Η συμβολή της ορθοπρωκτικής μανομετρίας στη διάγνωση της ακράτειας κοπράνων

Abstract

Combined anorectal manometry, electromyography of anal sphincters and rectal sensory testing were carried out in 302 patients (235 females, 67 males) with faecal incontinence and in 35 normal, volunteers (20 females, 15 males). The results showed that the majority of patients had more than one abnormality, nevertheless, there was always one that played a major role. The following are the main cause of faecal incontinence identified. Nine–two per cent of patients had weak external anal sphincter, of whom 67% also had abnormal perineal descent. This abnormality was overlapped with a weak internal anal sphincter, obstetric trauma, and irritable rectum. Twelve per cent of them also had absent consious control of external anal sphincter with or without enhanced reflex external anal sphincter activity. Impaired internal sphincter function was the second major abnormality observed in incontinent patients. Thirty–two per cent of patients had a weak internal anal sphincter in that patients showed low resting pressure and no internal anal sphincter relaxation upon rectal distension. Twenty seven per cent of patients showed an ustable internal sphincter, characterized by prolonged spontaneous anal post–squeeze and post internal anal pressure reduction in anal pressure. Two strictly different abnormalities of rectal sensation were found in patients with faecal blunted sensation upon rectal balloon distension, hence impaired the spinal reflex and consious control mechanism. Forty–seven per cent of patients, on the other hand, a hypersensitive rectum which was associated with an hyperreactive rectum and weak external anal sphincter.