Non-parametric statistical testing was done.

RESULTS

Forty-four FI patients and 20 NS participated. The FISI score was 0 (0-0) in the NS group and 28 (22-35) in the FI group. Resting pull-through pressure did not differ between FI patients (82.0 (56.0-145.5 cmH2O)) and NS (99.5 (64.8-138.5 cmH2O)), whereas the maximum squeeze pressure was lower in FI (124.5 (85.5-208.8 cmH2O)) than NS (169.5 (122.3-262.0 cmH2O)) (p < 0.02). Furthermore, the difference between maximum squeeze and resting pressure differed between groups (p < 0.01). ARM did not show differences between the groups at rest or maximum squeeze (p >>0.2). Strong association was found between the resting and contracted pull-through pressures (r = 0.74, p < 0.001). Similar strong association was found in traumatic, atraumatic, passive, and urge FI subgroups. Data were not influenced by the magnitude of internal or external anal sphincter defects. Bland Altman plots showed agreement between Fecobionics pull-throughs and ARM.

CONCLUSIONS

Fecobionics device showed lower squeeze pressures in FI patients compared to NS during anal pull-through procedure and strong associations between these pressures and FI subgroups.