The clinical contribution of integrated laboratory and ambulatory anorectal physiology assessment in faecal incontinence.

To determine the clinical value of anorectal physiology testing, we have assessed 73 patients with neurogenic incontinence (median age 55 years, 60 female) and 115 controls (median age 48 years, 81 female). All the faecally incontinent patients displayed abnormal anal mucosal electrosensitivity and prolonged pudendal nerve latencies. Rectal compliance was poor in 14% of patients with neurogenic incontinence. Twenty-seven sphincter injuries were identified by endoanal ultrasonography in patients with neurogenic incontinence. Anal sphincter electromyographic abnormalities were demonstrated in all the incontinent patients. Anal pressures were lower in the incontinent group. Frequent, abnormal internal sphincter relaxations were observed in patients with incontinence during ambulatory assessment. These tests provide objective evidence of injury but do not frequently affect clinical decision making. Endoanal ultrasonography and ambulatory assessment provided clinical information of the mechanism of incontinence in 60% of patients.