**Evaluation**

**Chapter 5**

**Practical Imaging of Faecal Incontinence: The Eyes of**

Faecal continence is achieved by equilibrium of several forces and a combination of factors related to stool consistency, colonic propulsion, rectal compliance and filling awareness, pelvic floor muscle reflex activity and outlet resistance. Any of these factors may be damaged and other factors can compensate for this impairment in function so that continence is ensured. Incontinence can result from the breakdown of any one or more of the mechanisms that normally ensure continence. Consequently, accurate diagnosis of all factors that interplay to cause incontinence is required in order for the condition to be treated effectively, alone or in

Until recently, diagnosis of fecal incontinence\*\*\*\* has relied on history taking, physical examination and anoproctoscopy. With the exception of endoanal ultrasonography (EAUS) [1-3], imaging studies have not been extensively considered as a valuable diagnostic tool for evaluating the disease, a possible explanation being that it is not easy for diagnostic imaging of the distal gut to reach the level of quality expected and achieved in most other fields of diagnosis; indeed, it demands a sufficient level of interest and commitment by the radiologist and an understanding of the inherent problems of physiology and technique. Not by chance, EAUS is traditionally performed and interpreted by the coloproctologist, who considers such an investigation the natural extension of the physical examination. Despite much controversy still in existence regarding this issue [4], recent reports have emphasized the potential role of imaging studies, including evacuation proctography, also called defecography (D) [5-7] and more recently, MR imaging of anal sphincters and the pelvic floor [8-13] in health and disease states. In particular, the development of fast-sequence MRI has renewed hope that a singular imaging study could be used to differentiate those patients requiring conservative treatment

> © 2014 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Science**

Piloni Vittorio and Ghiselli Roberto

http://dx.doi.org/10.5772/57591

**1. Introduction**

Additional information is available at the end of the chapter

combination, by medical or surgical management.

from those necessitating surgery.
