Application of The Theory

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The Equation
Flow Index calculator
Flow Index contispation
Defecation Norm Gram
Anal Incontinence
Continence Norm Gram
Applications of the Theory
Facts and Controversies

Passive Anal Incontinence:

  • A 50 Years old male with post-hemorroidectomy.
    Passive Solid incontinence (Grade VI p).
    His maximum Intrarectal pressure (rest) = 7.9 mmHg.
    A.CL. (rest) = 4 cm
    A.C.D. (rest) = 0.6 cm.
  • Measurement without correction = Grade I (i.e. continent).
    Correction for delayed first sensation at 120 ml.
    where Maximum IRP (before the first sensation) = 18.69 mmHg.
    And profound RAIR takes place at 100 ml water.
    where: A.C.L. (Defecation) = 1.7 cm, and A.C.D. (DEF.) = 2.5 cm.

Measurement after correction for delayed sensation and premature RAIR
Flow Index = 1.07 cc Barium Sulphate /S = Grade VI p. (Passive solid incontinence).

Planning for treatment and predicting outcome:

1. Accordingly the mechanical factors namely IRP, ACL AND ACD, do not contribute to the incontinence accordingly sphincter repairs are not indicted.

2. Delayed first sensation and premature profound RAIR being responsible for incontinence are in need of sensory biofeedback in order to shift the point of first sensation before 120 ml water (i.e. before the threshold rectal volume causing premature profound RAIR)

3. According to the measurement of IRP the insufflation of 120 ml. Air causes an increase in IRP of 10.79 mmHg. the rectal compliance = 0.089 mmHg/ml. Anti-cholinergics which would decrease recta compliance more than 10% may result in Post-treatment passive solid fecal soiling instead of pre-treatment frank soild stool incontinence.





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