SEARCH · PubMed Health

Results for “Fecal Incontinence”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMed2004

Incontinence severity and QOL scales for fecal incontinence.

This article reviews self-reporting instruments to measure severity and quality of life in fecal incontinence. Severity instruments assess the frequency, type, and amount of stool loss and the impact of fecal incontinence on coping mechanisms and lifestyle/behavioral change. Non-weighted instruments use simple numerical totals to gauge severity; however, the use of vague quantifiers to describe severity can make the results highly subjective. In weighted surveys, every possible response (indicating the frequency of each type of incontinence) is multiplied by a weight that reflects the average severity assigned by a representative group of patients (or physicians), and the weighted responses are added to compile a total score. When variables such as coping mechanisms and lifestyle changes are included in severity questionnaires, the results tend to reflect patient functioning more than severity and should be interpreted cautiously. Quality-of-life scales assess variables that are not directly observable and are highly subjective. Quality-of-life scales are divided into 3 categories: (1) generic scales permit the measurement of gross change and compare the experience of the target population to other populations; (2) specialized scales are most useful in trying to isolate effects of specific variables, such as depression; and (3) condition-specific quality-of-life scales measure the relationship between specific medical conditions or treatments, and quality of life outcomes. Future research should focus on the need for weighting, further evaluation of the use of coping mechanisms as an indicator of severity, and how to integrate measures of urgency. In the area of quality of life, "modules" are needed that can be appended to established instruments to help assess and compare the experience of specific populations.

Fecal Incontinence↗

PubMed1999

Cure of urinary and fecal incontinence by pelvic ligament reconstruction suggests a connective tissue etiology for both.

The aim was to prospectively follow a group of 25 patients (mean age 60.5 years) presenting with double incontinence, urinary and fecal. Other than endoanal ultrasound, no allowance was made for fecal incontinence. All patients were treated exclusively according to an anatomical classification used for the management of urinary incontinence. Initially, all patients underwent surgical reconstruction of their pubourethral neoligaments with intravaginal slingplasty. All 25 patients reported complete cure of their fecal incontinence for a minimum of 6 months (mean 26 months, range 6-48 months) after surgery, and 22 patients of their urinary incontinence as well. The external anal sphincter was normal in all 25 patients (100%). The internal anal sphincter (IAS) was normal in 18 patients (72%). In 3 patients fecal incontinence recurred simultaneously with the occurrence of herniations in the posterior and middle parts of the vagina. Subsequent surgical repair of the uterosacral and arcus tendineus fasciae pelvis ligaments cured the recurrence. The results appear to indicate that non-traumatic ('idiopathic') fecal incontinence may have the same cause as urinary incontinence. As only connective tissue was repaired, it is suggested that connective tissue damage may be an important cause of fecal as well as urinary incontinence.

Adult↗

PubMed1998

Antegrade continent enema management of chronic fecal incontinence in children.

BACKGROUND/PURPOSE: Fecal incontinence impedes social and psychological development in children. Conventional bowel management with rectal enemas, medication, and biofeedback frequently will provide intervals free of fecal soiling sufficient for children to be socially continent. METHODS: This report details the improvement achieved by antegrade irrigation of the colon when conventional bowel management programs have failed to provide satisfactory intervals free of fecal soiling. Twenty-three children had conduits performed to administer antegrade continent enemas in the colon from December 1993 to May 1997. RESULTS: Twenty of the children were available for evaluation. One child was lost to follow-up, and two were noncompliant with the irrigation program. Fourteen of the 20 children are out of diapers. Four of the six wearing diapers, do so for urinary, not fecal incontinence. Two patients (10%) still require diapers for fecal incontinence. Parents were pleased with the efficacy of antegrade irrigation and the decrease in family stress with the elimination of fecal soiling. CONCLUSIONS: Ninety percent of the children available for follow-up benefited from antegrade irrigations of the colon. The antegrade irrigations were an improvement over conventional bowel management programs because a predictable interval free of soiling could be established. This allowed families to plan activities and improved the self-esteem of their children.

Adolescent↗

PubMed1996

Epidemiology of fecal incontinence: the silent affliction.

OBJECTIVE: Fecal incontinence represents an embarrassing social problem, the magnitude of which remains largely unknown. The present study prospectively examined the prevalence and demographic distributions of fecal incontinence. METHODS: demographic data, in addition to information regarding the reason for visit, bowel habits, and the frequency, type, and severity of fecal incontinence, were collected from individuals at the time of visits to their primary care physician or gastroenterologist. RESULTS: Eight hundred and eighty-one individuals 18 yr or older were included in the analysis. The overall prevalence of fecal incontinence was 18.4%. When stratified by frequency, 2.7, 4.5, and 7.1% of participants admitted to incontinence daily, weekly, or once per month or less, respectively. Incontinence increased progressively with age and was 1.3 times more common in males than females. Only one-third of individuals with fecal incontinence had ever discussed the problem with a physician. CONCLUSIONS: The prevalence of fecal incontinence appears to be more common than previously appreciated. Moreover, only a minority with a physician. It would seem important to more actively pursue this "silent affliction" particularly in patients who do not readily volunteer this information.

Adolescent↗

PubMed1997

Fecal incontinence: evaluation and treatment.

Fecal incontinence, the involuntary passage of gas, liquid, or solid stool, is an underreported problem in our society. The evaluation of fecal incontinence includes a focused history, physical examination, and assessment of the pelvic floor musculature. This article describes the assessment of fecal incontinence, focusing on specific diagnostic tests designed to identify dysfunction of the anal sphincter and adjacent pelvic floor musculature and on the use of these tests in determining an appropriate treatment plan.

Fecal Incontinence↗

PubMed2005

Validity and reliability of the Modified Manchester Health Questionnaire in assessing patients with fecal incontinence.

PURPOSE: To date, no measures of fecal incontinence severity or its impact on quality of life have been validated for telephone interview. This study was designed to 1) compare responses of a self-administered and a telephone-administered Fecal Incontinence Severity Index; 2) compare a self-administered Fecal Incontinence Quality of Life Scale to the Manchester Health Questionnaire after modifying the latter for telephone administration and American English (Modified Manchester Health Questionnaire); 3) assess test-retest reliability of the telephone-administered Modified Manchester Health Questionnaire; and 4) assess the internal consistency of the Modified Manchester Health Questionnaire subscales. METHODS: Consecutive, English-speaking, nonpregnant females known to have fecal incontinence were invited to participate. Two validated paper questionnaires accompanied the letter informing them of the study: Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale. Consenting patients were contacted for the initial telephone administration of the Modified Manchester Health Questionnaire, and patients who agreed to continue the study were contacted for a repeat telephone administration of the Modified Manchester Health Questionnaire two to four weeks after completing the first interview. RESULTS: Fifty-one females were invited to participate in the study; however, 13 declined or were ineligible. Thirty females, aged 49.3 +/- 10.3 years, returned self-administered questionnaires and completed the first telephone interview, and 21 completed a second telephone interview after an average interval of 23 days. The telephone-administered Fecal Incontinence Severity Index scores were significantly lower than those yielded by the self-administered Fecal Incontinence Severity Index, (6.19 vs. 9.85; P < 0.001), but the telephone and written administrations were significantly correlated (r = 0.5; P < 0.02). Correlations between the Modified Manchester Health Questionnaire quality of life subscales and the paper Fecal Incontinence Quality of Life subscales ranged from 0.6 to 0.9 (median, r = 0.81). The correlation between the total score for the Fecal Incontinence Quality of Life and the total score for the Modified Manchester Health Questionnaire quality of life scales was 0.93 (P < 0.001). Test-retest reliability for the eight Modified Manchester Health Questionnaire subscales ranged from 0.55 to 0.98 (median, r = 0.83), and test-retest reliability for the two telephone administrations of the Fecal Incontinence Severity Index was r = 0.75. Cronbach's alpha for the eight Modified Manchester Health Questionnaire subscales ranged from 0.79 to 0.92 (median, alpha = 0.85). CONCLUSIONS: Telephone-administered versions of the Modified Manchester Health Questionnaire showed good-to-excellent validity, internal consistency, and test-retest reliability. The telephone-administered Fecal Incontinence Severity Index yielded lower severity scores than the written Fecal Incontinence Severity Index; however, the difference (3.66 units) was not clinically significant.

Adult↗

PubMed2003

Measuring fecal incontinence.

The measurement of fecal incontinence is challenging. Because fecal incontinence is a symptom, the subjective perception of the patient must be the foundation of any evaluation of incontinence or the impact of incontinence. The lack of a criterion standard makes testing measures for reliability and validity more difficult. Despite this, many measures are available and can be divided into three broad categories: descriptive measures that do not provide summary scores; severity measures that assess the frequency and type of incontinence; and impact measures that assess the effect of incontinence on quality of life. The strengths and weaknesses of currently available measures are presented in this review.

Endpoint Determination↗

PubMed1996

Diagnosis and management of fecal incontinence in elderly patients.

Fecal incontinence is a physically and psychologically disabling condition that affects millions of Americans, especially those over the age of 65 years. The pathophysiology is often multifactorial, with decreased anorectal sensation, reduced rectal compliance. anal sphincter dysfunction, altered stool consistency and immobility playing significant roles. A detailed history and a thorough physical examination are always necessary in patients with fecal incontinence and physiologic tests, including anorectal manometry, cinedefecography and electromyography, may be required for proper diagnosis and treatment. In most patients fecal incontinence is initially treated with conservative measures, such as biofeedback training or alteration of the stool consistency (if appropriate). If conservative management fails, surgical intervention, such as sphincteroplasty or gracilis muscle transposition, may be considered.

Aged↗

PubMed2005

Advances in the surgical treatment of fecal incontinence.

Although surgery for fecal incontinence has been shown to be effective, it is still very challenging and sometimes frustrating. Overlapping sphincteroplasty, by far the most common procedure, is effective in patients with sphincter defects; however, recent data suggest that success rates tend to deteriorate over time. A thorough preoperative evaluation incorporates numerous factors, including patient characteristics, severity of incontinence, type and size of the sphincter defect as assessed by physical examination, anal ultrasound, and anorectal physiology studies including anal manometry, electromyography, and pudendal nerve terminal motor latency assessment. The use of these evaluation methods has allowed better patient assignment for a variety of new alternative treatment options. Innovations in the surgical treatment of fecal incontinence range from simple, office-based sphincter augmentation techniques to surgical implantation of mechanical devices. This article reviews 5 alternative surgical treatment options for fecal incontinence: injection of carbon-coated beads in the submucosa of the anal canal, radiofrequency energy delivery, stimulated graciloplasty, artificial bowel sphincter, and sacral nerve stimulation.

Anal Canal↗

PubMed2003

Fecal incontinence: evaluation and treatment.

Fecal incontinence affects men and women of all ages, leading to personal disability and high financial costs. The evaluation of the patient should clarify the pathophysiology of the symptoms and provide guidance in choosing the appropriate treatment. A comprehensive history and physical examination including endoscopic assessment is able to identify the cause of most cases of fecal incontinence. If necessary, functional methods can be used to confirm the diagnosis. Patient selection for suitable treatment is most important and should be based on clinical and physiologic findings. Conservative dietary or medical treatment is often effective, when the symptoms are mild. Biofeedback therapy is effective in most patients. It has no side effects and is well tolerated. Structural damage to the anus may be repaired by surgery, like sphincter repair, the best treatment of selective sphincter defects. Neoanal sphincters and artificial sphincters are the last possibility after failed surgery and before colostomy. They are less attractive because of technical difficulties and low success rate. A multidisciplinary approach to treatment has the potential to improve the outcome for patients with fecal incontinence.

Biofeedback, Psychology↗

PubMed2003

Endoanal sonography in assessment of fecal incontinence following obstetric trauma.

OBJECTIVES: Fecal incontinence is a common, incapacitating and largely unrecognized medical problem and can be caused by various factors. Obstetric trauma is the most common cause of fecal incontinence secondary to trauma. We aimed to analyze the role of endoanal ultrasound in assessment of this type of fecal incontinence, and report the functional results of surgical treatment. METHODS: We reviewed the records of all 22 patients with fecal incontinence secondary to obstetric trauma who were evaluated by endoanal ultrasound and underwent surgical management in our department from April to 1997 to April 2002. Pre- and postoperative evaluation of the degree of incontinence was done using the incontinence score of Jorge and Wexner. RESULTS: The patients had a median age of 43 (range, 29-68) years. All had vaginal deliveries, five of which (22.7%) were instrumental. Most of the patients had total fecal incontinence (solids) with preoperative incontinence score values of 15-20 (median, 18). Endoanal ultrasound confirmed structural defects in the anterior external anal sphincter alone in 16 (72.7%) patients, and both anterior external and internal sphincter defects in six (27.3%) patients. A thinned perineal body was present in all patients. All patients received surgical treatment with overlapping sphincteroplasty and there was improvement of continence in 19 (86.4%) patients with postoperative incontinence score values between 4 and 0 (median, 2). CONCLUSIONS: Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome.

Adult↗

PubMed1997

Combined Mitrofanoff and antegrade continence enema procedures for urinary and fecal incontinence.

PURPOSE: Fecal soiling or intractable constipation frequently occurs in association with urinary incontinence in children undergoing major reconstructive urological operations. To treat double incontinence or the combination of wetting and severe constipation, we constructed a Mitrofanoff conduit and a channel for antegrade continence enemas in 18 patients between 1989 and 1995. We review the underlying pathological conditions, various surgical techniques and outcomes of these operations. MATERIALS AND METHODS: Underlying abnormalities mainly included spinal lesions, bladder exstrophy, imperforate anus and various cloacal anomalies. Patient age ranged from 2 to 18 years (average 8.4). In 13 patients both procedures were done simultaneously. The appendix was used to construct the antegrade continence enema channel in 8 cases and the Mitrofanoff channel in 5. It was long enough to be divided and used for both procedures in 2 cases but it was missing or unsuitable in 3. Alternative antegrade continence enema conduits were cecal flap in 7 patients and ileum in 1, while the ureter, ileum and detrusor tube were used to establish Mitrofanoff channels in 5, 5 and 1, respectively. Stomas were constructed according to the V-flap or V. Z. Q. technique and situated in close proximity in the right lower abdominal quadrant in 13 cases. RESULTS: Convalescence was uneventful except for 1 abscess near an antegrade continence enema stoma. Ten patients needed dilation or minor revisions due to difficulty in catheterizing the antegrade continence enema (5), Mitrofanoff (3) or both conduits (2). Subsequently 3 patients underwent repeat operations for reconstruction of 2 antegrade continence enema channels (cecal flap and ileum) and 1 detrusor tube Mitrofanoff channel. Currently 15 patients are dry on regular clean intermittent catheterization using 10 to 12F catheters. Outcomes of the antegrade continence enema channels are satisfactory in 15 patients who are clean or rarely soil. Failure occurred in 1 patients with severe constipation necessitating colostomy and 2 (1 noncompliant who stopped catheterizing regularly) in whom the channels subsequently closed. CONCLUSIONS: Synchronous construction of antegrade continence enema and Mitrofanoff channels is successful in the majority of doubly incontinent patients. Selection of patients with high motivation is important to obtain satisfactory results.

Adolescent↗

PubMed2004

A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence.

BACKGROUND: Severe fecal incontinence remains a disabling condition for the patient and a major therapeutic challenge for the physician. A series of observational studies have indicated that placement of an artificial bowel sphincter is associated with marked improvement of continence and quality of life. We have performed a prospective, randomized, controlled trial to evaluate the effect of placement of an artificial bowel sphincter (Acticon Neosphincter) on continence and quality of life in a group of severely incontinent adults. METHODS: Fourteen adults (male:female, 1:13; age range, 44-75 years) were randomized to placement of the artificial bowel sphincter or to a program of supportive care and were followed for six months from operation or entry into the study. The principal outcome measure was the level of continence, measured with the Cleveland Continence Score, which provides a scale from 0 to 20, representing perfect control through to total incontinence. Secondary outcome measures were perioperative and late complications in the artificial bowel sphincter group, and the changes in quality of life in both groups. RESULTS: In the control group, the Cleveland Continence Score was not significantly altered, with an initial value of 17.1 +/- 2.3 and a final value of 14.3 +/- 4.6 at six months. The artificial bowel sphincter group showed a highly significant improvement, changing from 19.0 +/- 1.2 before placement to 4.8 +/- 4.0 at six months after placement. One patient in the artificial bowel sphincter group had failure of healing of the perineal wound and explantation of the device (14 percent explantation rate). There were two other significant perioperative events of recurring fecal impaction initially after placement in one patient and additional suturing of the perineal wound in another. There were major improvements in the quality of life for all measures in the artificial bowel sphincter group. There was significant improvement in all eight subscales of the Medical Outcome Study Short Form-36 measures. The American Medical Systems Quality of Life score was raised from 39 +/- 6 to 83 +/- 14 and the Beck Depression Inventory showed reduction from a level of mild depression (10.8 +/- 9.3) to a normal value (6.8 +/- 8.7). No significant changes in any of the quality of life measures occurred for the control group. CONCLUSIONS: Through a prospective, randomized trial format, we have shown that placement of an artificial bowel sphincter is safe and effective when compared with supportive care alone. Perioperative and late problems are likely to continue to occur and between 15 percent and 30 percent of patients may require permanent explantation. For the remainder, the device is easy and discrete to use, highly effective in achieving continence, and able to generate a major improvement in the quality of life.

Adult↗

PubMedDate not supplied

[Biofeedback therapy for constipation and fecal incontinence].

Constipation and fecal incontinence are problems that are frequently encountered in daily practice. Over the last decade biofeedback therapy has emerged as a useful adjunct for the treatment of these problems. Biofeedback therapy is a learning process that is based on "operant conditioning" techniques. Biofeedback training aims to restore a degree of continence that enables patients to resume their activities to a satisfactory level with good success rates and prolonged benefits. The technique requires height levels of motivation not only in the patients but also in the instructor who is providing verbal feedback about the adequacy of a patients performance.

Biofeedback, Psychology↗

PubMedDate not supplied

A case of idiopathic fecal incontinence. Evaluation and management.

Idiopathic fecal incontinence is a clinical entity described mostly in the colorectal surgical literature and seldom encountered by the physiatrist. Evidence exists suggesting neuropathic injury to the external anal sphincter. Several reports have linked this syndrome to the descending perineum syndrome. A final answer to this diagnostic puzzle is yet to be found. This article presents a case of probable "idiopathic" fecal incontinence presenting during an evaluation for low back pain. Full evaluation yielded a denervating lesion of unknown etiology to the pudendal nerve. The patient was managed with a bowel program without success. Because physiatrists often find themselves managing cases of neurogenic bowel or bladder, it is important for the physiatrist to have a thorough understanding of idiopathic fecal incontinence. A discussion of the differential diagnosis and management of fecal incontinence is included.

Adult↗

PubMed2004

Outcome measures for fecal incontinence: anorectal structure and function.

Fecal incontinence is a symptom attributable to a variety of disorders affecting one or more factors that maintain continence. Objective assessments should complement symptom assessments as outcome measures in therapeutic trials; conceivably, these assessments may also predict the response to therapy. Consistent with existing trends, most therapeutic trials should incorporate anal sphincter pressures and rectal sensation as outcome variables, paying meticulous attention to techniques. Rectal sensation is increased after pelvic floor retraining by biofeedback therapy in fecal incontinence; however, the predictive value of improved anal pressures after biofeedback has not been clearly established. Other factors maintaining continence can be assessed by newer approaches. In addition to assessing rectal sensation, a barostat also measures rectal compliance; alterations in rectal compliance modulate rectal perception. Particularly appropriate end points for trials involving surgical repair are sphincter integrity, assessed by endoanal ultrasound or magnetic resonance imaging (MRI), and puborectalis and pelvic floor motion, assessed by dynamic MRI. Despite disagreement about which technique is superior for evaluating the internal sphincter, MRI performs the same or better than ultrasound for assessing the external sphincter. The utility of measuring pudendal nerve latencies as a marker of pudendal nerve injury is limited; needle electromyography provides a sensitive measure of denervation and can usually identify myopathic damage, neurogenic damage, or mixed injury. These standardized, reproducible assessments of the multifaceted mechanisms maintaining fecal incontinence should be incorporated as outcome variables in therapeutic trials of fecal incontinence.

Anal Canal↗

PubMed2004

[Sacral nerve stimulation in fecal incontinence; efficacy and safety].

Fecal incontinence is common due to various reasons. Conservative therapy of fecal incontinence may sometimes be effective in improving function, but usually many patients require surgery. Sacral nerve stimulation is another treatment modality which gained interest, and appears to be an alternative method that is successful with low morbidity. With the approval of the local ethical committee a total of 14 patients with rectal incontinence had undergone trial stimulation of sacral neuromodulation after failure of conservative treatment modalities. The implantations were performed under surgical sterile conditions with fluoroscopic guidance through the S3 foramen. After correct placement 0.5-2 V, 15 /min, pulse width 210 micro s stimulus was given. The patients had trial period longer than 6 weeks; 9 of 14 patients responded positively to the trial period. Of these 1 had permanent implantation, 3 were booked for permanent implantation, and 2 of the patients had complete incontinence relief from the trial period. Evaluating the data and the results of our study we may conclude that sacral nerve stimulation is an emerging surgical technique to produce a clinically beneficial physiological effect on the lower bowel, pelvic floor and anal canal.

Electric Stimulation Therapy↗

PubMed1995

Functional colonic and anorectal disorders. Detecting and overcoming causes of constipation and fecal incontinence.

Evaluation of constipation and fecal incontinence begins with comprehensive history taking, which may include overcoming a significant psychosocial barrier. Before functional anorectal diseases can be controlled, the fundamental cause must be determined and any underlying disorder corrected. In constipation, a colonic or anorectal motility disorder is often the cause; about half of refractory cases are the result of obstructive defecation. In fecal incontinence, dysfunction of several anatomic or physiologic mechanisms may be the cause. Anorectal manometry is useful in assessment in both disorders. Other helpful tests are colonic-transit measurement in constipation and electrophysiologic tests and defecography in fecal incontinence. Treatment of constipation often includes dietary measures and use of laxatives or prokinetic agents; fecal incontinence may respond to bulking or antidiarrheal agents. In both disorders, some patients have responded to the recently described technique of neuromuscular conditioning with biofeedback. In some cases, surgical repair must be considered.

Constipation↗