Rehabilitation of fecal incontinence: What is the influence of anal sphincter lesions?

The aim of this study was to evaluate the results of rehabilitative treatment of incontinent patients with anal sphincter lesions in order to verify whether these lesions influence the outcome of rehabilitation. Between January 2008 and June 2011, 48 patients [36 women, age range 51-77 years; 12 men, age range 57-70 years] affected by fecal incontinence were included in the study. After a preliminary clinical evaluation, including the Fecal Incontinence Severity Index (FISI) score, all patients were studied by means of endoanal ultrasound and anorectal manometry. Two patients groups were identified: Group 1 comprised 27 patients with sphincter lesions and Group 2 had 21 patients without sphincter lesions. All 48 underwent a multimodal rehabilitation program. At the end of the rehabilitation program, all patients were reassessed by means of clinical evaluation and anorectal manometry and their data were analyzed. Although we obtained an overall significantly lower FISI score in all patients after rehabilitation (p < 0.001) when compared with pre-treatment values, our study revealed that patients with sphincter lesions had a significantly worse post-rehabilitative FISI score (p < 0.003) when compared with those patients with intact anal sphincters and that there is a linear relationship between post-rehabilitative FISI scores and severity of sphincter lesions (rho (s) 0.69). These data suggest that rehabilitation may be less effective in patients affected by sphincter defects.