Abstract
We studied 16 patients with diabetes and fecal incontinence. The onset of incontinence coincided with the onset of chronic diarrhea in most patients. Episodes of incontinence occurred when stools were frequent and loose; however, 24-hour stool weights were usually within normal limits. All patients had evidence of autonomic neuropathy, and one third had steatorrhea. Incontinent diabetics had a lower mean basal anal-sphincter pressure than 35 normal subjects (63 ± 4 vs. 37 ± 4 mm Hg; P < 0.001), reflecting abnormal internal-anal-sphincter function. The increment in sphincter pressure with voluntary contraction (external-sphincter function) was not significantly different from normal. Incontinent diabetics also had impaired continence for a solid sphere and for rectally infused saline. In contrast, 14 diabetics without diarrhea or incontinence had normal sphincter pressures and normal results on tests of continence, even though 79 per cent had evidence of autonomic neuropathy and nearly half had steatorrhea. We conclude that incontinence in diabetic patients is related to abnormal internal-anal-sphincter function, and that as a group, diabetics without diarrhea do not have latent defects in continence.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1666-1671 |
| Number of pages | 6 |
| Journal | New England Journal of Medicine |
| Volume | 307 |
| Issue number | 27 |
| State | Published - 1982 |
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Pathogenesis of fecal incontinence in diabetes mellitus. Evidence for internal-anal-sphincter dysfunction. / Schiller, L. R.; Santa Ana, C. A.; Schmulen, A. C.; Hendler, R. S.; Harford, W. V.; Fordtran, J. S.
In: New England Journal of Medicine, Vol. 307, No. 27, 1982, p. 1666-1671.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Pathogenesis of fecal incontinence in diabetes mellitus. Evidence for internal-anal-sphincter dysfunction
AU - Schiller, L. R.
AU - Santa Ana, C. A.
AU - Schmulen, A. C.
AU - Hendler, R. S.
AU - Harford, W. V.
AU - Fordtran, J. S.
PY - 1982
Y1 - 1982
N2 - We studied 16 patients with diabetes and fecal incontinence. The onset of incontinence coincided with the onset of chronic diarrhea in most patients. Episodes of incontinence occurred when stools were frequent and loose; however, 24-hour stool weights were usually within normal limits. All patients had evidence of autonomic neuropathy, and one third had steatorrhea. Incontinent diabetics had a lower mean basal anal-sphincter pressure than 35 normal subjects (63 ± 4 vs. 37 ± 4 mm Hg; P < 0.001), reflecting abnormal internal-anal-sphincter function. The increment in sphincter pressure with voluntary contraction (external-sphincter function) was not significantly different from normal. Incontinent diabetics also had impaired continence for a solid sphere and for rectally infused saline. In contrast, 14 diabetics without diarrhea or incontinence had normal sphincter pressures and normal results on tests of continence, even though 79 per cent had evidence of autonomic neuropathy and nearly half had steatorrhea. We conclude that incontinence in diabetic patients is related to abnormal internal-anal-sphincter function, and that as a group, diabetics without diarrhea do not have latent defects in continence.
AB - We studied 16 patients with diabetes and fecal incontinence. The onset of incontinence coincided with the onset of chronic diarrhea in most patients. Episodes of incontinence occurred when stools were frequent and loose; however, 24-hour stool weights were usually within normal limits. All patients had evidence of autonomic neuropathy, and one third had steatorrhea. Incontinent diabetics had a lower mean basal anal-sphincter pressure than 35 normal subjects (63 ± 4 vs. 37 ± 4 mm Hg; P < 0.001), reflecting abnormal internal-anal-sphincter function. The increment in sphincter pressure with voluntary contraction (external-sphincter function) was not significantly different from normal. Incontinent diabetics also had impaired continence for a solid sphere and for rectally infused saline. In contrast, 14 diabetics without diarrhea or incontinence had normal sphincter pressures and normal results on tests of continence, even though 79 per cent had evidence of autonomic neuropathy and nearly half had steatorrhea. We conclude that incontinence in diabetic patients is related to abnormal internal-anal-sphincter function, and that as a group, diabetics without diarrhea do not have latent defects in continence.
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M3 - Article
C2 - 7144865
AN - SCOPUS:0020367136
VL - 307
SP - 1666
EP - 1671
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 27
ER -