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T1345 Fecal Incontinence in Men: Coexistent Constipation and Impact of Rectal Hyposensitivity
T1344
consulters vs. 16.1 for non-consulters; p= 0.1). However, scores on the symptom specific FIQOL (for subjects answering > half of the questions) found that consulters had significantly lower scores on all four of the FIQOL subscales: 1) Lifestyle (p<0.001), 2) Coping/Behaviors (p<0.001), 3) Depression/Self Perception (p<0.05), and 4) Embarrassment (p<0.05). For subjects with FI, higher FISI scores were associated with poorer QOL on the Lifestyle and Coping Behaviors subscales (p=0.01 and 0.001, respectively), but not the Depression or Embarrassment subscales. (p=0.26 and 0.5). Discussion: Even in CCRCs where upper SES residents are frequent utilizers of health care, only 36% of subjects with FI had discussed having this symptom with their doctor, replicating our earlier finding in a larger dataset. Those who had discussed FI with their doctor did not have worse symptoms, but were significantly more distressed by their FI than those who had not discussed FI with their doctor. This finding is consistent with previous reports that FI severity is associated with poorer QOL (Bharucha et al, 2006). In addition, our findings suggest that physicians are not screening for FI and that patients who are coping better with FI (higher QOL scores) are less likely to be identified, and thus less likely to receive widely available and effective treatment for FI. [Supported by grants from NIDDK (R24 DK067674) and the UNC School of Medicine]
AGA Abstracts
Prevalence of Pelvic Floor Dysfunction Syndromes. A Community Survey in an Argentine Population Jorge A. Olmos, Guido Iantorno, Carlos Sarsotti, Mauricio Guzman, Oscar Gadea, Rosa I. Ramos, Laura I. Sole, Jose Tawil, Luis O. Soifer Background: the pelvic floor dysfunction is a common disorder. Epidemiological studies related to this syndrome are lacking in Latin America. Aim: to assess the prevalence of fecal incontinence(FI), urinary incontinence(UI) and outlet constipation(OC) in Argentine. Methods: FICA self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-70 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census. Results: 831 subjects returned valid questionnaires (445 F, mean age 40.2 ± 13.8 y)Prevalence of FI was 11.4% (95% CI: 9.2% - 13.7%). 10.7% in males, and 12.1% in females; 17.1% in olders than 55y. And 10.3%. in youngers than 55. FI of solids and liquids was 1.3% and gas FI 10.6%. Severity score for FI was Slight 19.6%, moderate 62.4 and severe 18%. UI global prevalence 17.1% (95% IC: 14.7% - 19.5%). 7.4% in males and 26.2% in females 14.8% in youngers than 55 and 28.8% in olders than 55y. Effort UI (EUI) subtype prevalence was 11.1%. 2.1% EUI in males and 19.6% in females, 9.7% in youngers than 55 and 18.6% in olders than 55. Urgency urinary incontinence (UUI) prevalence was present in 6.1%, 2.8% in male, 9.3% in females, 4.3% in youngers than 55 y. and 15.3% in olders than 55y. Global OC prevalence was 5.1% (95% CI: 3.6% - 6.7%). 0.7% in males and, 9.3% in females, 5.2% in youngers than 55 y. and 5.0% in olders than 55y. Combined FI and UI prevalence was 2.7%, FI and OC 1.1%, UI and OC 1.4%. FI+UI+OC, 0.3% Conclusions: Pelvic floor syndromes are very prevalent in Argentina particularly in older people
T1347 High-Definition Manometry Can Predict Damage to External Anal Sphincter & Puborectalis Muscle Thuy Anh T. Le, Valmik Bhargava, Anna M. Karstens, Ravinder K. Mittal Introduction: High definition anal manometery (HDAM) and 3D-US images of anal canal are new modalities to assess functional anal canal anatomy. Aims: 1) evaluate anal highpressure zone (HPZ) using HDAM, (2) compare HDAM profile with 3D-US. Methods: HDAM (16x16 transducer) & 3D-US performed in 11 normal & 9 women with fecal incontinence (FI). US images were evaluated for damage to the external anal sphincter (EAS) & internal anal sphincter (IAS). The puborectalis muscle (PRM) was evaluated for damage & hiatus length. HDAM pressures were digitized - mean + 2 SD of the 2 proximal and distal rows of sensors was used to define abdominal (ABD) and anal verge respectively of the HPZ. An average anal canal HPZ profile for normal subjects was created (fig). The length of HPZ in anterior (A) and posterior (P) midline and its surface area were determined. Results: 8/9 FI patients had damage to both the EAS and PRM, which correlated with a decrease in length of the HPZ profile at rest but not at squeeze. There was a decrease in HDAM surface area at rest in both anterior and posterior zone and squeeze in the anterior only. In 8/9 FI with EAS damages, a visible decrease in pressures in the lower ½ of HPZ profile at rest and squeeze was observed. 8/9 FI with PRM damage had low pressure in upper ½ of HPZ profile at rest. At squeeze there were high pressures seen in upper ½ of HPZ profile in FI with a decrease in hiatus size of > 0.4mm with squeeze. Conclusion: HDAM profile in patients with FI shows abnormalities of length and surface areas, especially at rest. Damage to EAS & PRM is revealed as abnormalities in the lower and upper halves of the anal HDAM profile respectively.
T1345 Fecal Incontinence in Men: Coexistent Constipation and Impact of Rectal Hyposensitivity Rebecca Burgell, Chetan Bhan, S Mark Scott, Peter J. Lunniss Aims: The pathophysiology of fecal incontinence (FI) in males is poorly understood and under-researched, unlike in females, in whom sphincter disruption from obstetric trauma is the major mechanism. Given the similar prevalence of FI between genders in the general population, other mechanisms must exist in males, and the reporting of incomplete rectal evacuation, reflecting coexistent constipation, has been recognized as an independent risk factor. The aims of this study were to assess the coexistence of constipation and to determine the impact of (suprasphincteric) rectal sensory and motor dysfunction in consecutive male patients referred to a tertiary centre. Method: Retrospective review of histories (standardized symptom questionnaire including Cleveland constipation and Vaziey incontinence score) and test results in consecutive male patients with FI over a 6 year period, who underwent comprehensive anorectal physiological investigation (anal manometry, endoanal ultrasound, rectal sensory testing to balloon distension, and evacuation proctography). Results: Of 161 patients who met the inclusion criteria, 48% described concurrent constipation. Only 55 patients (34%) had sphincter dysfunction on manometry, of whom 19 had a structural abnormality on ultrasound. Overall, more than a quarter of patients had rectal sensory dysfunction: 9% rectal hypersensitivity, 17% rectal hyposensitivity (RH). There were no relations between type of FI and presence of sensory disturbance. Patients with RH were more likely to subjectively report constipation (75%) compared to patients with normal rectal sensation (NS: 39%; p= 0.002), with decreased bowel frequency and higher prevalence of inability to evacuate (25% vs. 7% in NS; p=0.02) the differentiating symptoms. There were no significant differences in need to strain, sense of obstruction, use of laxatives or frequency of hard stools. At evacuation proctography, a higher proportion of patients with RH had protracted defecation (>180 sec: RH 18% vs. NS 6%; p=0.049) and incomplete rectal evacuation (<50% of barium neostool excreted: RH 36% vs. NS 14% vs. rectal hypersensitivity 0%; p=0.005). Conclusion: Only one third of men with FI in this study had significant sphincteric dysfunction. Therefore other pathophysiologies must be considered. Nearly half of patients reported concurrent constipation, and one in six had rectal hyposensitivity; this was associated with both symptomatology and objective measures of rectal evacuatory dysfunction. In comparison to FI in females, a history of constipation and rectal sensorimotor dysfunction should be explored in males, irrespective of the nature of the incontinence. T1346 Residents at Continuing Care Residential Centers (CCRC) Who Consult With Their Doctors Regarding the Presence of Fecal Incontinence (FI) Have Significantly Lower Quality of Life (QOL) Scores Steve Heymen, Olafur S. Palsson, Marsha J. Turner, Jane Tucker, Mary H. Palmer, Jan Busby-Whitehead, William E. Whitehead Background: A preliminary report from our survey of two CCRCs found that only 36% of subjects with FI had discussed this with their doctor. Aim: To identify subject characteristics influencing this decision in a larger dataset from three local CRCCs. Methods: Residents of three CCRCs in Orange County, NC were surveyed by post. This survey included questions about the frequency and severity of FI (FISI) and the impact of FI on QOL (FIQOL). Results: 390 out of 929 (42%) residents surveyed completed the questionnaire. Their average age was 82 years; 99% were Caucasian, 64% females, and 90% were college graduates. These subjects had ready access to health care and reported a mean of over five visits to the doctor within the last year, and 87% reported being in good to excellent health. 174 subjects reported having FI (excluding those incontinent of gas only). 62 (36%) subjects with FI had discussed having FI with their doctor, 78 (45%) had not, and 34 (20%) did not answer this question. The decision to consult for FI was not explained by age, gender, education level, report of general health, or number of health care visits in the previous year. Nor was it explained by FI symptom severity (modified FISI scores excluding gas were 18.5 for
AGA Abstracts
S-542
consulters vs. 16.1 for non-consulters; p= 0.1). However, scores on the symptom specific FIQOL (for subjects answering > half of the questions) found that consulters had significantly lower scores on all four of the FIQOL subscales: 1) Lifestyle (p<0.001), 2) Coping/Behaviors (p<0.001), 3) Depression/Self Perception (p<0.05), and 4) Embarrassment (p<0.05). For subjects with FI, higher FISI scores were associated with poorer QOL on the Lifestyle and Coping Behaviors subscales (p=0.01 and 0.001, respectively), but not the Depression or Embarrassment subscales. (p=0.26 and 0.5). Discussion: Even in CCRCs where upper SES residents are frequent utilizers of health care, only 36% of subjects with FI had discussed having this symptom with their doctor, replicating our earlier finding in a larger dataset. Those who had discussed FI with their doctor did not have worse symptoms, but were significantly more distressed by their FI than those who had not discussed FI with their doctor. This finding is consistent with previous reports that FI severity is associated with poorer QOL (Bharucha et al, 2006). In addition, our findings suggest that physicians are not screening for FI and that patients who are coping better with FI (higher QOL scores) are less likely to be identified, and thus less likely to receive widely available and effective treatment for FI. [Supported by grants from NIDDK (R24 DK067674) and the UNC School of Medicine]
AGA Abstracts
Prevalence of Pelvic Floor Dysfunction Syndromes. A Community Survey in an Argentine Population Jorge A. Olmos, Guido Iantorno, Carlos Sarsotti, Mauricio Guzman, Oscar Gadea, Rosa I. Ramos, Laura I. Sole, Jose Tawil, Luis O. Soifer Background: the pelvic floor dysfunction is a common disorder. Epidemiological studies related to this syndrome are lacking in Latin America. Aim: to assess the prevalence of fecal incontinence(FI), urinary incontinence(UI) and outlet constipation(OC) in Argentine. Methods: FICA self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-70 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census. Results: 831 subjects returned valid questionnaires (445 F, mean age 40.2 ± 13.8 y)Prevalence of FI was 11.4% (95% CI: 9.2% - 13.7%). 10.7% in males, and 12.1% in females; 17.1% in olders than 55y. And 10.3%. in youngers than 55. FI of solids and liquids was 1.3% and gas FI 10.6%. Severity score for FI was Slight 19.6%, moderate 62.4 and severe 18%. UI global prevalence 17.1% (95% IC: 14.7% - 19.5%). 7.4% in males and 26.2% in females 14.8% in youngers than 55 and 28.8% in olders than 55y. Effort UI (EUI) subtype prevalence was 11.1%. 2.1% EUI in males and 19.6% in females, 9.7% in youngers than 55 and 18.6% in olders than 55. Urgency urinary incontinence (UUI) prevalence was present in 6.1%, 2.8% in male, 9.3% in females, 4.3% in youngers than 55 y. and 15.3% in olders than 55y. Global OC prevalence was 5.1% (95% CI: 3.6% - 6.7%). 0.7% in males and, 9.3% in females, 5.2% in youngers than 55 y. and 5.0% in olders than 55y. Combined FI and UI prevalence was 2.7%, FI and OC 1.1%, UI and OC 1.4%. FI+UI+OC, 0.3% Conclusions: Pelvic floor syndromes are very prevalent in Argentina particularly in older people
T1347 High-Definition Manometry Can Predict Damage to External Anal Sphincter & Puborectalis Muscle Thuy Anh T. Le, Valmik Bhargava, Anna M. Karstens, Ravinder K. Mittal Introduction: High definition anal manometery (HDAM) and 3D-US images of anal canal are new modalities to assess functional anal canal anatomy. Aims: 1) evaluate anal highpressure zone (HPZ) using HDAM, (2) compare HDAM profile with 3D-US. Methods: HDAM (16x16 transducer) & 3D-US performed in 11 normal & 9 women with fecal incontinence (FI). US images were evaluated for damage to the external anal sphincter (EAS) & internal anal sphincter (IAS). The puborectalis muscle (PRM) was evaluated for damage & hiatus length. HDAM pressures were digitized - mean + 2 SD of the 2 proximal and distal rows of sensors was used to define abdominal (ABD) and anal verge respectively of the HPZ. An average anal canal HPZ profile for normal subjects was created (fig). The length of HPZ in anterior (A) and posterior (P) midline and its surface area were determined. Results: 8/9 FI patients had damage to both the EAS and PRM, which correlated with a decrease in length of the HPZ profile at rest but not at squeeze. There was a decrease in HDAM surface area at rest in both anterior and posterior zone and squeeze in the anterior only. In 8/9 FI with EAS damages, a visible decrease in pressures in the lower ½ of HPZ profile at rest and squeeze was observed. 8/9 FI with PRM damage had low pressure in upper ½ of HPZ profile at rest. At squeeze there were high pressures seen in upper ½ of HPZ profile in FI with a decrease in hiatus size of > 0.4mm with squeeze. Conclusion: HDAM profile in patients with FI shows abnormalities of length and surface areas, especially at rest. Damage to EAS & PRM is revealed as abnormalities in the lower and upper halves of the anal HDAM profile respectively.
T1345 Fecal Incontinence in Men: Coexistent Constipation and Impact of Rectal Hyposensitivity Rebecca Burgell, Chetan Bhan, S Mark Scott, Peter J. Lunniss Aims: The pathophysiology of fecal incontinence (FI) in males is poorly understood and under-researched, unlike in females, in whom sphincter disruption from obstetric trauma is the major mechanism. Given the similar prevalence of FI between genders in the general population, other mechanisms must exist in males, and the reporting of incomplete rectal evacuation, reflecting coexistent constipation, has been recognized as an independent risk factor. The aims of this study were to assess the coexistence of constipation and to determine the impact of (suprasphincteric) rectal sensory and motor dysfunction in consecutive male patients referred to a tertiary centre. Method: Retrospective review of histories (standardized symptom questionnaire including Cleveland constipation and Vaziey incontinence score) and test results in consecutive male patients with FI over a 6 year period, who underwent comprehensive anorectal physiological investigation (anal manometry, endoanal ultrasound, rectal sensory testing to balloon distension, and evacuation proctography). Results: Of 161 patients who met the inclusion criteria, 48% described concurrent constipation. Only 55 patients (34%) had sphincter dysfunction on manometry, of whom 19 had a structural abnormality on ultrasound. Overall, more than a quarter of patients had rectal sensory dysfunction: 9% rectal hypersensitivity, 17% rectal hyposensitivity (RH). There were no relations between type of FI and presence of sensory disturbance. Patients with RH were more likely to subjectively report constipation (75%) compared to patients with normal rectal sensation (NS: 39%; p= 0.002), with decreased bowel frequency and higher prevalence of inability to evacuate (25% vs. 7% in NS; p=0.02) the differentiating symptoms. There were no significant differences in need to strain, sense of obstruction, use of laxatives or frequency of hard stools. At evacuation proctography, a higher proportion of patients with RH had protracted defecation (>180 sec: RH 18% vs. NS 6%; p=0.049) and incomplete rectal evacuation (<50% of barium neostool excreted: RH 36% vs. NS 14% vs. rectal hypersensitivity 0%; p=0.005). Conclusion: Only one third of men with FI in this study had significant sphincteric dysfunction. Therefore other pathophysiologies must be considered. Nearly half of patients reported concurrent constipation, and one in six had rectal hyposensitivity; this was associated with both symptomatology and objective measures of rectal evacuatory dysfunction. In comparison to FI in females, a history of constipation and rectal sensorimotor dysfunction should be explored in males, irrespective of the nature of the incontinence. T1346 Residents at Continuing Care Residential Centers (CCRC) Who Consult With Their Doctors Regarding the Presence of Fecal Incontinence (FI) Have Significantly Lower Quality of Life (QOL) Scores Steve Heymen, Olafur S. Palsson, Marsha J. Turner, Jane Tucker, Mary H. Palmer, Jan Busby-Whitehead, William E. Whitehead Background: A preliminary report from our survey of two CCRCs found that only 36% of subjects with FI had discussed this with their doctor. Aim: To identify subject characteristics influencing this decision in a larger dataset from three local CRCCs. Methods: Residents of three CCRCs in Orange County, NC were surveyed by post. This survey included questions about the frequency and severity of FI (FISI) and the impact of FI on QOL (FIQOL). Results: 390 out of 929 (42%) residents surveyed completed the questionnaire. Their average age was 82 years; 99% were Caucasian, 64% females, and 90% were college graduates. These subjects had ready access to health care and reported a mean of over five visits to the doctor within the last year, and 87% reported being in good to excellent health. 174 subjects reported having FI (excluding those incontinent of gas only). 62 (36%) subjects with FI had discussed having FI with their doctor, 78 (45%) had not, and 34 (20%) did not answer this question. The decision to consult for FI was not explained by age, gender, education level, report of general health, or number of health care visits in the previous year. Nor was it explained by FI symptom severity (modified FISI scores excluding gas were 18.5 for
AGA Abstracts
S-542