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Positive Anal Fatigue Rates

Positive Anal Fatigue Rates. Kirsty Cattle Research Registrar. Background. Faecal incontinence has complex pathophysiology and is incompletely understood. Internal anal sphincter. External anal sphincter. Anal pressures are lower in incontinent patients

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Positive Anal Fatigue Rates

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  1. Positive Anal Fatigue Rates Kirsty Cattle Research Registrar

  2. Background • Faecal incontinence has complex pathophysiology and is incompletely understood

  3. Internal anal sphincter External anal sphincter

  4. Anal pressures are lower in incontinent patients • Internal anal sphincter function is reflected in the resting tone of the anal canal • External anal sphincter function is reflected in the voluntary squeeze pressure of the anal canal • Incontinent patients have slower external anal sphincter (EAS) fatigue rate

  5. Methods • Anal manometry: • Water filled microballoon • Measure anal pressure at 1cm intervals for 5cm from the anal verge • Resting and squeeze pressures are recorded for each point

  6. Pressure (cm H2O) Maximum resting pressure Distance from anal verge (cm) 5cm 1cm

  7. Pressure (cm H2O) Maximum squeeze pressure Distance from anal verge (cm) 5 cm 1 cm

  8. Methods • Anal manometry: • Water filled microballoon • Measure anal pressure at 1cm intervals for 5cm from the anal verge • Resting and squeeze pressures are recorded for each point • EAS fatigue: • 22 second maintained maximum voluntary contraction at point of maximum squeeze pressure • Measured twice

  9. MSP FR TII FR TI FR

  10. The Problem • In a proportion of subjects, the fatigue rate is positive • Why?

  11. Results • Of 138 EAS fatigue measurements: • 105 (76%) produced only negative fatigue rates • 12 (9%) produced only a positive fatigue rate • 21 (15%) produced mixed responses

  12. Possible causes • A strain effort

  13. Possible causes • A strain effort • Inability to maintain a voluntary contraction

  14. Possible causes • A strain effort • Inability to maintain a voluntary contraction • Motor unit recruitment?

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