Significance of pelvic floor muscles in anal incontinence

Xose FernándezFraga, Fernando Azpiroz, Juan R. Malagelada

Research output: Contribution to journalArticleResearchpeer-review

111 Citations (Scopus)


Background & Aims: The pathophysiology of anal incontinence may be elusive using current parameters. Our aim was to establish the role of the levator ani in anal continence. Methods: In 53 patients with anal incontinence, 30 with constipation as disease controls, and 15 healthy controls, we evaluated incontinence severity by a 0-12 scale, anorectal function by standard manometric tests, and levator ani contraction by a perineal dynamometer. Results: Patients with incontinence exhibited various physiologic abnormalities (3.2 ± 0.3 per patient), but multiple regression analysis showed that levator ani contraction was the independent variable with strongest relation to the severity of incontinence (R = -0.84; P < 0.0001), as well as a predictive factor of the response to treatment (R = 0.53; P < 0.01). Furthermore, in contrast to other physiologic parameters, clinical improvement in response to treatment (4.4 ± 0.5 score vs. 7.9 ± 0.5 score pre; P < 0.001) was associated with a marked and significant strengthening of levator ani contraction (448 ± 47 g vs. 351 ± 35 g pre; P < 0.05). Conclusions: We have shown the importance of levator ani failure in understanding the etiology of anal incontinence and in predicting response to treatment.
Original languageEnglish
Pages (from-to)1441-1450
Publication statusPublished - 1 Nov 2002


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