GASTROENTEROLOGY ARTICLE OF THE WEEK

NOVEMBER 30, 2000 

 1.  Regarding obstetric injury as a cause of fecal incontinence

            a.  It is the commonest cause of fecal incontinence among healthy adult women

            b.  the most common cause is nerve damage associated with childbirth, not

sphincter injury         

            c.  evidence of  structural sphincter damage can be detected in many cases.

            d.  forceps delivery is associated with a higher risk of incontinence.

  True or False

 2.  Defecography or defecating proctography is used to measure the length of the anal canal, the anorectal angle, and the degree of perineal descent.

 3.  Fecal impaction is probably the leading cause of incontinence in institutionalized older patients.

 4.  Medical therapy of incontinence includes high fiber diet, fiber supplement and antidiarrheal agents, particularly loperamide, which may have an independent effect on improving anal canal resting pressures

 5.  Sphincter repair surgery for idiopathic incontinence, in the absence of obvious sphincter defects, usually yields poor results.

 6.  Two thirds of patients with incontinence have a reduced anal canal pressure, reflecting an abnormally low internal anal sphincter resting pressure.

 7.  The external anal sphincter does not contribute to the resting anal canal pressure

 8.  Surgical correction of rectal prolapse restores continence to over 80% of patients.

9.  The role of the puborectalis muscle and the anorectal angle in maintenance of continence is controversial.

 10.  Which of the following represent the normal sequence of events during defecation:

            a.  rectal distention à EAS relaxation à IAS contraction

            b.  rectal distention   à simultaneous reflex EAS and IAS relaxation

            c.  rectal distention à reflex IAS relaxation à voluntary EAS relaxation

            d.  rectal distention à voluntary IAS relaxation à reflex EAS relaxation

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