AIM: To evaluate manometric parameters that could explain the improvement achieved by the use of silicone bulking agent for anal incontinence.
METHOD: Selected incontinent patients were injected with a silicone bulking agent. Clinical evaluation included a Scoring System and the Fecal Incontinence Quality of Life Scale. Patients underwent anal manometry and ultrasound before and after silicone injection. Parameters evaluated were resting and squeeze pressures, high-pressure zone, and asymmetry index. A control group of 20 continent healthy volunteers was used solely for manometric comparison.
RESULTS: A total of 35 incontinent patients (28 females) with a mean age of 60.3 (19-80) were evaluated. Manometric pressures pre and post injection were not changed (P = 0.20). However, the length of the high pressure zone increased from 1 to 1.7 cm post injection (P = 0.002). In addition, asymmetry index at 2 and 3 cm showed a significant change post injection (P < 0.05 and P = 0.001, respectively). Asymmetry improvement correlated to clinical improvement.
CONCLUSION: Silicone injection is a useful option. Clinical improvement correlated to a change in both the high pressure zone and asymmetry index and may explain the mechanism of this bulking agent.
Source: PubMed 19546122