Original Article

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

  • PETER PETROS
  • PETER RICHARDSON

Pelviperineology 2008;27(3):111-113

AIM:

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

METHODS:

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).

RESULTS:

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.

CONCLUSION:

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