Paradoxical high anal resting pressures in men with idiopathic fecal seepage

PURPOSE: Fecal incontinence has been a matter of concern for many years, but seepage is poorly understood, especially in men. METHODS: We compared the results of anorectal physiologic tests in a group of 16 male patients who complained of fecal soiling but had no previous history of anorectaI surgery or disease and had normal clinical examinations with findings of 26 normal male controls. Physical examination and proctosigmoidoscopy were normal in each patient. RESULTS: Maximum anal resting pressure (median interquartile range) was 136 (120-145) cm H2O in the "seepage" group and 104 (83-112) cm H2O in controls (P < 0.01). Inflation volumes at which patients and controls experienced rectal sensation were 45 (35-80) and 90 (75-100) mi of air, respectively (P < 0.01). Maximum tolerated volumes in the rectum were 130 (85-180) mi of air in the seepage group and 190 (140-240) mi of air in controls (P < 0.01). Median length of the anal sphincter was 3.75 (3.5-4) cm in patients and 3 (3-3.5) cm in controls (P < 0.01). Maximum squeeze pressures, sensation in the anal canal, and sphincter relaxation in response to rectal distention were similar in the two groups. CONCLUSION: Male patients with "idiopathic" fecal seepage have a long anal sphincter with abnormally high resting tone.