Exercise-Induced Urinary and Fecal Incontinence: An Exceedingly Unusual Presentation of Aortoiliac Occlusive Disease

Abstract

Fecal and urinary incontinence is an exceedingly unusual manifestation of aortoiliac occlusive disease, with only 4 previous cases having been reported in the literature. The authors report the case of a sixty-two-year-old woman with a long history of bilateral lower extremity claudication and exercise-induced urinary and fecal incontinence. Angiography demonstrated a complete infrarenal aortic occlusion. Following aortofemoral bypass, peripheral perfusion normalized and the patient experienced complete relief of claudication and incontinence. The authors propose that the patient's incontinence was due to intermittent pelvic ischemia as a consequence of her aortoiliac disease. In contrast to the cauda equina syndrome, a “steal” mechanism is the most likely explanation for the pathophysiology of exercise-induced pelvic ischemia, which may be completely eradicated by aortoiliac revascularization.