Systematic Evaluation of External Anal Sphincter Fatigability in Healthy Women and Women With Fecal Incontinence: A High-Resolution Anorectal Manometric Study
4 affiliations
- 1Department of Digestive Physiology, INSERM U1073, CIC-CRB 1404, Université de Rouen Normandie Rouen France
- 2Department of Digestive Surgery, INSERM U1073, Université de Rouen Normandie Rouen France
- 3Department of Radiology, AIMS, Université de Rouen Normandie Rouen France
- 4Department of Clinical Research, INSERM U1096, Université de Rouen Normandie Rouen France
Abstract
Background/Aims: International consensus guidelines recommend assessing the external anal sphincter (EAS) function using a short maximal contraction. The clinical value of sustained contractions for assessing EAS fatigability remains controversial, partly because most studies have used water-perfused anorectal manometry systems rather than the more recent three-dimensional high-resolution anorectal manometry (3D HR-ARM) approach. We aimed to determine the discriminative ability of EAS fatigability between patients with fecal incontinence (FI) and healthy volunteers (HV), as well as its pathophysiological implications in patients with FI assessed using 3D HR-ARM.
Methods: 3D HR-ARM data from 160 adult female with FI (median age, 64 years) were compared with data from 39 healthy female volunteers (median age, 52 years; P < 1.10-3). EAS fatigability was assessed during a long squeeze (LS) using mean incremental LS pressure (LSP), LS duration, fatigue rate index, and contractile integral (CI). Patients additionally underwent endoanal ultrasound and anal sphincter electromyography. The discriminative performance was evaluated through repeated cross-validation using logistic regression and classification and regression tree models.
Results: The most discriminative model for distinguishing FI from HV combined resting pressure (RP) with maximal incremental LSP (area under the ROC curve [AUROC], 0.82; sensitivity, 0.91; specificity, 0.72). RP combined with LS duration showed similar discrimination, but lower specificity (AUROC, 0.82; sensitivity, 0.94; specificity, 0.44). Maximal incremental short squeeze pressure and maximal incremental LSP were associated with neuropathic processes (P = 0.031 and P = 0.034, respectively).
Conclusions: EAS fatigability during LS, assessed using 3D HR-ARM, did not discriminate between patients with FI and HV, nor did it identify specific pathophysiological mechanisms.
Related
- ‘Efficacy and safety outcomes after slings or artificial urinary sphincter implantation for non-neurogenic male stress urinary incontinence: a systematic review’ for more clarity
- The relationship between endometrial cancer and urinary incontinence: systematic review
- Qualitative clinician feedback on a systematic urinary incontinence screening and patient education intervention in primary care
- Sarcopenia as an independent associated factor for urinary incontinence in adults: a systematic review and meta-analysis of observational studies
- Post-Treatment Response and Safety of Stem Cell-Based Urethral Injection Therapy for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis
BibTeX
@article{desprez2026systematic,
title = {{Systematic Evaluation of External Anal Sphincter Fatigability in Healthy Women and Women With Fecal Incontinence: A High-Resolution Anorectal Manometric Study}},
author = {Charlotte Desprez and Guillaume Gourcerol and Valérie Bridoux and Céline Savoye-Collet and Thomas Duflot and Anne-Marie Leroi},
journal = {Journal of Neurogastroenterology and Motility},
year = {2026},
month = oct,
doi = {10.5056/jnm26027},
url = {https://doi.org/10.5056/jnm26027},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Systematic Evaluation of External Anal Sphincter Fatigability in Healthy Women and Women With Fecal Incontinence: A High-Resolution Anorectal Manometric Study
AU - Charlotte Desprez
AU - Guillaume Gourcerol
AU - Valérie Bridoux
AU - Céline Savoye-Collet
AU - Thomas Duflot
AU - Anne-Marie Leroi
PY - 2026
DA - 2026/10/31
JO - Journal of Neurogastroenterology and Motility
DO - 10.5056/jnm26027
UR - https://doi.org/10.5056/jnm26027
AB - Background/Aims: International consensus guidelines recommend assessing the external anal sphincter (EAS) function using a short maximal contraction. The clinical value of sustained contractions for assessing EAS fatigability remains controversial, partly because most studies have used water-perfused anorectal manometry systems rather than the more recent three-dimensional high-resolution anorectal manometry (3D HR-ARM) approach. We aimed to determine the discriminative ability of EAS fatigability between patients with fecal incontinence (FI) and healthy volunteers (HV), as well as its pathophysiological implications in patients with FI assessed using 3D HR-ARM. Methods: 3D HR-ARM data from 160 adult female with FI (median age, 64 years) were compared with data from 39 healthy female volunteers (median age, 52 years; P < 1.10-3). EAS fatigability was assessed during a long squeeze (LS) using mean incremental LS pressure (LSP), LS duration, fatigue rate index, and contractile integral (CI). Patients additionally underwent endoanal ultrasound and anal sphincter electromyography. The discriminative performance was evaluated through repeated cross-validation using logistic regression and classification and regression tree models. Results: The most discriminative model for distinguishing FI from HV combined resting pressure (RP) with maximal incremental LSP (area under the ROC curve [AUROC], 0.82; sensitivity, 0.91; specificity, 0.72). RP combined with LS duration showed similar discrimination, but lower specificity (AUROC, 0.82; sensitivity, 0.94; specificity, 0.44). Maximal incremental short squeeze pressure and maximal incremental LSP were associated with neuropathic processes (P = 0.031 and P = 0.034, respectively). Conclusions: EAS fatigability during LS, assessed using 3D HR-ARM, did not discriminate between patients with FI and HV, nor did it identify specific pathophysiological mechanisms.
SN - 2093-0879
SN - 2093-0887
ER -