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PubMed2006

Association of fecal incontinence with physical disability and impaired cognitive function.

OBJECTIVES: Fecal incontinence is a common health problem for older people and is associated with significant morbidity and cost. In this study, we report on the association of fecal incontinence with physical disability and impaired cognitive function in a large bi-racial population of individuals aged 65 yr and older. METHODS: Study subjects are participants of the Chicago Health and Aging Project (CHAP), an ongoing study of older Chicago residents. A total of 6,099 participants completed the baseline in-home interview and assessments used in this analysis. Physical disability was assessed using a performance-based measure of basic physical functions and three commonly used self-report measures. Impaired cognitive function was assessed using a global measure of the averaged scores of four cognitive tests. The question used to determine the presence of fecal incontinence was: "In the past few months have you ever lost control of your bowels when you didn't want to?" RESULTS: In multiple logistic regression models adjusted for age, sex, and race, fecal incontinence was correlated with the presence of physical disability and impaired cognitive function on every measure. For example, using the performance-based measure of physical function, the odds of prevalent fecal incontinence were higher by 20% (OR 1.20, 95% CI 1.2-1.2) for each additional unit higher on the performance score, indicating a lower physical performance. The prevalence odds ratio for fecal incontinence was decreased by 51% for each one-point increase in the global cognitive score, indicating higher cognitive function. We found a statistically significant interaction between both race and physical disability and race and impaired cognitive function, such that the associations were stronger in blacks than in non-blacks. These associations remained after further adjustment for diabetes and stroke, and the intake of psychoactive medications. CONCLUSION: In urban, community-dwelling, older adults, fecal incontinence may be more common among persons with physical disability and impaired cognitive function.

Aged↗

PubMedDate not supplied

Fecal incontinence in older patients.

Fecal incontinence (FI), the involuntary passage of fecal material through the anus, is a common medical problem in older people, especially in frail older nursing home residents. FI is often associated with urinary incontinence. Severe constipation leading to fecal impaction, laxative abuse, diarrhea, cognitive impairment, senescence, and neuromuscular disorders including autonomic neuropathy, are among the leading causes of FI in older patients. FI affects patients' physical and psychological well-being, and is responsible for considerable morbidity and mortality in older patients. This results in significant healthcare costs. Comprehensive management of this disorder requires a systematic approach including thorough history, physical examination, and step-wise evaluation. This review in contrast to others published in last decade, focuses on management of FI in frail older nursing home patients, who require an individualized approach, which should be minimally invasive and cost-effective. In many cases of FI, treatment of the underlying condition; adequate control of diarrhea, constipation, or fecal impaction; adjustment of medications; and proper feeding may control or reduce FI. Advanced tests are often not necessary in this population.

Aged↗

PubMed1998

Bowel management for fecal incontinence in patients with anorectal malformations.

BACKGROUND/PURPOSE: Fecal incontinence is common in patients operated on for anorectal malformations. Treatment with enemas, laxatives, and medications are often given by clinicians in an indiscriminate manner and without a demonstrated benefit. A systematic diagnostic approach and bowel management program was developed for patients suffering from fecal incontinence, and a retrospective analysis of the results is presented. METHODS: Three hundred forty-eight patients were seen in consultation for fecal incontinence after repair of imperforate anus at other institutions. Clinical and radiological evaluation helped determine different types of patients. Group I consisted of 147 patients who were considered candidates for reoperation and forms the basis of a future report. Group II included 172 patients who had no potential for bowel control and were therefore candidates for bowel management. These patients fell into two categories; group IIA included 44 patients with incontinence and constipation. The bowel management involved the use of daily large enemas only. Group IIB included 128 patients with incontinence and a tendency to diarrhea. Group III consisted of 29 patients who had pseudoincontinence. They had an original defect with good prognosis, good sphincters, good sacrum, and a well-located rectum. They suffered from severe constipation, megasigmoid, chronic fecal impaction, and overflow pseudoincontinence and were treated with laxatives or sigmoid resection. RESULTS: Bowel management was successful in 93% of patients in the constipation group (IIA) and 88% in the diarrhea group (IIB). Ninety-seven percent of patients in group III became fecally continent. CONCLUSION: Bowel management consisting of enemas, laxatives, and medications is successful when administered in an organized manner. It is vital to determine the type of fecal incontinence from which the patients suffer and to target their treatment accordingly.

Anus, Imperforate↗

PubMed2002

Fecal incontinence.

The treatment of fecal incontinence is particularly gratifying because the loss of fecal control has a devastating effect on a patients lifestyle. One must consider the myriad factors that influence bowel control to properly diagnose and treat each patient. Physiology testing, particularly the use of ultrasound, is essential when treatment extends beyond dietary and medical management. Recent reports suggest that the success of typical treatments may diminish with time. This may indicate a greater need in the future for innovative options such as the artificial bowel sphincter or sacral stimulation.

Fecal Incontinence↗

PubMed2000

Fecal incontinence: hope for an underdiagnosed condition.

Fecal incontinence is often suffered in silence leading one to become a social recluse. This has led to the belief that the problem does not exist and therefore underdiagnosed. In the last decade, much has been learnt about the understanding of continence and defecation. Quantification of appropriate physiological parameters associated with fecal incontinence have allowed the patients to be assessed using a logical algorithm. More importantly, parallel developments in management techniques of fecal incontinence now allow the categorised patients to be managed logically. The assessment is thus translated into appropriate management plans which range from simple nonoperative medical and dietary manipulation to pelvic floor retraining, sphincter augmentation and finally sphincter reconstruction.

Combined Modality Therapy↗

PubMed2003

Frequency and predictors for postpartum fecal incontinence.

OBJECTIVE: The goal of this study was to describe the frequency of postpartum fecal incontinence and to examine associated delivery events in a group of women participating in a validation study of a postpartum fecal incontinence survey. STUDY DESIGN: A self-administered survey of fecal incontinence symptoms and delivery events was administered to 50 women seen for their 6-week postpartum appointments. An analysis of association between postpartum fecal incontinence and individual delivery characteristics was performed. RESULTS: The frequency of at least one fecal incontinence symptom post partum was 38%. Specifically, 24% of women reported incontinence to flatus and 10% incontinence to stool. Vaginal delivery and perineal laceration were associated with an increased risk of reporting at least one symptom. Neither infant birth weight nor parity was associated with an increased risk of postpartum fecal incontinence. Cesarean delivery was associated with a lower frequency of overall fecal incontinence symptoms. CONCLUSION: The frequency of postpartum fecal incontinence was higher than previously reported. Similar to other studies, perineal laceration, especially extension into the anal sphincter, was an important risk factor for postpartum fecal incontinence.

Adult↗

PubMed1985

Biofeedback treatment of fecal incontinence in geriatric patients.

Eighteen fecally incontinent geriatric patients were first treated for constipation as a possible cause of incontinence, and the 13 who remained incontinent were provided sphincter biofeedback training. Half the patients were instructed to perform 50 sphincter exercises per day for a four-week period prior to the start of biofeedback training to determine whether such exercises would improve bowel control in the absence of biofeedback training. Sphincter exercises alone did not produce clinical improvements and did not significantly increase the strength of sphincter contractions. Biofeedback training did significantly augment sphincter strength and was associated with greater than 75 per cent decreases in incontinence for 10 (77 per cent) of the patients. Improvements were maintained in 60 per cent at six months and in 42 per cent at one year. Thus biofeedback training appears to be of specific value in the treatment of fecal incontinence in geriatric patients.

Aged↗

PubMed2006

Treatment strategies in obstructed defecation and fecal incontinence.

Obstructed defecation (OD) and fecal incontinence (FI) are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders socially and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories (ARP), radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.

Biofeedback, Psychology↗

PubMed1994

Long-term efficacy of biofeedback training for fecal incontinence.

PURPOSE: Biofeedback therapy in fecal incontinence has been reported to improve continence in more than 70 percent of patients, but most studies have followed patients for less than two years. METHODS: Patients treated by biofeedback training between 1985 and 1986 were given a questionnaire in 1991, as were incontinent patients who had not entered this treatment program. All were asked for the occurrence, frequency, and severity of incontinence events in the past two weeks. Anamnestic and anorectal manometry data from the initial visit were also compared. RESULTS: Eighteen of 24 treated patients and 40 of 71 untreated patients responded. Of those treated by biofeedback, 78 percent reported episodes of fecal incontinence as compared with 77.5 percent of those not treated by biofeedback. Severity of incontinence, however, was significantly less (P < 0.02) in the treatment group (mean number of events, 0.2/day) than in those without treatment (1/day). In biofeedback-treated patients, it was identical with the frequency and severity reported immediately after therapy. No differences were found with respect to initial clinical data and anorectal manometry between both groups. CONCLUSION: Biofeedback training improves continence in patients not only during treatment and within the first two years but also for several years after therapy.

Adolescent↗

PubMed2003

Fecal incontinence in the elderly patient.

Fecal incontinence is an underreported problem in the general population; it is especially common in elderly persons (aged >or=65 years) residing in the community or in long-term care settings. It affects more women than men during younger years, but this differential narrows with age. Physiological changes such as sphincter muscle and sensory abnormalities in the anorectal region contribute to this problem, as do factors such as dementia, physical disability, and fecal impaction. Treatment with biofeedback is feasible in many elderly patients. Those with advanced dementia or physical disability may benefit from a bowel habit training program. Selected patients may require surgical sphincter repair. Minimally invasive techniques such as radiofrequency energy application offer promising future treatment options. The purpose of this review is to provide current information on fecal incontinence and its management in the elderly.

Aged↗

PubMed2004

[Fecal incontinence].

Diagnosis and management of fecal incontinence requires exact understanding of the anatomic and pathophysiologic principles involved and demands a methodical, stepwise approach. Despite the potential appeal of surgical intervention, a considerable number of patients can be helped by comparatively simple, noninvasive measures. Initial treatment should be medical, including biofeedback in combination with a bowel management program. In the presence of a severely denervated pelvic floor, physiotherapeutic techniques rarely give rise to a satisfactory and long-lasting response. Obvious external sphincter defects and patients who failed medical management are treated surgically. Many injuries of the external sphincter can be treated by direct sphincter repair. If patients with intact external sphincters are unresponsive to medical measures, descending perineum and resultant idiopathic fecal incontinence will improve by radio-frequency delivery, sacral nerve stimulation, or postanal plication. Patients with complex neurologic disorders or extensive sphincter defects or who have undergone previous unsuccessful attempts at repair of the puborectalis itself should be considered for dynamic gracilis plastic or an artificial sphincter.

Aged↗

PubMed2001

[Fecal incontinence. Personal experience in direct sphincteric repair].

BACKGROUND: Fecal incontinence is a disabling condition causing social isolation, whose real incidence is difficult to be exactly valued because patients are often reluctant to speak about it, even with their physician, or because they don't trust on surgical procedure. Aim of this study is report our experience in sphincteric reconstruction by direct sphincteric repair in patients suffering from post-traumatic fecal incontinence. METHODS: Seven patients suffering from fecal incontinence due to traumatic lesions of anal sphincterial apparatus were surgically treated between 1981-2000; in the first patient cause was an injury due to impaling, in the second a previous obstetrical lesion and in the last five a previous fistulectomy. Direct sphincteric reconstruction after finding and isolation of two retracted terminals of sectioned sphincter was performed in all the patients. Sphincteric reconstruction has been always accompanied by total parenteral nutrition for about two weeks during the postoperative period. A protective colostomy was never performed. RESULTS: In five cases the results were excellent: patients had continence total recovery and postoperative manometry recorded basal and voluntary contraction pressures normalisation. In the two remaining cases there was only a modest improvement because of concomitant pudendal neuropathy. No operative wound infection was observed. CONCLUSIONS: We hope that more attention is paid to fecal incontinence either regarding instrumental semeiotics or medical or surgical therapy. In particular, direct sphincteroplasty can restore a satisfactory continence in a strong number of patients with anal sphincterial apparatus single traumatic lesions without pudendal neuropathy, relieving them from a heavily disabling condition.

Adolescent↗

PubMed1997

Fecal incontinence in women with urinary incontinence and pelvic organ prolapse.

OBJECTIVE: To determine the prevalence of and factors associated with fecal incontinence in women with urinary incontinence or pelvic organ prolapse. METHODS: Study subjects were recruited prospectively, and all participants received questionnaires regarding bowel function and underwent a standardized history and physical examination. Fecal incontinence was defined as the involuntary loss of feces sufficient to be considered a problem by the patient. RESULTS: Forty-two subjects had fecal incontinence, an overall prevalence of 17%. One hundred seventy women had urinary incontinence, pelvic organ prolapse, or both, and 36 of these (21%) had fecal incontinence. One hundred (40%) women had urinary incontinence, of whom 31 also had fecal incontinence. Seventy women had isolated pelvic organ prolapse and five (7%) were incontinent of feces. Univariate analysis revealed that any degree of pelvic organ prolapse, increasing degrees of prolapse within each vaginal segment, urinary incontinence, advanced age, postmenopausal status, increased vaginal parity, prior hysterectomy, history of irritable bowel syndrome, and abnormal sphincter tone were associated significantly with fecal incontinence. Multiple logistic regression analysis indicated that only urinary incontinence (odds ratio [OR] 4.6, P < .001, 95% confidence interval [CI] 1.9, 11.2), abnormal anal sphincter tone (OR 2.3, P = .04, 95% CI 1.1, 5.1), and irritable bowel syndrome (OR 8.3, P = .002, 95% CI 2.1, 32.8) were associated with fecal incontinence. CONCLUSIONS: There is a high rate of fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Clinicians providing health care to a similar group of women should inquire routinely and specifically about fecal incontinence.

Adult↗

PubMed2005

Fecal incontinence after radical perineal prostatectomy: a prospective study.

OBJECTIVES: To assess, in a prospective study, the incidence of fecal incontinence after radical perineal prostatectomy. METHODS: Bowel symptoms were evaluated with questionnaires mailed to 132 patients preoperatively and 6 months postoperatively, and annually thereafter. All patients had undergone extrafascial perineal prostatectomy for Stage cT1-cT3N0M0 prostate cancer. The data of 116 patients (88%), who answered at least the preoperative and 12-month questionnaires, were analyzed. Reduced sensibility, reduced discrimination, urgency, or stool smearing were symptoms indicative of fecal incontinence. Patients with one symptom of fecal incontinence were evaluated further with a structured telephone interview. RESULTS: Daily stool smearing was reported preoperatively by 4% of the patients. Two symptoms related to fecal incontinence were present preoperatively in 6% of the patients. At 12 months postoperatively, 15 patients (13%) reported at least two symptoms of fecal incontinence. The structured telephone interview revealed that 6 of these 15 patients had symptoms of fecal incontinence that were related to the perineal prostatectomy; 9 patients had newly developed symptoms not related to surgery or symptoms due to tumor recurrence or radiotherapy. Patients with the presence of at least one symptom of fecal incontinence before surgery had an almost fourfold increased risk of developing at least two symptoms of fecal incontinence postoperatively compared with patients without any symptom of fecal incontinence. CONCLUSIONS: Significant fecal incontinence after radical extrafascial perineal prostatectomy is a rare event. The results of questionnaires should be supplemented by additional interviews to obviate wrong interpretations.

Adenocarcinoma↗

PubMed2004

Psychological and cognitive variables affecting treatment outcomes for urinary and fecal incontinence.

An estimated 15% to 30% of adults over the age of 60 years have urinary incontinence, which is often reported as severe. Although psychological symptoms, especially anxiety and depression, are often associated with urinary incontinence, it seems likely that psychological distress is not a cause but a consequence of suffering from the condition. Cognitive deficits that directly interfere with the neurologic function of the bladder and/or diminish the ability to communicate appear to be important contributors to urinary incontinence. The incidence of fecal incontinence is high in children up to the age of 9 years and ranges from 7% to nearly 10% in adults over the age of 65 years. Although it has been suggested that psychological symptoms can cause fecal incontinence, data are lacking to support a causative association. Psychological disorders and incontinence of urine and feces appear to be common comorbidities. Studies are needed to determine whether the incidence of psychological symptoms in persons with incontinence is comparable for those who seek treatment and those who do not and to compare psychometric and quality-of-life measures before and after treatment to help determine the role of psychological symptoms in persons with fecal and urinary incontinence.

Fecal Incontinence↗

PubMed1988

Clinical and manometric assessment of gracilis muscle transplant for fecal incontinence.

Six cases of gracilis muscle transplant for fecal incontinence are reported. The causes of fecal incontinence included previous anal operation, idiopathic incontinence, and rectal prolapse. All patients had had a previous operation for fecal incontinence. Postoperative sepsis developed at the operative site in five patients despite a defunctioning colostomy in two. Functional results of the operation were poor in all patients and a colostomy has now been raised in all cases. The operation was not associated with any objective improvement in resting or voluntary component pressure.

Adult↗

PubMed2001

Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence.

OBJECTIVE: To assess the role of anal sphincter damage following delivery in the development of anorectal complaints and urinary incontinence, and to identify obstetric factors associated with subsequent fecal incontinence. METHODS: The retrospective cohort study with matched controls used a postal questionnaire and analysis of delivery and operation records from all women who underwent primary repair of a third or fourth degree perineal rupture in our hospital between 1971 and 1991, and their controls, matched for date and parity. Frequencies of complaints were compared using the Mantel-Haenszel common odds ratio [OR] for matched-control studies. Obstetric risk factors for fecal incontinence were assessed with multivariate logistic regression analysis. RESULTS: In the period studied, 171 women underwent a primary repair. One hundred and forty-seven of which returned the questionnaire (86%), compared with 131 of the controls (73%). Analysis was performed on 125 matched pairs with a median follow-up of 14 years. Fecal incontinence was reported by 39 patients and 16 controls (OR: 3.09; 95% confidence interval: 1.57-6.10). Urinary incontinence was reported by 65 cases and 52 controls (OR:1.46; 95% CI: 0.91-2.37). Among women with anal sphincter damage, the extent of anal sphincter damage was an independent risk factor for fecal incontinence. (OR: 2.54; 95% CI: 1.45-4.45). Subsequent vaginal delivery was not associated with the development of fecal incontinence (OR: 2.32; 95% CI: 0.85-6.33). In primiparous women mediolateral episiotomy protected for fecal incontinence after anal sphincter damage (OR: 0.17; 95% CI: 0.05-0.60). CONCLUSIONS: Anal sphincter damage following delivery is significantly associated with subsequent anorectal complaints, but not with urinary incontinence. The extent of sphincter damage is an independent risk factor for the development of fecal incontinence. Mediolateral episiotomy protects for fecal incontinence in primiparous women.

Adolescent↗

PubMed1999

Rectal prolapse and fecal incontinence.

Rectal prolapse and fecal incontinence are problems with enormous social, functional, and economic significance to hundreds of thousands of people every year. Through a knowledgeable approach and careful diagnostic studies, many people can be cured or helped.

Fecal Incontinence↗