Am J Physiol Gastrointest Liver Physiol. 2024 Jan 9. doi: 10.1152/ajpgi.00113.2023.Online ahead of print.

Reuma Margalit-Yehuda ¹, Carla Maradey-Romero ¹, Yana Davidov ², Edward Ram ³, Dan Carter ¹

Author information

¹Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel.

²Liver Diseases Center, Sheba Medical Center, Ramat Gan, Israel.

³Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel.

Abstract

Background and aims: Fecal incontinence (FI) is often underreported and underestimated in men. Our aims were to clarify the causes and the physiologic characteristics of FI in men and to underline the differences between etiological and physiological factors in men and women diagnosed with FI.

Methods: The study cohort encompassed 200 men and 200 women that underwent anatomical and physiological evaluation for FI in a tertiary referral center specializing in pelvic floor disorders. All patients underwent endoanal ultrasound and anorectal manometry. Evacuation proctography was performed in some patients. Demographic, medical, anatomic and physiologic parameters were compared between the 2 study groups.

Results: Urge incontinence was the most frequent type of FI in both genders. In men, anal fistula, history of anal surgeries, rectal tumors and pelvic radiotherapy were common etiologic factors, while history of pelvic surgeries was more common in women. Associated urinary incontinence was reported more frequently by women. External anal sphincter defects, usually anterior, were more common in women (M:1.5%,W:24%,p<0.0001), while Internal anal sphincter defects prevalence was similar in men and women (M:16%,W12%,p=0.19). Decreased resting and squeeze pressures were less common in men (M:29%,W:46%,p<0.0001: M:44%,W:66%,p<0.0001). The incidence of rectal hyposensitivity was higher in men (M:33%,W:18%,p<0.0001), while rectal hypersensitivity was higher in women (M:29%,W:49%,p<0.0001). Anorectal dyssynergia was more common in men (M:66%,W:37%,p<0.0001).

Conclusions: Significantly different etiologic factors and physiologic characteristics for FI were found in men. Acknowledging these differences is significant and may yield better treatment options.