Incontinence and rectal prolapse: A prospective manometric study

A prospective, manometric study has been performed on 23 female patients with rectal prolapse and varying degrees of incontinence. Seven of the 14 incontinent patients regained continence after surgery, and a further two patients improved. Improvement in internal and external sphincter function follows correction of rectal prolapse. Preoperative resting anal pressure was significantly higher in continent patients than in incontinent patients (P< 0.05), as was the maximum voluntary contraction pressure (P< 0.027). Postoperatively there was a significant increase in the resting anal pressure (P< 0.0001) and maximum voluntary contraction pressure (P< 0.003)in the whole group. The preoperative resting anorectal angle was significantly more acute (P< 0.028) in continent patients than in incontinent patients. There was no significant change in the resting anorectal angle following prolapse repair. Patients who remained incontinent had a significantly lower preoperative resting anal pressure (P< 0.01) than patients who improved or regained continence. Similarly, maximum voluntary contraction pressure was lower preoperatively in these patients (P< 0.02). Preoperative resting anal pressure below 10 mm Hg and maximum voluntary contraction pressure below 50 mm Hg are associated with persisting incontinence after surgery.