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Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence.
Dis Colon Rectum. 1994 Jun; 37(6):595-601.DC

Abstract

PURPOSE

This study was designed to evaluate the relationship between internal sphincter electromyographic frequency and ambulatory anal pressures in order to clarify the pathophysiology of internal anal sphincter dysfunction in fecal incontinence.

METHODS

Seventy-two patients of median age 55 years (range, 24-75; 63 females) with neurogenic fecal incontinence and 33 normal subjects of median age 48.5 years (range, 25-74; 21 females) underwent fine-wire anal sphincter electromyography and anal manometry.

RESULTS

The median internal anal sphincter electromyographic frequency was incontinent 0.25 Hz (0.2-0.34) and the control was 0.44 Hz (0.36-0.55; P < 0.03). Ambulatory resting pressures were incontinent median 54 cm of H2O (34-68 cm of H2O) and control 94 cm of H2O (72-102; P < 0.01). Internal sphincter electromyographic frequency correlated with anal resting pressures in both groups (P < 0.002). Internal sphincter electromyographic silence not attributable to electrode movement or the rectoanal inhibitory reflex, lasting 0.5 to 4 minutes occurred in all but two of the incontinent patients. The anal pressure during this period did not significantly change (P > 0.1). No recruitment of the external sphincter or puborectalis was noted during these episodes. Such electromechanical dissociation was not seen in the control group. The frequency of transient internal sphincter relaxation was 4 (ranges 2-6) per hour in controls and 8 (ranges, 6-12) per hour in incontinent patients (P < 0.01). Rectal pressures did not exceed midanal pressures in any of the controls but did in all of the incontinent patients on at least one occasion per hour in the incontinent group.

CONCLUSION

Internal anal sphincter activity exhibits electromechanical dissociation and relaxes abnormally in incontinent patients.

Authors+Show Affiliations

Department of Surgery, Royal Infirmary of Edinburgh, Scotland.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8200240

Citation

Farouk, R, et al. "Evidence of Electromechanical Dissociation of the Internal Anal Sphincter in Idiopathic Fecal Incontinence." Diseases of the Colon and Rectum, vol. 37, no. 6, 1994, pp. 595-601.
Farouk R, Duthie GS, MacGregor AB, et al. Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(6):595-601.
Farouk, R., Duthie, G. S., MacGregor, A. B., & Bartolo, D. C. (1994). Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence. Diseases of the Colon and Rectum, 37(6), 595-601.
Farouk R, et al. Evidence of Electromechanical Dissociation of the Internal Anal Sphincter in Idiopathic Fecal Incontinence. Dis Colon Rectum. 1994;37(6):595-601. PubMed PMID: 8200240.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence of electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence. AU - Farouk,R, AU - Duthie,G S, AU - MacGregor,A B, AU - Bartolo,D C, PY - 1994/6/1/pubmed PY - 1994/6/1/medline PY - 1994/6/1/entrez SP - 595 EP - 601 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 37 IS - 6 N2 - PURPOSE: This study was designed to evaluate the relationship between internal sphincter electromyographic frequency and ambulatory anal pressures in order to clarify the pathophysiology of internal anal sphincter dysfunction in fecal incontinence. METHODS: Seventy-two patients of median age 55 years (range, 24-75; 63 females) with neurogenic fecal incontinence and 33 normal subjects of median age 48.5 years (range, 25-74; 21 females) underwent fine-wire anal sphincter electromyography and anal manometry. RESULTS: The median internal anal sphincter electromyographic frequency was incontinent 0.25 Hz (0.2-0.34) and the control was 0.44 Hz (0.36-0.55; P < 0.03). Ambulatory resting pressures were incontinent median 54 cm of H2O (34-68 cm of H2O) and control 94 cm of H2O (72-102; P < 0.01). Internal sphincter electromyographic frequency correlated with anal resting pressures in both groups (P < 0.002). Internal sphincter electromyographic silence not attributable to electrode movement or the rectoanal inhibitory reflex, lasting 0.5 to 4 minutes occurred in all but two of the incontinent patients. The anal pressure during this period did not significantly change (P > 0.1). No recruitment of the external sphincter or puborectalis was noted during these episodes. Such electromechanical dissociation was not seen in the control group. The frequency of transient internal sphincter relaxation was 4 (ranges 2-6) per hour in controls and 8 (ranges, 6-12) per hour in incontinent patients (P < 0.01). Rectal pressures did not exceed midanal pressures in any of the controls but did in all of the incontinent patients on at least one occasion per hour in the incontinent group. CONCLUSION: Internal anal sphincter activity exhibits electromechanical dissociation and relaxes abnormally in incontinent patients. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/8200240/Evidence_of_electromechanical_dissociation_of_the_internal_anal_sphincter_in_idiopathic_fecal_incontinence_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=8200240.ui DB - PRIME DP - Unbound Medicine ER -