A 53-year-old woman presents with a history of intermittent fecal incontinence. Physical activity often precipitates an episode, and she wears absorbent pads. She has occasional urinary incontinence when she coughs or sneezes. There is no history of gastrointestinal or rectal surgery and no neurologic symptoms. Examination reveals no perianal deformity or rectal prolapse. The tone of the anal canal is adequate, whereas contractions of the anal sphincter and puborectalis muscles are weak. When the patient bears down, there is no rectal prolapse, and perineal descent is approximately 2 cm. How should she be evaluated and treated?
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Arnold Wald (2007) studied this question.
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