Table 1 Overview of similarity and difference in three sphincter dysfunctions

Incidence rate

50% (F, ≥ 45 yrs)

20% (M, ≥ 70 yrs)

11 to 15%

18 to 28%

Structure

Urinary sphincter

Anal sphincter

LES

Location

Between ladder and urethra

Anorectum

Gastroesophageal junction

Causes

Vaginal childbirth

injury and aging in women; neuromuscular injury after radical prostatectomy in men

Obstetrical surgical injury

Obesity

Mechanistic

Effect

Urethral sphincter impairment or weakness due to pelvic floor muscles and nerve injure

Anal sphincter impairment or weakness

Low LES pressure, transient LES relaxation

Function testing

UPP, LPP, RUPP, EMG, ENG, bladder capacity, contractility test

EMG, anal pressure, contractility test

LES pressure measurement,

pH monitoring

Histological evaluation

H&E, Masson trichrome for college compound, picrosirius red for collagen networks, Hart elastin for elastin content, Gordon and Sweet staining for reticular (retic) fibers

Immunohistochemical stain: Muscle: desmin, myosin, α-SMA, myogenin, Myo D, Myf-5; Peripheral nerve: neurofilament, PGP9.5, βII-tubulin, S100; NMJ: neurofilament, α-Bungarotoxin, phalloidin

Symptoms

Urine leakage when intra- abdominal pressure increases (e.g., coughing)

Stool leakage

Frequent reflux of gastric contents into the esophagus causing heartburn, regurgitation, and esophageal chest pain

Complications

Emotional and social distress,

skin irritation, and mixed urinary incontinence

Emotional and social distress and skin irritation

Esophageal stricture,

Barrett’s esophagus, and

esophageal adenocarcinoma

Nonsurgical therapy

Surgical therapy

Pelvic floor exercises, behavioral modification

Pelvic floor exercises, biofeedback

behavioral modifications, (e.g., lose weight), PPIs

SLING procedure or injectable bulking agents

Sphincteroplasty or

injectable bulking agents

Fundoplication surgery