Original Article

Descending perineum syndrome: pathophysiology of fecal incontinence

  • FILIPPO PUCCIANI

Pelviperineology 2018;37(2):57-62

Aim of the study:

Patients with descending perineum syndrome (DPS) may also experience fecal incontinence. This study was undertaken to understand the types and pathophysiology of fecal incontinence in patients affected by DPS.

Methods:

Two groups of DPS patients were investigated. Group 1 included 62 women who had fecal incontinence and descending perineum. Group 2 consisted of 70 female patients affected by descending perineum but without fecal incontinence. All 132 patients received a preliminary clinical evaluation and were studied using defecography, endoanal ultrasound and anorectal manometry. Their results were compared with data obtained from 20 healthy women with normal bowel habits (control group).

Results:

There was a significantly higher Fecal Incontinence Severity Index (FISI) score in Group 1 compared to Group 2 (P < 0.001). Urge incontinence was present in 56.4% of Group 1 patients, passive incontinence in 13 patients (20.9%), mixed incontinence in 16.1% and post-defecatory incontinence in only 4 patients (6.4%). Endoanal ultrasound revealed a significantly diffuse thinning of the external anal sphincter (EAS) in Group 1 patients (P < 0.02) with a linear relationship between signs of EAS atrophy and FISI score (ps: 0.78; P < 0.03); EAS atrophy was also inversely correlated with anal pressure (ps: 0.71; P < 0.04). Anal resting pressure (Pmax and Pm) was significantly lower in Group 1 patients than Group 2 patients (P < 0.04). The pelvic floor descent values in Group 1 patients were significantly higher at rest and during evacuation (P < 0.01) than in Group 2 patients.

Conclusions:

Urge incontinence, related to external anal sphincter atrophy, is the predominant pattern of fecal incontinence.

Keywords: Descending perineum syndrome,Fecal incontinence,Pelvic organ prolapse,Rectoanal intussusception,Anorectal manometry