562 EVOLUTION OF ANORECTAL PHYSIOLOGY IN PATIENTS TREATED FOR FECAL SOILING (FS)

Abstract

Physiological explanations for recurrent FS were sought in a longitudinal study of rectal contour, elasticity (E), sensation, and internal anal sphincter (IAS) action in 26 patients with chronic FS. Manometric tracings from the IAS and rectal ampulla were recorded prior to treatment, after initial rectal evacuation, and after 6 months on a standard treatment regimen which included oral mineral oil, enemas and positive reinforcement of bowel habit. Data were compared to those of 10 age-matched controls. Barium enemas were obtained before and after the study. 9 patients became totally asymptomatic, 13 improved substantially, and 4 who were non-compliant remained symptomatic. The magnitude and duration of reflex IAS relaxation were normal but decreased transiently (p<.05), after initial evacuation. The volume eliciting IAS relaxation decreased from 18±2 to 13±3 (p<.04) over 6 months. Megacolon was apparent in 11 and resolved in 9. E was consistently low, improved with treatment (p<.05), but never reached control values. A striking deficit in the appreciation of rectal volumes (25±3 vs. 9±2 p<.01) and tolerance for distending volumes (180±15 vs. 85±13 p<.001) persisted for 6 months in the FS patients including the 9 asymptomatic and the 15 with normal colon size.

Conclusion: After 6 months of treatment, despite improvements in symptoms and E, failure to perceive rectal distention at rectal volumes that induce IAS relaxation leaves FS patients vulnerable to recurrence of symptoms. This is true even in the absence of acquired megacolon.

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