Functional Evaluation of Obese Patients with Symptoms of Fecal Incontinence Using Anorectal Electromanometry

Abstract

Obesity is a modifiable risk factor to fecal incontinence (FI) and weight loss result in improvement in the frequency and severity of FI. Introduction: Fecal incontinence (FI) has a multifactorial etiology and is most common in women. The prevalence is variable, though generally underestimated due to embarrassment. Since the incidence of pelvic floor disorders is higher among obese individuals, obesity may be considered a modifiable risk factor for FI. Weight loss seems to result in improvement in the frequency and severity of FI episodes. However, little has been published on FI in obese subjects and on its impact on quality of life in this patient population. Objective: Perform functional evaluations of obese patients with FI using anorectal electromanometry and determine the incidence of anismus. Materials and methods: Retrospective study including 58 obese subjects with FI aged 18-60 years. The patients were diagnosed clinically, and then submitted to physical examination followed by ARM. Results: The sample included 58 obese patients with an average BMI of 35 kg/m² (range: 30-52). The female gender was predominant: n=44 (75.87%) vs. male n=14 (24.13%). The average age was 49 years (23-60), the average pressure at rest was 49 mmHg (8-94) and the average pressure during straining was 124 mmHg (34-263). Half the patients (50%) presented hypotonia at rest and/or during straining, and 45% had anismus. Conclusion: Obesity is a modifiable risk factor for fecal incontinence, the etiology can be varied and needs to be established. In our results show that functional evaluation is necessary to determine the etiology of FI in obese patients and choose the best therapeutic approach in each case.