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Defecation Norm Gram
Continence Norm Gram
Applications of the Theory
Facts and Controversies
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.
without correction = Grade I (i.e. continent).
Correction for delayed first sensation at 120 ml.
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
after correction for delayed sensation and premature RAIR
Flow Index = 1.07 cc Barium Sulphate /S = Grade VI p. (Passive
for treatment and predicting outcome:
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