Original Article

Study No. 10: Fecal incontinence cure by surgical reinforcement of the pelvic ligaments suggests a connective tissue aetiology


Pelviperineology 2008;27(3):111-113


To test the hypothesis that the pubourethral and uterosacral suspensory ligaments are an important cause of idiopathic fecal incontinence.


Thirty patients with urinary and fecal incontinence were tested with pre-operative endoanal ultrasound, pre- and postoperative anorectal manometry and pudendal nerve conduction times. Only 10 had stress incontinence. Polypropylene mesh tapes were inserted in the position of the pubourethral ligament (n = 3), uterosacral ligament (n = 9) and both ligaments (n = 18). Surgery was guided by the same diagnostic algorithm used to manage urinary incontinence (see Fig. 1, Theory paper).


All patients were discharged within 24 hours of surgery. Post-operative assessment included anal manometry and pudendal nerve conduction time (PNCT) assessments. Twenty-five patients (83%) reported >85% improvement in their fecal incontinence symptoms. Low mean anal pressure, low squeeze pressure, prolonged pudendal nerve conduction times (n = 15) and thinned internal anal sphincters (n = 13) were not predictors of surgical success or failure, nor did these parameters change significantly with surgery. Only the functional anal length demonstrated a mildly significant improvement postoperatively (p = 0.049). Cure rates varying between 76% and 100% were reported for the various urinary symptoms.


The results indicate that damaged pelvic ligaments may be an important cause of idiopathic fecal incontinence, possibly by inactivating the anorectal closure muscles.

Keywords: Fecal incontinence; PNCT; Urinary incontinence; Connective tissue; Integral Theory