Cure of Urinary and Fecal Incontinence by Pelvic Ligament Reconstruction Suggests a Connective Tissue Etiology for Both

Abstract:

The aim was to prospectively follow a group of 25 patients (mean age 60.5 years) presenting with double incontinence, urinary and fecal. Other than endoanal ultrasound, no allowance was made for fecal incontinence. All patients were treated exclusively according to an anatomical classification used for the management of urinary incontinence. Initially, all patients underwent surgical reconstruction of their pubourethral neoligaments with intravaginal slingplasty. All 25 patients reported complete cure of their fecal incontinence for a minimum of 6 months (mean 26 months, range 6–48 months) after surgery, and 22 patients of their urinary incontinence as well. The external anal sphincter was normal in all 25 patients (100%). The internal anal sphincter (IAS) was normal in 18 patients (72%). In 3 patients fecal incontinence recurred simultaneously with the occurrence of herniations in the posterior and middle parts of the vagina. Subsequent surgical repair of the uterosacral and arcus tendineus fasciae pelvis ligaments cured the recurrence. The results appear to indicate that non-traumatic (‘idiopathic’) fecal incontinence may have the same cause as urinary incontinence. As only connective tissue was repaired, it is suggested that connective tissue damage may be an important cause of fecal as well as urinary incontinence.