Assessment of Sacral Ratio in Patients with Fecal Incontinence and Its Correlation with Treatment Response among Iranian Pediatric Patients

Hosseini, Amirhossein; Salehi, Sadaf; Farjad, Roshanak; Hossein Zadeh, Rasoul; Galaki Tabari, Maziar; Moravej, Khashayar; Hajipour, Mahmoud; Rahimi, Benyamin; Dara, Naghi; Imanzadeh, Negar; Sayyari, Aliakbar; Imanzadeh, Farid

doi:10.22038/jpp.2025.90525.5590

Assessment of Sacral Ratio in Patients with Fecal Incontinence and Its Correlation with Treatment Response among Iranian Pediatric Patients

Document Type : original article

Authors

Amirhossein Hosseini ¹

Sadaf Salehi ² ^¶

Roshanak Farjad ¹ ^¶

Rasoul Hossein Zadeh ¹

Maziar Galaki Tabari ³

Khashayar Moravej ⁴

Mahmoud Hajipour ¹

Benyamin Rahimi ⁵

Naghi Dara ⁶

Negar Imanzadeh ⁷

Aliakbar Sayyari ¹

Farid Imanzadeh ¹

¹ Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

² Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.

³ Imam Reza Hospital, Tabriz University of Medical Science, Tabriz, Iran.

⁴ Faculty of Dentistry, Islamic Azad University of Medical Sciences, Isfahan Branch, Isfahan, Iran.

⁵ Department of Urology, Imam Reza Hospital, Tabriz University of Medical Science, Tabriz, Iran.

⁶ School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁷ School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

10.22038/jpp.2025.90525.5590

Abstract

Background and Objective: Fecal incontinence (FI) is a multifactorial condition characterized by involuntary fecal excretion, impacting quality of life. Approximately 1 in 12 adults worldwide suffer from FI, with a higher prevalence among women and the elderly. FI patients often experience physical and psychological problems, including infections, skin issues, and social anxiety. Sacral anomalies may contribute to FI, and the sacral ratio (SR) is a reliable metric for evaluating sacral development in anorectal malformations. This study aims to investigate changes in SR among children with FI to assess its role in FI diagnosis and prediction.
Methods: This case-control study was conducted on 288 children aged 4-18 years referred to Mofid Children's Hospital in Tehran, Iran. The data were analyzed using SPSS software to control for confounders. Demographic data, FI condition, and radiological findings were evaluated, and SR values were compared between the case and control groups.
Results: The study involved 288 children (158 females, 130 males). The average age for the FI group was 7.12 ± 2.57 years, and for the control group, it was 8.56 ± 2.89 years. The overall SR was 0.6760 ± 0.12369 with a confidence interval of 0.6616 to 0.6904. The control group had a higher SR (0.6968 ± 0.10) compared to the FI group (0.65 ± 0.13), with a significant difference between groups (effect size: Cohen’s d = 0.34, p-value = 0.005). Nine subjects in the case group did not respond to treatment. SR (P=0.993) and sex (P=0.237) were not significantly associated with response to treatment
Conclusion: This study highlights the complex role of SR in the field of pediatric FI, emphasizing the need for a nuanced, multidisciplinary approach to address this challenging clinical condition. Continued research in this area will undoubtedly advance our understanding and lead to more targeted and effective interventions for affected children.

Keywords

Chronic constipation

Fecal incontinence

Sacral ratio

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