{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:18:07Z","timestamp":1787062687852,"version":"build-2736575974"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2008,10,9]],"date-time":"2008-10-09T00:00:00Z","timestamp":1223510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,10,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although surgery for congenital anorectal anomalies (ARAs) aims to preserve anorectal function, faecal incontinence and constipation often result. Apart from the anal sphincters, continence is dependent on multiple anatomical and physiological factors. The aim of this study was to evaluate adults with a history of ARA to determine the role of such factors in functional outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study included 20 consecutive adult patients with faecal incontinence who had undergone anorectal surgery as infants. Comprehensive testing included anal manometry, endoanal ultrasonography, tests of pudendal nerve function and rectal sensory function, evacuation proctography and colonic transit studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Anal resting tone and squeeze increments were both attenuated in 15 of 19 patients. Integrity of the internal and external anal sphincters was compromised in 16 and 15 of 18 patients respectively. Eleven of 13 had evidence of pudendal neuropathy. Rectal sensation was abnormal in 14 of 18 patients, of whom ten were hypersensitive and four hyposensitive. Rectal evacuation was abnormal in nine of 14. Colonic transit was delayed in five of eight patients with constipation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Faecal incontinence in adult patients with ARA is related to various pathophysiologies. Structural integrity of the anal sphincters is a major factor, but extrasphincteric mechanisms, notably rectal sensory function, may be as important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.6327","type":"journal-article","created":{"date-parts":[[2008,10,10]],"date-time":"2008-10-10T11:45:33Z","timestamp":1223639133000},"page":"1394-1400","source":"Crossref","is-referenced-by-count":16,"title":["Importance of extrasphincteric mechanisms in the pathophysiology of faecal incontinence in adults with a history of anorectal anomaly"],"prefix":"10.1093","volume":"95","author":[{"given":"E P","family":"Athanasakos","sequence":"first","affiliation":[{"name":"Centre for Academic Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"},{"name":"Department of Paediatric Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H C","family":"Ward","sequence":"additional","affiliation":[{"name":"Centre for Academic Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"},{"name":"Department of Paediatric Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N S","family":"Williams","sequence":"additional","affiliation":[{"name":"Centre for Academic Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S M","family":"Scott","sequence":"additional","affiliation":[{"name":"Centre for Academic Surgery, Barts and The London School of Medicine and Dentistry, The Royal London Hospital, Whitechapel, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2008,10,9]]},"reference":[{"key":"2021070911085211900_bib1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s00383-004-1231-6","article-title":"Long-term outcomes of anorectal malformations","volume":"20","author":"Davies","year":"2004","journal-title":"Pediatr Surg Int"},{"key":"2021070911085211900_bib2","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/0022-3468(92)90394-M","article-title":"Fecal continence and quality of life in adult patients with an operated low anorectal malformation","volume":"27","author":"Rintala","year":"1992","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib3","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/0022-3468(93)90518-P","article-title":"Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations","volume":"28","author":"Rintala","year":"1993","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib4","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0022-3468(97)90628-X","article-title":"Do children with repaired low anorectal malformations have normal bowel function?","volume":"32","author":"Rintala","year":"1997","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib5","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0022-3468(97)90722-3","article-title":"Rectal ectasia associated with anorectal anomalies","volume":"32","author":"Zia-ul-Miraj","year":"1997","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib6","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00383-002-0808-1","article-title":"Evaluation of dysfunction following reconstruction of an anorectal anomaly","volume":"18","author":"Hettiarachchi","year":"2002","journal-title":"Pediatr Surg Int"},{"key":"2021070911085211900_bib7","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1023\/A:1026614726976","article-title":"Colonic motility in children with repaired imperforate anus","volume":"44","author":"Heikenen","year":"1999","journal-title":"Dig Dis Sci"},{"key":"2021070911085211900_bib8","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/0022-3468(95)90064-0","article-title":"Is normal bowel function possible after repair of intermediate and high anorectal malformations?","volume":"30","author":"Rintala","year":"1995","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib9","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/0022-3468(91)90424-R","article-title":"Long-term continence in patients with high and intermediate anorectal anomalies treated by sacroperineal (Stephens) rectoplasty","volume":"26","author":"Ong","year":"1991","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib10","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1136\/adc.71.3.194","article-title":"Social and emotional impact of faecal incontinence after surgery for anorectal abnormalities","volume":"71","author":"Ludman","year":"1994","journal-title":"Arch Dis Child"},{"key":"2021070911085211900_bib11","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/S0022-3468(98)90090-2","article-title":"Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung's disease and low anorectal anomalies","volume":"33","author":"Diseth","year":"1998","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib12","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1097\/01.ju.0000145201.94571.67","article-title":"Surgical reconstruction of cloacal malformation can alter bladder function: a comparative study with anorectal anomalies","volume":"172","author":"Warne","year":"2004","journal-title":"J Urol"},{"key":"2021070911085211900_bib13","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/S0022-3468(96)90664-8","article-title":"Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies","volume":"31","author":"Diseth","year":"1996","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S1743-9191(06)60052-6","article-title":"Life after definitive treatment for children with Hirschsprung's disease","volume":"2","author":"Athanasakos","year":"2002","journal-title":"Int J Surg"},{"key":"2021070911085211900_bib15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/978-1-84628-503-5_8","volume-title":"Perineal and Anal Sphincter Trauma: Diagnosis and Clinical Management","author":"Lunniss","year":"2007"},{"key":"2021070911085211900_bib16","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/BF02234292","article-title":"Rectal augmentation and stimulated gracilis anal neosphincter: a new approach in the management of fecal urgency and incontinence","volume":"44","author":"Williams","year":"2001","journal-title":"Dis Colon Rectum"},{"key":"2021070911085211900_bib17","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1136\/gut.2004.047696","article-title":"Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence","volume":"54","author":"Bharucha","year":"2005","journal-title":"Gut"},{"key":"2021070911085211900_bib18","doi-asserted-by":"crossref","first-page":"S90","DOI":"10.1053\/j.gastro.2003.10.014","article-title":"Outcome measures for fecal incontinence: anorectal structure and function","volume":"126","author":"Bharucha","year":"2004","journal-title":"Gastroenterology"},{"key":"2021070911085211900_bib19","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1111\/j.1572-0241.2001.03954.x","article-title":"Rectal compliance, capacity, and rectoanal sensation in fecal incontinence","volume":"96","author":"Salvioli","year":"2001","journal-title":"Am J Gastroenterol"},{"key":"2021070911085211900_bib20","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1136\/gut.2005.071613","article-title":"Rectal sensoriomotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies","volume":"54","author":"Chan","year":"2005","journal-title":"Gut"},{"key":"2021070911085211900_bib21","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1053\/j.gastro.2006.03.008","article-title":"The functional gastrointestinal disorders and the Rome III process","volume":"130","author":"Drossman","year":"2006","journal-title":"Gastroenterology"},{"key":"2021070911085211900_bib22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1136\/gut.19.1.64","article-title":"Sensibility of the rectum to distension and the anorectal distension reflex in ulcerative colitis","volume":"19","author":"Farthing","year":"1978","journal-title":"Gut"},{"key":"2021070911085211900_bib23","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1007\/BF01295718","article-title":"Oral [111In]DTPA scintigraphic assessment of colonic transit in constipated subjects","volume":"38","author":"Roberts","year":"1993","journal-title":"Dig Dis Sci"},{"key":"2021070911085211900_bib24","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1002\/bjs.4912","article-title":"Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers","volume":"92","author":"Dvorkin","year":"2005","journal-title":"Br J Surg"},{"key":"2021070911085211900_bib25","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0022-3468(82)80448-X","article-title":"Posterior sagittal anorectoplasty: important technical considerations and new applications","volume":"17","author":"Pena","year":"1982","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib26","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/S0039-6109(16)43733-3","article-title":"Surgery of anorectal anomalies","volume":"65","author":"DeVries","year":"1985","journal-title":"Surg Clin North Am"},{"key":"2021070911085211900_bib27","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0022-3468(87)80236-1","article-title":"The bath water needs changing, but don't throw out the baby: an overview of anorectal anomalies","volume":"22","author":"Smith","year":"1987","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib28","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/BF00298538","article-title":"Relationship of symptoms in faecal incontinence to specific sphincter abnormalities","volume":"10","author":"Engel","year":"1995","journal-title":"Int J Colorectal Dis"},{"key":"2021070911085211900_bib29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/014107680409700303","article-title":"Risk factors in acquired faecal incontinence","volume":"97","author":"Lunniss","year":"2004","journal-title":"J R Soc Med"},{"key":"2021070911085211900_bib30","doi-asserted-by":"crossref","first-page":"723","DOI":"10.2214\/ajr.173.3.10470912","article-title":"Transanal MR imaging after repair of anorectal anomalies in children: appearances in pull-through versus posterior sagittal reconstructions","volume":"173","author":"de Souza","year":"1999","journal-title":"AJR Am J Roentgenol"},{"key":"2021070911085211900_bib31","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s10350-004-0774-x","article-title":"Rectal hypersensitivity worsens stool frequency, urgency, and lifestyle in patients with urge fecal incontinence","volume":"48","author":"Chan","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"2021070911085211900_bib32","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1111\/j.1572-0241.2006.00604.x","article-title":"Rectal hyposensitivity","volume":"101","author":"Gladman","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"2021070911085211900_bib33","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1136\/gut.31.9.1056","article-title":"Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence","volume":"31","author":"Sun","year":"1990","journal-title":"Gut"},{"key":"2021070911085211900_bib34","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1007\/BF02236859","article-title":"Rectal compliance as a routine measurement: extreme volumes have direct clinical impact and normal volumes exclude rectum as a problem","volume":"43","author":"Felt-Bersma","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"2021070911085211900_bib35","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1111\/j.1572-0241.2004.40387.x","article-title":"Investigation of the pathophysiology of fecal seepage","volume":"99","author":"Rao","year":"2004","journal-title":"Am J Gastroenterol"},{"key":"2021070911085211900_bib36","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1002\/bjs.1800751112","article-title":"Faecal incontinence associated with reduced pelvic sensation","volume":"75","author":"Lubowski","year":"1988","journal-title":"Br J Surg"},{"key":"2021070911085211900_bib37","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1053\/j.gastro.2003.10.012","article-title":"Pathophysiology of pediatric fecal incontinence","volume":"126","author":"Di Lorenzo","year":"2004","journal-title":"Gastroenterol"},{"key":"2021070911085211900_bib38","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jpedsurg.2006.09.021","article-title":"Outcome of excision of megarectum in children with anorectal malformation","volume":"42","author":"Keshtgar","year":"2007","journal-title":"J Pediatr Surg"},{"key":"2021070911085211900_bib39","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s10350-003-0061-2","article-title":"The combination of electrically stimulated gracilis neoanal sphincter and continent colonic conduit: a step forward for total anorectal reconstruction","volume":"47","author":"Saunders","year":"2004","journal-title":"Dis Colon and Rectum"},{"key":"2021070911085211900_bib40","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/00000658-200007000-00020","article-title":"Permanent sacral nerve stimulation for fecal incontinence","volume":"232","author":"Malouf","year":"2000","journal-title":"Ann Surg"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.6327","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/95\/11\/1394\/36709812\/bjs6327.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/95\/11\/1394\/36709812\/bjs6327.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T16:34:38Z","timestamp":1625848478000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/95\/11\/1394\/6142648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10,9]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2008,10,9]]},"published-print":{"date-parts":[[2008,10,9]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.6327","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2008,11]]},"published":{"date-parts":[[2008,10,9]]}}}