| Summary: | Abstract Faecal incontinence disables the patients physically, emotionally and socially. The subjects affected are heterogenous and the tests and treatments offered vary widely. Knowledge of methods of assessments and treatments available is important in optimising the management. As General Practitioners are the first point of contact, we carried out a postal survey to assess this among 1100 General Practitioners and this showed that their knowledge is limited in this regard. Lack of standardisation of tests and the definition of variables used along with the heterogenous nature of the aetiology of this condition; make it difficult to compare the treatment outcomes from various centres. Hence we proposed a new classification based on anorectal investigation which helped comparison between patients from various centres easier. Faecal incontinence is more likely to happen in the erect posture but most of the tests are carried out in the left lateral position. We assessed the manometric variables in both positions which showed a significant difference in two positions. Studies have explained the role of anal cushions in normal continence. We devised a method to quantify the anal cushions with the help of yielding a cushion-canal (C: C) ratio based on the measurements made by transvaginal ultrasound scans. Initially we carried out this study in 106 continent subjects and -, ----------- 5 defined the normal range. This has shown that the method is simple and repeatable with good correlation coefficients. In a subset of patients (n=15) we assessed the ratio in both supine and semi erect postures which confirmed a significant rise in the semi erect posture. Subsequently, we measured the anal cushions in patients with idiopathic faecal incontinence (n=21) which has shown a significant decrease in the cushion canal ratio in these patients suggesting a possibility that the atrophy of these cushions might well be a cause for their incontinence
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