OJGas  Vol.3 No.1 , February 2013
Risk factors for internal anal sphincter dysfunction in Japanese adults
ABSTRACT

Purpose: The internal anal sphincter provides most of the resting anal tone and is the main muscle responseble for continence. This study was designed to estimate the prevalence of, and identify risk factors associated with, internal anal sphincter dysfunction in Japanese adults. Methods: Anorectal manometry was performed in 1193 women and 1124 men aged 20 years or older. The maximal resting pressure, measured by a rapid pull-through technique, was defined as the highest resting pressure recorded. Internal anal sphincter dysfunction was defined as a maximal resting pressure less than 30 mmHg. Potential risk factors were assessed through self-reports, interviews, physical examinations, and medical record reviews. Multivariate logistic regression analysis was used to identify independent risk factors for internal anal sphincter dysfunction. Results: Significant differences in maximal resting pressure were seen between women (58.1 ± 24.9 mmHg) and men (68.8 ± 23.5 mmHg, P < 0.001). Maximal resting pressure decreased significantly with increasing age in both sexes. The prevalence of internal anal sphincter dysfunction was 10.4% (15.5% in women, 5.1% in men). In a multivariate logistic regression model, age, mental disease, pelvic organ prolapse repair, and fecal incontinence were independently associated with a greater risk of internal anal sphincter dysfunction in women and men. Conclusions: Internal anal sphincter dysfunction is a common problem for women and men. Several of the identified risk factors are preventable or modifiable, and may direct future research in fecal incontinence therapy.


Cite this paper
Abe, T. , Kono, T. , Hachiro, Y. , Kunimoto, M. and Furukawa, H. (2013) Risk factors for internal anal sphincter dysfunction in Japanese adults. Open Journal of Gastroenterology, 3, 25-34. doi: 10.4236/ojgas.2013.31004.
References
[1]   Madoff, R.D., Parker, S.C., Varma, M.G., et al. (2004) Faecal incontinence in adults. Lancet, 364, 621-632. doi:10.1016/S0140-6736(04)16856-6

[2]   Rao, S.S.C. (2004) Diagnosis and management of fecal incontinence. American Journal of Gastroenterology, 99, 1585-1604. doi:10.1111/j.1572-0241.2004.40105.x

[3]   Frenckner, B. and Euler, C.V. (1975) Influence of pudendal block on the function of the anal sphincters. Gut, 16, 482-489. doi:10.1136/gut.16.6.482

[4]   Barnett, J.L., Hasler, W.L. and Camilleri, M. (1999) American gastroenterological association medical position statement on anorectal testing techniques. Gastroenterology, 116, 732-760. doi:10.1016/S0016-5085(99)70194-0

[5]   Bordeianou, L., Lee, K.Y., Rockwood, T., et al. (2008) Anal resting pressures at manometry correlate with the fecal incontinence severity index and with presence of sphincter defects on ultrasound. Disease of Colon and Rectum, 51, 1010-1014. doi:10.1007/s10350-008-9230-7

[6]   Varma, M.G., Brown, J.S., Creasman, J.M., et al. (2006) Fecal incontinence in females older than aged 40 years: Who is at risk? Disease of Colon and Rectum, 49, 841 851. doi:10.1007/s10350-006-0535-0

[7]   Whitehead, W.E., Borrud, L., Goode, P.S., et al. (2009) Fecal incontinence in US adults: Epidemiology and risk factors. Gastroenterology, 137, 512-517. doi:10.1053/j.gastro.2009.04.054

[8]   Joh, H.K., Seong, M.K. and Oh, S.W. (2010) Fecal incontinence in elderly Koreans. Journal of the American Geriatrics Society, 58, 116-121. doi:10.1111/j.1532-5415.2009.02613.x

[9]   Lewis, S.J. and Heaton, K.W. (1997) Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology, 32, 920-924. doi:10.3109/00365529709011203

[10]   Rao, S.S. and Patel, R.S. (1997) How useful are manometric tests of anorectal function in the management of defecation disorders? American Journal of Gastroenterology, 92, 469-475.

[11]   Abe, T., Kunimoto, M. and Hachiro, Y. (2008) Diagnosis and management of fecal incontinence at a specialty outpatient clinic. Journal of Japan Society of Coloproctology, 61, 247-253. doi:10.3862/jcoloproctology.61.247

[12]   Laurberg, S. and Swash, M. (1989) Effects of aging on the anorectal sphincters and their innervation. Disease of Colon and Rectum, 32, 737-742. doi:10.1007/BF02562120

[13]   Enck, P., Kuhlbusch, R., Lübke, H., et al. (1989) Age and sex and anorectal manometry in incontinence. Disease of Colon and Rectum, 32, 1026-1030. doi:10.1007/BF02553874

[14]   Rao, S.S., Hatfield, R., Soffer, E., et al. (1999) Manometric tests in anorectal function in healthy adults. American Journal of Gastroenterology, 94, 773-783. doi:10.1111/j.1572-0241.1999.00950.x

[15]   Gundling, F., Seidl, H., Scalercio, N., et al. (2009) Influence of gender and age on anorectal function: Normal values from anorectal manometry in a large Caucasian population. Digestion, 81, 207-213. doi:10.1159/000258662

[16]   Speakman, C.T.M., Hoyle, C.H.V., Kamm, M.A., et al. (1995) Abnormal internal anal sphincter fibrosis and elasticity in fecal incontinence. Disease of Colon and Rectum, 38, 407-410. doi:10.1007/BF02054231

[17]   Abe, T., Sato, Y., Kunimoto, M., et al. (2008) Effect of aging and gender on internal anal sphincter thickness. Anti-Aging Medicine, 5, 46-48. doi:10.3793/jaam.5.46

[18]   MacLennan, A.H., Taylor, A.W., Wilson, D.H., et al. (2000) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. British Journal of Obstetrics and Gynaecology, 107, 1460-1470. doi:10.1111/j.1471-0528.2000.tb11669.x

[19]   Nelson, R., Norton, N., Cautley, E., et al. (1995) Community-based prevalence of anal incontinence. Journal of the American Medical Association, 274, 559-561. doi:10.1001/jama.274.7.559

[20]   Bharucha, A.E., Zinsmeister, A.R., Locke, G.R., et al. (2006) Risk factors for fecal incontinence: A population based study in women. American Journal of Gastroenterology, 101, 1305-1312. doi:10.1111/j.1572-0241.2006.00553.x

[21]   Faltin, D.L., Boulvain, M., Irion, O., et al. (2000) Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstetrics and Gynecology, 95, 643-647. doi:10.1016/S0029-7844(99)00631-6

[22]   Burnett, S.J., Spence-Jones, C., Speakman, C.T., et al. (1991) Unsuspected sphincter damage following childbirth revealed by anal endosonography. British Journal of Radiology, 64, 225-227. doi:10.1259/0007-1285-64-759-225

[23]   Ward, A. and Tunuguntla, A.K. (1984) Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. New England Journal of Medicine, 310, 1282 1287. doi:10.1056/NEJM198405173102003

[24]   Schiller, L.R., Santa Ana, C.A., Schmulen, C., et al. (1982) Pathogenesis of fecal incontinence in diabetes mellitus: Evidence for internal anal sphincter dysfunction. New England Journal of Medicine, 307, 1666-1671. doi:10.1056/NEJM198212303072702

[25]   Rogers, J., Levy, D.M., Henry, M.M., et al. (1988) Pelvic floor neuropathy: A comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut, 29, 756-761. doi:10.1136/gut.29.6.756

[26]   Pintor, M.P., Zara, G.P., Falletto, E., et al. (1994) Pudendal neuropathy in diabetic patients with faecal incontinence. International Journal of Colorectal Disease, 9, 105-109. doi:10.1007/BF00699423

[27]   Erckenbrecht, J.F., Winter, H.J., Cicmir, I., et al. (1988) Faecal incontinence in diabetes mellitus: Is it correlated to diabetic autonomic or peripheral neuropathy? Zeits chrift fur Gastroenterologie, 26, 731-736.

[28]   Watanabe, M., Tsunoda, A., Kamiyama, G., et al. (2003) Pathophysiology in diabetic patients with fecal incontinence. Showa University Journal of Medical Sciences, 15, 21-26.

[29]   Mills, K. and Chess-Williams, R. (2009) Pharmacology of the internal anal sphincter and its relevance to faecal incontinence. Autonomic and Autacoid Pharmacology, 29, 85-95. doi:10.1111/j.1474-8673.2009.00437.x

[30]   Yamato, S. and Rattan, S. (1990) Role of alpha adrenoceptors in opossum internal anal sphincter. Journal of Clinical Investigation, 86, 424-429. doi:10.1172/JCI114728

[31]   Mendhekar, D.N., Srivastav, P.K., Sarin, S.K., et al. (2003) A case report of olanzapine-induced fecal incontinence. Journal of Clinical Psychiatry, 61, 601-602.

[32]   Sagar, R., Varghese, S.T. and Balhara, Y.P. (2005) Olanzapine-induced double incontinesnce. Indian Journal of Medical Sciences, 59, 163-164. doi:10.4103/0019-5359.16123

[33]   Siproudhis, L., Dinasquet, M., Sébille, V., et al. (2004) Differential effects of two types of antidepressants, ami trptyline and fluoxetine, on anorectal motility and visceral perception. Alimentary Pharmacology and Therapeutics, 20, 689-695. doi:10.1111/j.1365-2036.2004.02151.x

[34]   Shamliyan, T., Wyman, J., Bliss, D.Z., et al. (2007) Prevention of urinary and fecal incontinence in adults. Evidence Reports/Technology Assessments, 161, 1-379.

[35]   Harmston, C., Jones, O.M., Cunningham, C., et al. (2011) The relationship between internal rectal prolapse and internal anal sphincter function. Colorectal Disease, 13, 791-795. doi:10.1111/j.1463-1318.2010.02266.x

[36]   Hiltunen, K.M., Matikainen, M., Auvinen, O., et al. (1986) Clinical and manometric evaluation of anal sphincter function in patients with rectal prolapse. American Journal of Surgery, 151, 489-492. doi:10.1016/0002-9610(86)90110-8

[37]   Furouk, R., Duthie, G.S., MacGregor, A.B., et al. (1994) Recto-anal inhibition and incontinence in patients with rectal prolapse. British Journal of Surgery, 81, 743-746. doi:10.1002/bjs.1800810542

 
 
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