Evaluating patients with anorectal incontinence.

Fecal incontinence is a devastating disability, and although this condition is widely accepted as a problem in the elderly, it is now becoming apparent that much younger age groups are also frequently affected. Thorough assessment of anorectal incontinence is very important to choosing the most appropriate treatment. Careful history-taking and physical examination can identify the cause of most cases of incontinence and are essential in every patient. Several incontinence scoring systems have been proposed to provide an objective measure of a subject's degree of fecal incontinence, but only one acknowledges the important contribution of the severity of symptoms to quality of life. The investigations used to evaluate anorectal physiology include anorectal manometry, anal endosonography, nerve stimulation techniques, electromyography, defecography, endoluminal magnetic resonance imaging, the saline continence test, and the balloon-retaining test. Although all of these tests are important, the most useful for patients with incontinence are anal manometry, anal endosonography, and the pudendal nerve terminal motor latency test, because they can identify anatomic or physiologic abnormalities for which there may be effective treatments.