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At least 19 recordsLinked to original sources

PubMed1992

[Psychosocial aspects of fecal incontinence].

Although fecal incontinence is one of the more frequent clinical symptoms of the gastrointestinal tract, its assessment is often neglected in clinical practice. The psychosocial aspects of the symptoms are also often overlooked: The number of undetected cases in comparison to those registered illustrates that not only patients but also physicians avoid this topic during clinical routine. Consequences of fecal incontinence for the quality of life of patients have rarely been investigated, but we could show that there are specific impacts of incontinence on family life, specifically with respect to sexuality, and on the job situation of those affected. Finally, it has been shown that in most cases continence can be achieved by management strategies deriving from psychological learning theory such as biofeedback training.

Adaptation, Psychological↗

PubMed1992

Combined anorectal manometry and defecography in 50 consecutive adults with fecal incontinence.

Fifty consecutive patients presenting with fecal incontinence were evaluated prospectively with anorectal manometry, defecography, and other tests of anorectal function to assess the clinical utility of defecography in fecal incontinence. Leakage of contrast at rest and failure to narrow the anorectal angle with pelvic squeezing were specific but not sensitive predictors of decreased sphincter pressures as determined by manometry. Thus, after manometry, defecography provided no additional information regarding sphincter strength. Retention of contrast in large rectoceles or incomplete rectal evacuation at defecography had excellent correlation with the presence of clinical symptoms of outlet obstruction constipation (present concurrently with incontinence) and indicated an etiology of outlet obstruction symptoms. Defecography may provide useful information in incontinent patients with outlet obstruction constipation symptoms but has little additive value to anorectal manometry in incontinent patients without such symptoms.

Adult↗

PubMed1992

Fecoflowmetry in fecal incontinence.

The fecoflowmetric pattern of fecal incontinence was studied in 38 patients. 21 patients had complete and 17 partial incontinence. Twenty normal controls of matching sex and age were also studied. EMG of external anal sphincter and puborectalis as well as the measuring of anal pressure were done. The fecal flow rate was determined by means of the fecoflowmeter. In complete incontinence, the EMG of the rectal sphincters showed no activity, and the anal pressure was lower than controls at rest and on squeezing (p less than 0.0001). The fecoflowgram showed as 'minicurve' because the patients had leaked most of the enema before the test started. In partial incontinence the enema before the test started. In partial incontinence EMG of the sphincters showed subnormal activity on squeezing. The anal pressure recorded values lower than in the normal controls at rest (p less than 0.001) and on voluntary squeezing (p less than 0.0001), though they were higher than those of complete incontinence. The flow rate parameters and curve were characteristics. The evacuated volume as well as the mean and maximum flow rate were higher (p less than 0.001), while the flow time (p less than 0.001) and the time to maximum flow (p less than 0.01) were shorter than in normal subjects. The ascending limb of the flow curve rose more steeply and was smooth. There was no plateau. The descending limb sloped more gradually and showed fluctuations. Fecoflowmetry could thus be an investigative tool not only in diagnosing but also in identifying the type of fecal incontinence.

Adult↗

PubMed1992

The bowel management tube: an effective means for controlling fecal incontinence.

Regular bowel washout enemas have been used as a method of management of fecal incontinence. The effective administration of a washout enema to a child with weak anal sphincters is often a problem. Using a new silastic balloon-tipped enema catheter (bowel management tube [BMT]) of our design, we prospectively studied its effectiveness in a group of children who suffered fecal incontinence. Thirty-one children were studied over a 1-year period. Their diagnoses included meningomyelocele (19), postoperative Hirschsprung's disease or imperforate anus (10), and other (2). Before and after starting the BMT enema system, clinical assessment and a diary, which graded the degree of fecal incontinence and satisfaction with the system, were completed. Five patients failed to benefit because of noncompliance (3) or balloon extrusion (2). Three more patients discontinued the use of the tube system. Twenty-three patients achieved successful results with this system as evidenced by a significant amelioration in their fecal incontinence and their unwillingness to give up the use of the BMT. We conclude that the use of a regular washout enemas with BMT can be an effective method for control of fecal incontinence in children.

Adolescent↗

PubMed1991

Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus.

We measured anorectal sensory and motor function in 11 patients with multiple sclerosis and fecal incontinence, 11 continent patients with multiple sclerosis, 10 diabetics with fecal incontinence, and 12 healthy control subjects. The threshold volume at which patients with multiple sclerosis and fecal incontinence experienced rectal sensation was higher than that in healthy controls (42.7 +/- 6.2 mL vs. 13.3 +/- 2.8 mL; P less than 0.01) and was similar to that in incontinent diabetics (36.5 +/- 5.7 mL). Patients with multiple sclerosis and incontinent diabetics also showed increased thresholds of phasic external sphincter contraction compared with controls (P less than 0.05). Diabetics with incontinence had reduced resting and maximal voluntary anal sphincter pressures compared with controls (P less than 0.05), whereas patients with multiple sclerosis and incontinence showed only decreased maximal voluntary anal sphincter pressures (P less than 0.01 vs. controls and diabetics). Incontinent patients with multiple sclerosis also required smaller volumes of rectal distention to inhibit internal sphincter tone compared with diabetics and controls (P less than 0.01). Decreased maximal voluntary squeeze pressures were less severe in continent patients with multiple sclerosis than in incontinent patients with multiple sclerosis. We conclude that impaired function of the external anal sphincter and decreased volumes of rectal distention to inhibit the internal anal sphincter or both may contribute to fecal incontinence in multiple sclerosis. In addition, increased thresholds of conscious rectal sensation in some incontinent patients with multiple sclerosis and diabetes mellitus may contribute to fecal incontinence by impairing the recognition of impending defecation.

Adult↗

PubMed1991

[Prevalence of fecal incontinence and degree of information possessed by family physicians and health insurance].

Previous investigations have demonstrated that the prevalence of fecal incontinence ranges between 1.5 and 5% in the general population. It is, however, known that only a small portion of these patients consult a doctor for the complaints. To investigate the prevalence of fecal incontinence in Germany and to determine the reliability of epidemiological data from different sources, we distributed a questionnaire to healthy controls. In addition, two samples of patients were drawn from a local health insurance organization. Finally, the family physicians of incontinence patients from a specialized outpatient clinic which are covered by this health plan (AOK) were interviewed for whether they had noted the incontinence symptoms and had reported them to the health plan. It is shown that approximately 5% of people suffer from occasional incontinence, but that only 1.5% shown severe incontinence excluded fecal soiling. In patients with various disorders, the prevalence ranges between 0.2 and 0.35% according to health insurance data. However, in only about 75% of cases, the family physicians knew about the symptom, and in less than 50% of cases they had informed the health insurance. Epidemiological data, thus, contain a detection bias leading to an underestimation of the true prevalence of fecal incontinence.

Adult↗

PubMed1990

Constipation and fecal incontinence in the elderly.

The successful management of constipation and fecal incontinence in the elderly requires an understanding of colorectal function, careful delineation of the patient's complaint, and in selected patients, specialized studies of colonic and anorectal function. This article reviews (1) the prevalence and nature of lower bowel dysfunction in the elderly population: (2) colonic and anorectal physiologic changes that are associated with aging; (3) the causes, consequences, and approaches to the management of constipation in the elderly; and (4) the causes of fecal incontinence in this age group and the treatment available.

Age Factors↗

PubMed1992

Idiopathic fecal incontinence.

Pelvic floor dysfunction is related to neuropathic injury to the pelvic floor musculature. Clinically, the patient may present with genital prolapse or urinary or fecal incontinence. For a successful outcome, the physician must consider all pelvic compartments in the evaluation and treatment of patients with these disorders. Disorders of the posterior compartment are the least familiar to the gynecologist. Idiopathic fecal incontinence, a posterior compartment defect, is defined as a progressive deterioration of anal sphincter function in patients with no history of sphincter damage. This review discusses the latest findings about idiopathic fecal incontinence within the context of pelvic floor dysfunction and neuropathy.

Electromyography↗

PubMed1991

Anorectal manometry and defecography in the diagnosis of fecal incontinence.

We carried out anorectal manometry and defecography prospectively in 43 consecutive patients with fecal incontinence. A subgroup of 17 patients with severe incontinence was identified radiologically by a short and incompletely closed anal canal. In these patients, the anal resting pressure was significantly lower than in the rest of the group (34.9 +/- 11.4 mm Hg versus 60.0 +/- 25.7 mm Hg, respectively; p less than 0.01). The anorectal angle did not change in 24 patients during squeezing, indicating a dysfunction of the puborectalis muscle. Manometric data did not differ between this subgroup and patients with a more acute anorectal angle during voluntary sphincter contraction. This indicates that the anal pressures recorded manometrically do not reflect the function of a muscular component that is important in the maintenance of fecal continence. We conclude that anorectal manometry and defecography are complementary diagnostic tools in the investigation of patients with fecal incontinence.

Adult↗

PubMed1992

Dynamic anal manometry: physiological variations and pathophysiological findings in fecal incontinence.

A recently developed technique for dynamic anal manometry was used to study 40 healthy volunteers and 23 patients with fecal incontinence. Seven parameters of anal function were measured. Intraindividual variation of the parameters was studied in 5 females and 5 males. The results of dynamic anal manometry were compared with standard pull-through static anal manometry and correlated well. During opening of the anal sphincter at rest, compliance increased with increasing distension. Males had higher maximal closing pressures during squeeze and lower anal compliance during squeeze than females. There was no sex differences of the sphincter measurements at rest. Age had little effect, and gender had no effect on the measurements. With standard anal manometry, 6 of 23 patients with fecal incontinence both had maximal resting pressure and maximal squeeze pressure within the normal range. When dynamic anal manometry was used, all 23 patients showed one or more abnormal values. The method of dynamic anal manometry provides an opportunity for a more thorough assessment of anal sphincter function than previous manometric methods.

Adult↗

PubMedDate not supplied

[Fecal incontinence in Hirschsprung's disease in children].

Among the criteria of evaluation of the results of operative treatment of Hirschsprung's disease in children, along with the absence of constipation is the function of defecation control. The authors examined 27 patients with fecal incontinence after Duhamel's operation. It was established that fecal incontinence in children after operative treatment of Hirschsprung's disease may be caused not only by affection of the external sphincter muscle of the anus, the nerve plexuses, and adaptation of the rectum to the new conditions after the pull-through operation, but also by trauma inflicted to the levator ani muscle. In children with severe damage to the levator group of muscles consequent upon operative treatment of Hirschsprung's disease, operative intervention for creating the anorectal angle is indicated.

Anal Canal↗

PubMed1992

[Nuclear magnetic resonance of anorectal malformations and persistent postoperative fecal incontinence].

We review our experience with Magnetic Resonance Imaging (MRI) in the evaluation of 6 patients showing anorectal malformation, and 4 more with persistent postoperative fecal incontinence. Preoperative sagittal, axial and coronal planes were studied with special consideration to the pelvic and vertebral structures. The excellent resolution of MRI allowed accurate identification of the pelvic musculature in all patients, including those with bizarre sacral abnormalities. MRI revealed structural anomalies not detected previously, such as teathering cord, intraspinal lipoma, presacral mass and renal malformation. In our institution, MRI has replaced the CT scan in the study of patients suffering of persistent fecal incontinence. In non operated on cases of anorectal malformations, MRI determines with extraordinary accuracy the location of the rectal atretic pouch, the actual pelvic muscular quality, and the detection of previously unsuspected associated anomalies.

Anal Canal↗

PubMed1990

Investigation of mode of action of biofeedback in treatment of fecal incontinence.

A study was carried out in 25 incontinent patients to evaluate some of the factors thought to be responsible for the success of retraining for fecal incontinence. Subjects were initially allocated to one of two groups; one group was trained to perceive small rectal volumes (active retraining), the other group carried out the same maneuvers but were not given any information or instruction. Active sensory retraining reduced the sensory threshold from 32 +/- 8 to 7 +/- 2 ml (P less than 0.001), corrected any sensory delay that was present (P less than 0.004), and reduced the frequency of incontinence from 5 +/- 1 to 1 +/- 1 episodes per week (P less than 0.01). Sham retraining caused a modest reduction in the sensory threshold (from 29 +/- 9 to 20 +/- 8; P less than 0.05) but did not significantly reduce the frequency of incontinence. Subsequent strength and coordination training did not significantly improve continence, although at the end of the study, 50% of patients had no incontinent episodes at all and 76% of patients had reduced the frequency of incontinence episodes by more than 75%. This improvement in continence was not associated with any change in sphincter pressures or in the continence to rectally infused saline but was associated with significant improvements in rectal sensation. The functional improvement was sustained over a period of two years in 16 of the 22 patients available for follow-up. In conclusion, the results support the use of retraining in the management of fecal incontinence and suggest that retraining may work by enhancing rectal sensitivity and instilling confidence.

Adolescent↗

PubMed1992

Anal sphincter imaging in fecal incontinence using endosonography.

Clinical anal examination, manometry (resting and squeeze pressures), and single-fiber electromyography were compared with endosonography of the anal sphincters in 14 patients with fecal incontinence. Technical aspects of the procedure and normal imaging of the puborectal muscle and both sphincters were defined. Defects in both sphincters were seen in nine patients. The defect is visualized as a clear discontinuity in the muscular ring. Compared with the conventional studies, anal endosonography gave significant information in six patients (four male patients after perianal surgery and two women), showing sphincter defects in five patients and integrity of the sphincters in another one. This information obtained by endosonography was important in understanding the type and extension of the lesion and deciding upon the surgical repair. Anal endosonography is an imaging technique of the sphincters that can assess their integrity in fecal incontinence.

Adult↗

PubMed1991

Transanal electrostimulation for fecal incontinence: clinical, psychologic, and manometric prospective study.

A prospective study was carried out to analyze the clinical, psychologic, and manometric short-term results of transanal electrostimulation (TES) in the treatment of fecal incontinence. Fifteen patients underwent TES. An initial clinical and manometric assessment was carried out before and 1 month after the procedure. A psychologic evaluation was also performed by means of interviews and appropriate tests. Early improvement of symptoms was noted in 10 patients. The nonresponders were women with gross daily incontinence to solid stool. At anal manometry, resting tone and rectal sensation remained unchanged, whereas a significant increase of voluntary contraction was observed following TES (from 48 +/- 26 to 59 +/- 39 mm Hg, P = 0.03). Psychologically, TES led to a significant decrease of both latent and paranoid anxiety related to symptoms (P = 0.02). At a clinical reassessment 6 months later, one of the nonresponders became continent after a further course of TES. In conclusion, TES is well accepted by the patients, is followed by positive emotional response, and, by improving striated sphincter function, seems to be effective in the treatment of partial fecal incontinence.

Adolescent↗

PubMed1977

[The management of urinary and fecal incontinence due to a neurinoma of the cauda equina with an electrode implanted in the pelvic muscles (Caldwell) (author's transl)].

A woman, aged 49, had a complete sensory and motor deficit of the S2-5 segments with urinary and fecal incontinence due to a neurinoma of the cauda. A Caldwell electrode was implanted surgically into the muscles of the pelvic floor in April 1974. The patient was observed for 2 years thereafter and had an excellent result. The medical and technical problems of treating urinary and fecal incontinence due to a lower motor neuron lesion of S2-5 can be handled satisfactorily with an implanted electrode.

Cauda Equina↗

PubMed1992

[A case report of cervical disc hernia presenting fecal incontinence evoked by walking; spinal intermittent rectal dysfunction].

Intermittent clinical manifestations, the representative one of which is claudication, can be classified into two types; neurogenic and vasculogenic. Although cauda equina lesions are well known as a neurogenic cause, spinal disorders, especially cervical or thoracic cord lesions, have been paid more attention to by several authors recently. We encountered a 42-year-old man with cervical soft disc hernia and ossification of longitudinal ligament, who showed intermittent rectal dysfunction evoked by walking. This peculiar clinical manifestation successfully disappeared after surgical decompression of the spinal cord. Such an interesting case has not been reported in the world literature. The patient was admitted because of numbness in both hands. Neurological examinations on admission showed neither motor weakness nor abnormally increased tendon reflex. Hypesthesia and hypalgesia were noticed below the Th4 dermatome on both sides. Adding to those symptoms, he complained of fecal incontinence evoked by walking 100 meters. This rectal dysfunction became gradually worse. At last he showed fecal incontinence after walking only 10 meters. This was ten days after his admission. Myelogram and computed tomographic scan revealed a cervical soft disc hernia at the C5/6 level and findings of OPLL at the C5 and C6 level. Anterior cervical approach for OPLL and soft disc was used for bone graft insertion from the C4 to the C7 vertebral body. The rectal dysfunction completely disappeared after the operation. The possible mechanisms of intermittent rectal dysfunction evoked by walking were discussed.

Adult↗

PubMed1991

Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic fecal incontinence.

Both postanal repair and anterior sphincteroplasty with levatorplasty have been advocated in the treatment of idiopathic fecal incontinence. To assess the functional results of these procedures, physiologic and radiologic measurements were carried out prospectively in 33 patients with idiopathic incontinence undergoing operative treatment, and 12 age- and sex-matched controls. Sixteen patients had anterior sphincteroplasty and levatorplasty and 17 had postanal repair. A satisfactory postoperative outcome was defined as perfect continence or incontinence of flatus only. Ten patients in the anterior sphincteroplasty group had satisfactory results (64 percent) and 10 in the postanal repair group (59 percent). Preoperatively, both groups had decreased resting and squeeze pressures, impaired and mucosal electrosensitivity, and marked pelvic descent vs. controls. Postoperatively, significant improvement in sphincter pressures and mucosal electrosensitivity was seen in both groups. No significant change in anorectal angle was demonstrated in the postanal repair group, whereas it was made significantly more obtuse in the anterior sphincteroplasty group. It is likely that the improved continence resulting from either of these two procedures is secondary to better anal sphincter muscle function and improved and sensation. It would appear that the anorectal angle is not crucial in maintaining continence.

Adult↗