It is obvious that a patient with a history of anal incontinence should not be offered a sphincter-saving operation. Elderly people have weaker anal sphincters than young people and therefore old age (>70) speaks against a sphincter-saving procedure. Whether objective assessment of anal sphincter function can be used to predict the outcome of a sphincter-saving operation as regards continence has not been settled. However, it appears reasonable to assume that a patient with a low anal pressure, although without a history of imperfect continence, carries a higher risk of developing incontinence than a patient with normal pressure, and in our experience recto-anal manometry is a valuable tool in selecting the patients most suitable for a restorative operation and to evaluate the mechanisms behind post-operative disturbances.
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