Faecal incontinence in men

Aim A few studies have specifically addressed faecal incontinence (FI) in men. We sought to describe patterns of male FI, assess treatment outcome and compare some aspects of FI between men and women, including quality of life. Method Prospectively recorded data on 85 consecutive male patients evaluated for FI at our pelvic floor centre in 2004 and 2005 were reviewed and compared with a cohort of 408 female patients. Treatment outcome in men was assessed by questionnaire. Results The aetiology of FI could be determined in 61 (72%) men and was most commonly related to anal surgery (n=23), prostate cancer therapy (n=9) and spinal injury (n=9). Eight patients had idiopathic soiling only. Mean age, Fecal Incontinence Severity Index (FISI) and quality of life scores were similar between men and women. Maximal mean resting pressure (MRP) and squeeze pressure (MSP) were on average higher in men than in women [MRP 56.9 (26.2) vs 40 (20.4) mmHg; P<0.0001]; [MSP 98.1 (67.3) vs 39.4 (28.5) mmHg; P<0.0001]. Sphincter defects involved the external sphincter less often in men (35 vs 70%, P=0.004). Differences in faecal incontinence quality of life (FIQL) and SF-36 scores between men and women were minimal. After a median follow up of 2years, complete resolution of symptoms was reported in 17% and improvement of symptoms in another 48% of men. Conclusion Although physiological and anatomical features of FI differ between men and women, its severity and impact on quality of life are similar. External sphincter defects are less common in men; hence, direct sphincter repair is less frequently an option. Evaluation and treatment improves symptoms in more than half of male patients.