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Luo Y, Wang K, Zou P, Li X, He J, Wang J. Prevalence and Associated Factors of Fecal Incontinence and Double Incontinence among Rural Elderly in North China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239105. [PMID: 33291250 PMCID: PMC7730966 DOI: 10.3390/ijerph17239105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
Fecal and double incontinence are known to be more prevalent among the rural elderly. Yet, there have been few studies on their epidemic condition among Chinese rural elders. This study estimated the prevalence and correlates of fecal and double incontinence in rural elderly aged 65 years and over in North China. A multisite cross-sectional survey was conducted in 10 villages, yielding a sampling frame of 1250 residents. Fecal and urinary incontinence assessments were based on the self-reported bowel health questionnaire and the International Consultation on Incontinence Questionnaire-Short Form, respectively. The concomitant presence of fecal and urinary incontinence in the same subject was defined as double incontinence. The prevalence of fecal and double incontinence was 12.3% and 9.3%, respectively. Factors associated with fecal incontinence included urinary incontinence, lack of social interaction, traumatic brain injury, cerebrovascular disease, and poverty. Physical activities of daily living dependence, traumatic brain injury, lack of social interaction, and poor sleep quality were associated with higher odds of having double incontinence, whereas tea consumption was correlated with lower odds. Individualized intervention programs should be developed targeting associated factors and high-risk populations. These intervention programs should be integrated into existing public health services for the rural elderly to facilitate appropriate prevention and management of incontinence.
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Affiliation(s)
- Yan Luo
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, 76# Yanta West Road, Xi’an 710061, China; (Y.L.); (X.L.); (J.H.)
| | - Kai Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13# Hang Kong Road, Wuhan 430030, China;
| | - Ping Zou
- School of Nursing, Nipissing University, 750 Dundas West, Room 209, Toronto, ON M6J 3S3, Canada;
| | - Xiaomei Li
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, 76# Yanta West Road, Xi’an 710061, China; (Y.L.); (X.L.); (J.H.)
| | - Jinjie He
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, 76# Yanta West Road, Xi’an 710061, China; (Y.L.); (X.L.); (J.H.)
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, 76# Yanta West Road, Xi’an 710061, China; (Y.L.); (X.L.); (J.H.)
- Correspondence: ; Tel.: +86-29-8265-7015
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52
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Heitmann PT, Rabbitt P, Schloithe AC, Wattchow DA, Scott SM, Dinning PG. The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence. Neurogastroenterol Motil 2020; 32:e13946. [PMID: 32683767 DOI: 10.1111/nmo.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/24/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Diagnostic investigations for fecal incontinence (FI) assess the structure and sensorimotor function of the anorectum. Investigations include anorectal manometry, anorectal sensory testing, pudendal nerve terminal motor latencies (PNTML), and endoanal sonography. The severity of FI and results of investigations are often discordant and the rate of symptom resolution following treatment remains <40%. High-resolution anorectal manometry (HRAM) and three-dimensional endoanal ultrasound (3D-US) have been introduced during the last decade. This study aims to assess the strength of relationships between contemporary investigation results and FI severity. METHODS Adults presenting for investigation of FI were assessed using the St Mark's FI severity score (SMIS), HRAM, anorectal sensory testing, PNTML, and 3D-US. KEY RESULTS 246 patients were included. There were significant relationships between the SMIS and HRAM (resting pressure rs = -0.23, 95% CI = (-0.34, -0.11), P < .001; squeeze pressure (rs = -0.26, 95% CI = (-0.37, -0.14), P < .001) and 3D-US (anterior EAS length rs = -0.22, 95% CI = (-0.34, -0.09), P = .001). The relationships between SMIS and HRAM had a greater effect size in those with urge-predominant symptoms (resting pressure: rs = -0.40, 95% CI = (-0.57, -0.20), P < .001, squeeze pressure: rs = -0.34, 95% CI = (-0.52, -0.12), P = .003). Overall, the variance in SMIS accounted for by anorectal investigations was 8.6% (R2 = 0.098, adjusted R2 = 0.086, P < .001). CONCLUSIONS AND INFERENCES Anorectal investigations are not strong predictors of FI severity. These findings may reflect the multifactorial, heterogeneous pathophysiology of FI, the limitations of the SMIS and anorectal investigations, and contributing factors extrinsic to the anorectum.
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Affiliation(s)
- Paul T Heitmann
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Departments of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Philippa Rabbitt
- Departments of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Ann C Schloithe
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David A Wattchow
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Departments of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - S Mark Scott
- Blizard Institute, Centre for Neuroscience, Surgery and Trauma, Queen Mary University, London, UK
| | - Phil G Dinning
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Departments of Surgery and Gastroenterology, Flinders Medical Centre, Bedford Park, SA, Australia
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53
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Updates in treating fecal incontinence in women. Curr Opin Obstet Gynecol 2020; 32:461-467. [PMID: 32925257 DOI: 10.1097/gco.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Fecal incontinence is a chronic condition that can significantly affect a woman's quality of life. The pathogenesis of fecal incontinence is multifaceted and management ranges from supportive care, medical therapy to more invasive surgical procedures. This review will discuss the recent advancements in treating fecal incontinence. RECENT FINDINGS The pelvic floor disorder consortium has created a consensus document with recommendations on pelvic floor symptom measurement tools, patient-reported instruments, and questionnaires that should be used when evaluating fecal incontinence. There is new robust data reinforcing the importance of conservative management prior to proceeding with more invasive treatment. Lastly, several novel therapies that were developed in the past decade now have longer term data on safety and efficacy. SUMMARY Management of fecal incontinence is challenging, as no one therapy has been proven to be predominately effective. We should continue to first optimize patients with conservative therapy followed by induction of more advanced therapies. There needs to be continued efforts to develop and evaluate effective treatment guidelines and therapies for fecal incontinence.
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54
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Abramowitz L, Mandelbrot L, Bourgeois Moine A, Tohic AL, Carne Carnavalet C, Poujade O, Roy C, Tubach F. Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury: the EPIC multicentre randomised trial. BJOG 2020; 128:685-693. [PMID: 32770616 DOI: 10.1111/1471-0528.16452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions. DESIGN Randomised trial. SETTING Six maternity units in the Paris area. SAMPLE Women at high risk of sphincter lesions (first delivery with third-degree laceration and/or forceps) but no symptomatic anal incontinence. METHODS Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomised to planned CS or vaginal delivery (VD). MAIN OUTCOME MEASURES Anal incontinence at 6 months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions. RESULTS Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%); 112 were randomised to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the two groups. At 6 months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0-4) in the CS group and 1 (interquartile range 0-3) in the VD group (P = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities. CONCLUSIONS In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication. TWEETABLE ABSTRACT Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions.
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Affiliation(s)
- L Abramowitz
- Hôpital Bichat, Proctology Unit, Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Ramsay général de santé, clinique Blomet, Paris, France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,Université de Paris, Paris, France.,Inserm IAME U1137, Paris, France
| | - A Bourgeois Moine
- Department of Obstetrics and Gynaecology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A L Tohic
- Department of Obstetrics and Gynaecology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - C Carne Carnavalet
- Department of Obstetrics and Gynaecology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Poujade
- Department of Obstetrics and Gynaecology Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, France.,Department of Obstetrics and Gynaecology, Hôpital des Rives de Seine, Neuilly, France
| | - C Roy
- Unité de Recherche Clinique, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM CIC-EC 1425, Paris, France
| | - F Tubach
- Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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55
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De Meyere C, Nuytens F, Parmentier I, D'Hondt M. Five-year single center experience of sacral neuromodulation for isolated fecal incontinence or fecal incontinence combined with low anterior resection syndrome. Tech Coloproctol 2020; 24:947-958. [PMID: 32556866 DOI: 10.1007/s10151-020-02245-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Sacral neuromodulation (SNM) has proven to be a safe and effective treatment for fecal incontinence (FI). For low anterior resection syndrome (LARS), however, SNM efficacy is still poorly documented. The primary aim of this study was to report on efficacy of SNM therapy for patients with isolated FI or LARS. Furthermore, we evaluated the safety of the procedure and the relevance of adequate follow-up. METHODS A retrospective analysis was performed upon a prospectively maintained database of all patients who underwent SNM therapy for isolated FI or LARS between January 2014 and January 2019. The Wexner and LARS scores were evaluated at baseline, during test phase, after definitive implantation and annually during follow-up. Treatment success was defined as at least 50% improvement of the Wexner score or a reduction to minor or no LARS. RESULTS Out of 89 patients with isolated FI or LARS who had a SNM test phase, 62 patients were eligible for implantation of the permanent SNM device. At baseline, 3 weeks, and 1, 2, 3, 4 and 5 years after definitive implantation the median Wexner score of all patients was 18, 2, 4.5, 5, 5, 4 and 4.5, respectively, and 18, 4, 5.5, 5, 4, 3 and 4, respectively, for patients with FI and LARS. Patients with LARS more frequently required changes in program settings. CONCLUSIONS SNM therapy is a safe and effective treatment for patients with isolated FI and patients with FI and LARS. Adequate follow-up is essential to ensure long-term effectivity, especially for LARS patients.
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Affiliation(s)
- C De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - F Nuytens
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - I Parmentier
- Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
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56
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Abstract
BACKGROUND Faecal incontinence (FI) affects 1-19% of the general population and carries significant physical and psychological morbidity. Treatment strategies vary greatly with respect to morbidity and efficacy and relatively little is known regarding the role of mechanical devices such as anal and vaginal inserts. This is an up-to-date systematic review of the use of these devices in the management of patients with FI. METHODS A systematic electronic search was performed of the Medline, Pubmed and Embase databases using the key words and/or MeSH 'anal plug', 'anal insert', 'vaginal insert' and 'faecal incontinence'. Only articles that reported clinical outcomes for these devices for FI in the English language were included. Review articles were excluded to avoid duplication of data. RESULTS Thirteen articles fulfilled the eligibility criteria. Two articles reported outcomes for the Eclipse vaginal insert and 11 articles reported on three types of anal inserts; the Coloplast 'Tulip' design (6), the Procon/ProTect device (2) and the Renew insert (3). When tolerated, both anal and vaginal inserts significantly improved continence, bowel function and quality of life where reported. Adverse effects included discomfort, leakage and slippage. Long-term compliance and benefit are yet to be determined. CONCLUSIONS Vaginal and anal inserts may be a useful treatment for FI. Better quality of evidence is needed to define its effectiveness.
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57
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Paskaranandavadivel N, Varghese C, Lara J, Ramachandran S, Cheng L, Holobar A, Gharibans A, Bissett I, Collinson R, Stinear C, O'Grady G. A Novel High-Density Electromyography Probe for Evaluating Anorectal Neurophysiology: Design, Human Feasibility Study, and Validation with Trans-Sacral Magnetic Stimulation. Ann Biomed Eng 2020; 49:502-514. [PMID: 32737639 DOI: 10.1007/s10439-020-02581-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
Fecal incontinence (FI) substantially impairs quality of life and imparts a major socioeconomic burden. Anal sphincter injury and possibly pudendal nerve damage are considered common causes, however, current clinical methods for evaluating their function remain suboptimal. Electromyography (EMG) and pudendal nerve terminal latencies have been applied with some success, but are not considered standard practice due to uncertain accuracy and clinical value. In this study we developed and applied a novel anorectal high-density (HD) EMG probe in humans and pigs to acquire quantitative electrophysiological metrics of the anorectum. In the human trial we assessed somatic pathways and showed that EMG amplitude was greater for tight voluntary squeezes than light voluntary squeezes (0.03 ± 0.02 mV vs. 0.05 ± 0.03 mV). In a porcine model we applied trans-sacral magnetic stimulation to evoke extrinsically activated involuntary pathways and the resulting motor evoked potentials (MEP) were captured using the HD-EMG probe. The mean MEP amplitude at 50% magnetic stimulation intensity output (MSO) was significantly lower that the MEP amplitude at 85, 95 and 100% MSO (1.52 ± 0.50 mV vs. 3.10 ± 0.60 mV). In conclusion, the use of HD-EMG probe in conjunction with trans-sacral magnetic stimulation, for spatiotemporal mapping of anorectal EMG and MEP activity is anticipated to achieve new insights into FI and could offer improved diagnostic and prognostic biomarkers for anorectal dysfunction.
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Affiliation(s)
- Niranchan Paskaranandavadivel
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jaime Lara
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Shasti Ramachandran
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Vanderbilt University, Nashville, TN, USA
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Armen Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | | | - Cathy Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
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58
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Lehmann JP, Johansson HÖ, Graf W. Long-term functional results after excisional haemorrhoidectomy. Colorectal Dis 2020; 22:824-830. [PMID: 31912937 DOI: 10.1111/codi.14954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022]
Abstract
AIM The aim of this work was to perform a long-term evaluation of a randomized trial focusing on functional aspects after excisional haemorrhoidectomy with a minimum follow-up of 9 years. METHOD A questionnaire-based study including patients operated on for haemorrhoids in Sweden between 1999 and 2003. A total of 225 patients were randomized to Milligan's or Ferguson's operation. Twenty-six patients had died and 151 (76%) participated after a median follow-up of 10.7 years (range 9.2-12.6 years). RESULTS Seventy-seven patients were in the Milligan group and 74 in the Ferguson group. Forty-eight (32%) reported recurrence. Anal bleeding was reported in 80% at baseline but in 28% at long-term follow-up (P < 0.0001). At baseline, 49% had spontaneous anal pain and 25% pain at defaecation. At follow-up, these figures were 17% and 11%. At follow-up, 19% described a sense of anal stenosis. At baseline, soiling was reported in 51% but in 20% at long-term follow-up (P < 0.001). Nineteen per cent used pads preoperatively and 6% at follow-up (P < 0.0001). Straining at defaecation was reported by 35% at baseline. At follow-up, this figure was 25% (P = 0.055). CONCLUSION Symptoms associated with haemorrhoids were reduced at long-term follow-up. The most common problems were perceived recurrence and a sense of anal stenosis.
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Affiliation(s)
- J-P Lehmann
- Department of Surgery, Östersunds Hospital, Östersund, Sweden
| | | | - W Graf
- Department of Surgical Sciences, Akademiska Sjukhuset Uppsala, Uppsala University, Uppsala, Sweden
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Li P, Ma X, Jin W, Li X, Hu J, Jiang X, Guo X. Effects of local injection and intravenous injection of allogeneic bone marrow mesenchymal stem cells on the structure and function of damaged anal sphincter in rats. J Tissue Eng Regen Med 2020; 14:989-1000. [PMID: 32537834 DOI: 10.1002/term.3079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 04/09/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
Anal sphincter injury leads to damage to the anal structure and functions and has been identified as a major risk factor for fecal incontinence. Bone marrow mesenchymal stem cells (BMSCs) with capacities of multidifferentiation, paracrine, and low immunogenicity have been widely used in tissue repair and regeneration. The primary objective of this research was to compare the effects of different injection therapies of BMSCs on the injured anal sphincters. Ninety-six Sprague-Dawley female rats were randomly divided into four groups (n = 24 each): intravenous injection, local injection, sham operation, and normal control. For the first three groups, 25% removal of the anal sphincter complex was performed and 0.3-ml phosphate-buffered saline (PBS) (containing 107 green fluorescent protein-labeled allogeneic BMSCs) was given accordingly to the treatment group 24 h after operation for 7 consecutive days. The sham operation group was injected with 0.3-ml PBS only. All cases had undergone evaluation in the 1st, 7th, 14th, and 28th postoperative days. The rats were sacrificed on the 28th postoperative day, and the anal sphincters were dissected to be analyzed by morphological examination. At 14 days postoperatively, local injection of BMSC significantly improved the peak contraction pressure, electromyography amplitude, and frequency of the injured anal sphincter compared with tail vein, but there was no significant difference in resting pressure until 28 days after sphincterectomy. Masson staining results confirmed that the local injection group had significantly more new muscles on the wound. BMSC could remarkably improve peak contraction pressure, electromyography amplitude, and muscle fibers on the wound, and local injection is superior to intravenous injection.
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Affiliation(s)
- Peng Li
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoying Ma
- School of Pharmacy, East China University of Science and Technology, Shanghai, China
| | - Wenqi Jin
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojia Li
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Hu
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoxue Jiang
- Department of Anorectal Surgery, Shanghai Eighth People's Hospital, Shanghai, China
| | - Xiutian Guo
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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60
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Hassani D, Arya L, Andy U. Continence: Bowel and Bladder and Physical Function Decline in Women. CURRENT GERIATRICS REPORTS 2020; 9:64-71. [PMID: 32440467 DOI: 10.1007/s13670-020-00313-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of review The purpose of this article is to review the various forms of incontinence, highlight their impact on older women, and to explore current literature regarding the link between physical activity, physical function, and incontinence. Recent findings Both urinary and fecal incontinence become more prevalent with age, and are associated with significant morbidity. In parallel, there is a well-established decline in physical function that occurs with age. Furthermore, incontinence has a bidirectional relationship with physical function decline. Given the known link between increasing physical activity and preserved physical function, there is an emerging body of literature seeking to determine whether increases in physical activity may also improve incontinence outcomes. We review some recent data on this topic. Summary Continence and physical function are two closely linked entities. Further research is needed to determine whether interventions that increase physical activity might result in improved continence outcomes.
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Affiliation(s)
- Daisy Hassani
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Lily Arya
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
| | - Uduak Andy
- Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
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61
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Litta F, Parello A, De Simone V, Campennì P, Orefice R, Marra AA, Goglia M, Moroni R, Ratto C. Efficacy of Sphinkeeper™ implant in treating faecal incontinence. Br J Surg 2020; 107:484-488. [PMID: 32064592 PMCID: PMC7154545 DOI: 10.1002/bjs.11558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
- F Litta
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Parello
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - V De Simone
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - P Campennì
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - R Orefice
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A A Marra
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Goglia
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - R Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - C Ratto
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Varghese C, Wells CI, O'Grady G, Bissett IP. Costs and outcomes of sacral nerve stimulation for faecal incontinence in New Zealand: a 10‐year observational study. ANZ J Surg 2020; 90:569-575. [DOI: 10.1111/ans.15656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chris Varghese
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
| | - Cameron I. Wells
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- Department of SurgeryAuckland District Health Board Auckland New Zealand
| | - Gregory O'Grady
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- Department of SurgeryAuckland District Health Board Auckland New Zealand
- Auckland Bioengineering InstituteThe University of Auckland Auckland New Zealand
| | - Ian P. Bissett
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- Department of SurgeryAuckland District Health Board Auckland New Zealand
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63
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Butcher L. Psychological issues surrounding faecal incontinence: experiences of patients and nurses. Br J Community Nurs 2020; 25:34-38. [PMID: 31874081 DOI: 10.12968/bjcn.2020.25.1.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continence care breaches social norms about privacy, nakedness and bodily functions. Faecal incontinence (FI) is a condition that is associated with a significant emotional impact, which extends to not only the patient but also the nurse or care worker. Patients can experience feelings of guilt and shame and a sense of 'incompetence', which can be connected to childhood experiences. Similarly, nurses and caregivers can encounter feelings of disgust and revulsion, which are often denied, as part of the perceived professional expectation. Nurses can develop self-protective behaviours including emotional detachment and development of a task-orientated approach to physical care. This can, in turn, accentuate the negative feelings experienced by patients with FI. Nurses developing self-awareness through reflection on their own difficult feelings can help to improve communication, which will meet patients' emotional needs and improve the therapeutic relationship. This article aims to encourage nurses and care workers to develop an empathetic understanding of the basic human emotional responses experienced by patients. It also aims to improve nurses' awareness of their own feelings and help them recognise the effect of these emotions on their own behaviours and their patients. Lastly, the importance of providing emotional care to patients with FI is discussed.
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Affiliation(s)
- Lesley Butcher
- Lecturer in Adult Nursing, School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University
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Relationships between the results of anorectal investigations and symptom severity in patients with faecal incontinence. Int J Colorectal Dis 2019; 34:1445-1454. [PMID: 31280351 DOI: 10.1007/s00384-019-03331-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Anorectal dysfunction is the focus of diagnostic investigations for faecal incontinence. However, severity of incontinence and anorectal investigation results can be discordant. The aim of this study was to define the relationships between anorectal investigation results and incontinence severity to determine which measures, if any, were predictive of incontinence severity. METHODS Patients presenting for investigation of faecal incontinence completed a symptom questionnaire, anorectal manometry, rectal sensation, pudendal nerve terminal motor latency, and endoanal ultrasound. Bivariate analyses were conducted between the Jorge-Wexner score and investigation results. Subgroup analyses were performed for gender and symptom subtypes (urge, passive, mixed). A multiple regression analysis was performed. RESULTS Five hundred and thirty-eight patients were included. There were weak correlations between the Jorge-Wexner score and maximal squeeze pressure [r = - 0.24, 95%CI(- 0.31, - 0.16), p < 0.001], and resting pressure [r = - 0.18, (95%CI(- 0.26, - 0.10), p < 0.001]. In men only, there were significant associations between the Jorge-Wexner score and endoanal sonography [IAS defects: t(113) = - 2.26, p = 0.03, d = 0.58, 95%CI(- 4.38, - 0.29)] and rectal sensation (MTV: rs = - 0.24, 95%CI(- 0.41, - 0.06), p = 0.01). No substantial differences were observed in the urge/passive/mixed subgroup analyses. Multiple regression analysis included three variables: age (β = 0.02, p = 0.17), maximal resting pressure (β = - 0.01, p = 0.28), and maximal squeeze pressure (β = - 0.01, p < 0.01). The variance in the Jorge-Wexner score accounted for by this model was < 10%, (R2 = 0.07, p = < 0.01, adjusted R2 = 0.06). CONCLUSION Anorectal investigations cannot predict the severity of faecal incontinence. This may be due to limitations of diagnostic modalities, the heterogeneity of anorectal dysfunction in these patients, or contributing factors which are extrinsic to the anorectum.
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Grimsland F, Seim A, Borza T, Helvik A. Toileting difficulties in older people with and without dementia receiving formal in-home care-A longitudinal study. Nurs Open 2019; 6:1055-1066. [PMID: 31367431 PMCID: PMC6650701 DOI: 10.1002/nop2.289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
AIM To estimate the prevalence of toileting difficulties over time among older people (≥70 years) with and without dementia receiving formal in-home care at baseline and to explore whether dementia at baseline was associated with toileting difficulties at the last assessment when adjusting for relevant covariates. We hypothesize that those with dementia have a higher prevalence and that baseline dementia is associated with toileting difficulties at last follow-up. DESIGN A longitudinal observational study with three assessments over 36 months. Older people (≥70 years) from 19 Norwegian municipalities with in-home care needs were included. The participants and their next of kin were interviewed. METHOD In total, 1,001 (68% women) persons with a mean (SD) age 83.4 (5.7) years participated at baseline. Toileting difficulties were assessed using Lawton and Brody's Physical Self-Maintenance Scale and Individual Nursing and Care Statistics. Information on physical comorbidity, number of prescribed drugs, cognitive function and formal care given was included. Dementia was diagnosed based on all information gathered. RESULTS At all time points, toileting difficulties were more prevalent in people with than without dementia. In adjusted analyses, dementia at baseline was associated with toileting difficulties at the last assessment. Nursing home admission was associated with increased odds for toileting difficulties.
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Affiliation(s)
- Frida Grimsland
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Arnfinn Seim
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Tom Borza
- Centre for Old Age Psychiatric ResearchInnlandet Hospital TrustOttestadNorway
| | - Anne‐Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- St Olavs University HospitalTrondheimNorway
- Norwegian National Advisory Unit on Ageing and HealthVestfold Health TrustTønsbergNorway
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Norderval S, Rydningen MB, Falk RS, Stordahl A, Johannessen HH. Strong agreement between interview-obtained and self-administered Wexner and St. Mark's scores using a single questionnaire. Int Urogynecol J 2019; 30:2101-2108. [PMID: 31172220 DOI: 10.1007/s00192-019-03945-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/28/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS St Mark's incontinence score (SMIS) and the Wexner score have been constructed and validated as interview-based scoring systems. We developed a single questionnaire from which a separate SMIS or Wexner score could be derived. This study aimed to demonstrate the level of agreement between self-administered (sSMIS and sWexner) and interview-based (iSMIS and iWexner) scores using this questionnaire. METHODS One hundred five consecutive patients (30 male) seen in the incontinence outpatient clinics at the Østfold Hospital Trust, Sarpsborg, and University Hospital of North Norway, Tromsø, completed the self-administered incontinence questionnaire prior to the appointment. Following clinical investigation, the patients were interviewed about their symptoms according to the SMIS and Wexner scores, with the interviewers blinded to the results from self-reported questionnaire. Agreement between total scores and between subscores of the various items were determined using interclass correlation coefficient (ICC) and kappa statistics, respectively. RESULTS The self-administered questionnaire was incomplete in six cases (5.7%) and the interview-based was incomplete in two cases. Agreement was almost perfect between the iSMIS and sSMIS and between the iWexner score and sWexner score (ICC 0.90 and 0.92, respectively). Agreement was substantial to almost perfect for all items in both scoring systems, with kappa values ranging from 0.64-0.94. Mean iSMIS was 9.48 versus 9.53 for sSMIS (p = 0.90) and 8.26 versus 8.44 for the iWexner and sWexner score, respectively (p = 0.42). CONCLUSION The SMIS and Wexner scores can be completed by the patients using a single questionnaire, and the derived SMIS and Wexner scores are highly consistent with scores obtained by interview.
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Affiliation(s)
- Stig Norderval
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9038, Tromsø, Norway.
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Mona Birgitte Rydningen
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9038, Tromsø, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Arvid Stordahl
- Department of Surgery, Østfold Hospital Trust, Sarpsborg, Norway
| | - Hege Hølmo Johannessen
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Sarpsborg, Norway
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The Prevalence, Incidence, and Correlates of Fecal Incontinence Among Older People Residing in Care Homes: A Systematic Review. J Am Med Dir Assoc 2019; 20:956-962.e8. [PMID: 31129021 DOI: 10.1016/j.jamda.2019.03.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Older people resident in care homes often rely on staff for support relating to their activities of daily living, including intimate care such as continence care. Managing fecal incontinence can be challenging for both residents and care staff. We conducted this review to describe the prevalence, incidence, and correlates of fecal incontinence among care home residents. DESIGN Systematic literature review. SETTING AND PARTICIPANTS Older care home residents (both nursing and residential care) aged 60 years and older. MEASURES We defined double incontinence as the presence of fecal plus urinary incontinence, isolated fecal incontinence as fecal incontinence with no urinary incontinence, and all fecal incontinence as anyone with fecal incontinence (whether isolated or double). The CINAHL and MEDLINE databases were searched up to December 31, 2017, to retrieve all studies reporting the prevalence and/or incidence and correlates of fecal incontinence. RESULTS We identified 278 citations after removing duplicates, and 23 articles met the inclusion criteria. There were 12 high-quality studies, 5 medium-quality studies, and 6 low-quality studies. The medians for prevalence (as reported by the studies) of isolated fecal incontinence, double incontinence, and all fecal incontinence were 3.5% [interquartile range (IQR) = 2.8%], 47.1% (IQR = 32.1%), and 42.8% (IQR = 21.1%), respectively. The most frequently reported correlates of fecal incontinence were cognitive impairment, limited functional capacity, urinary incontinence, reduced mobility, advanced age, and diarrhea. CONCLUSIONS/IMPLICATIONS Fecal incontinence is prevalent among older people living in care homes. Correlates included impaired ability to undertake activities of daily living, reduced mobility, laxative use, and altered stool consistency (eg, constipation or diarrhea) which are potentially amenable to interventions to improve fecal incontinence.
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68
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Larsson C, Hedberg CL, Lundgren E, Söderström L, TunÓn K, Nordin P. Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study. Lancet 2019; 393:1233-1239. [PMID: 30799061 DOI: 10.1016/s0140-6736(18)32002-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men). METHODS In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups. FINDINGS 3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0·22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0·37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1·65 (95% CI 1·49-1·82; p<0·0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2·05 (1·92-2·19; p<0·0001). For the nulliparous women compared with men, the OR for anal incontinence was 1·89 (1·75-2·05; p<0·0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age. INTERPRETATION The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed. FUNDING County Council of Jämtland.
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Affiliation(s)
- Charlotta Larsson
- Department of Surgical and Perioperative Sciences, University of Umeå and Hospital of Östersund, Östersund, Sweden
| | | | - Ewa Lundgren
- Department of Surgery, Hospital of Östersund, Östersund, Sweden
| | - Lars Söderström
- Department of Research and Development, Hospital of Östersund, Östersund, Sweden
| | - Katarina TunÓn
- Department of Clinical Science, Obstetrics and Gynecology Umeå University, Umeå, Sweden
| | - Pär Nordin
- Department of Surgical and Perioperative Sciences, University of Umeå and Hospital of Östersund, Östersund, Sweden.
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69
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Trans-anal irrigation should be offered to patients with severe bowel dysfunction. Br J Gen Pract 2019; 69:136. [PMID: 30819744 DOI: 10.3399/bjgp19x701573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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70
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Butcher L. Causes of and factors that exacerbate faecal incontinence in older people. Br J Community Nurs 2019; 24:134-138. [PMID: 30817205 DOI: 10.12968/bjcn.2019.24.3.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lesley Butcher
- Lecturer in Adult Nursing, School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University
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71
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Mazi B, Kaddour O, Al-Badr A. Depression symptoms in women with pelvic floor dysfunction: a case-control study. Int J Womens Health 2019; 11:143-148. [PMID: 30863189 PMCID: PMC6390859 DOI: 10.2147/ijwh.s187417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, we aimed to estimate the prevalence of depression symptoms in women with pelvic floor dysfunction (PFD) and to assess their quality of life (QOL). Patients and methods A case-control study assessing depression and its severity in women with PFD (urinary incontinence, pelvic organ prolapse, and fecal incontinence) was conducted. Patients attending the Urogynecology Department of the Women's Specialized Hospital, King Fahad Medical City, were requested to complete the self-reported Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Beck Inventory Scale for Depression. Women presenting with no PFD symptoms were recruited from other clinics as controls. Results Data of 100 women diagnosed with PFD (mean age, 45.18±10.50 years) and 100 control participants (mean age, 45.14±13.03 years; P=0.644) were collected. Patients with PFD showed significantly higher (7.3%) body mass index (BMI) (32.59±6.22 kg/m2) than controls (30.37±8.08 kg/m2) (OR, 1.044, 95% CI: 1.001-1.091; P=0.043). Patients with PFD exhibited a threefold higher prevalence of depression symptoms than controls (43% vs 14%, respectively; P<0.001). QOL scores in patients with PFD were significantly higher in patients with depression (P-values, 0.024 to <0.001). Conclusion There is a significant association between depression and PFD, and QOL scores in patients with PFD were significantly higher in patients with depression.
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Affiliation(s)
- Baraa Mazi
- National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ouhoud Kaddour
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia, .,Prince Naif Healthcare Research Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al-Badr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia, .,Urogynecology & Pelvic Reconstructive Surgery Department, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia,
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Autologous Myoblasts for the Treatment of Fecal Incontinence: Results of a Phase 2 Randomized Placebo-controlled Study (MIAS). Ann Surg 2019; 267:443-450. [PMID: 28426476 PMCID: PMC5805121 DOI: 10.1097/sla.0000000000002268] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of intrasphincteric injections of autologous myoblasts (AMs) in fecal incontinence (FI) in a controlled study. SUMMARY OF BACKGROUND DATA Adult stem cell therapy is expected to definitively cure FI by regenerating damaged sphincter. Preclinical data and results of open-label trials suggest that myoblast therapy may represent a noninvasive treatment option. METHODS We conducted a phase 2 randomized, double-blind, placebo-controlled study of intrasphincteric injections of AM in 24 patients. The study compared outcome after AM (n = 12) or placebo (n = 12) injection using Cleveland Clinic Incontinence (CCI), score at 6 and 12 months. Patients in the placebo group were eligible to receive frozen AM after 1 year. RESULTS At 6 months, the median CCI score significantly decreased from baseline in both the AM (9 vs 15, P = 0.02) and placebo (10 vs 15, P = 0.01) groups. Hence, no significant difference was found between the 2 groups (primary endpoint) at 6 months. At 12 months, the median CCI score continued to ameliorate in the AM group (6.5 vs 15, P = 0.006), while effect was lost in the placebo group (14 vs 15, P = 0.35). Consequently, there was a higher response rate at 12 months in the treated than the placebo arm (58% vs 8%, P = 0.03). After delayed frozen AM injection in the placebo group, the response rate was 60% (6/10) at 12 months. CONCLUSIONS Intrasphincteric AM injections in FI patients have shown tolerance, safety, and clinical benefit at 12 months despite a transient placebo effect at 6 months.
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73
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Dedemadi G, Takano S. Efficacy of Bilateral Transcutaneous Posterior Tibial Nerve Stimulation for Fecal Incontinence. Perm J 2019; 22:17-231. [PMID: 30028671 DOI: 10.7812/tpp/17-231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT Posterior tibial nerve stimulation is a new second-line treatment for refractory fecal incontinence. OBJECTIVE To assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation (BTPTNS) for treatment of fecal incontinence in Japanese patients and its impact on quality of life. DESIGN A prospective observational-interventional study was conducted from May 2015 to June 2017 in patients with fecal incontinence in whom conservative treatment had failed. All patients received a 30-minute session of stimulation twice weekly for 6 consecutive weeks. Evaluation at baseline and at 6 weeks involved the Wexner score, Fecal Incontinence Quality of Life (FIQL) questionnaire, and anal manometry. Patients recorded episodes of incontinence in a weekly diary. MAIN OUTCOME MEASURES Reduction of 50% or greater in incontinence episodes, decreased Wexner score, and improved FIQL scores. RESULTS Twenty-two patients with a median age of 64.1 years (range, 26-81 years) and men:women ratio of 9:13 completed BTPTNS. Mean episodes of fecal incontinence were significantly reduced from 4.7 to 1.5 (p < 0.05). An improvement of 50% or better in episodes of fecal incontinence was achieved in 77.2% of patients. The median Wexner score significantly decreased from 10.2 to 6.9 (p < 0.05). The median FIQL score improved from 2.7 to 3.1 (p = 0.06), and significant improvement was seen in the embarrassment domain (2.2 vs 2.8, p < 0.05). Resting and squeezing anal pressures revealed no significant changes. CONCLUSION Our findings suggest that BTPTNS is safe and well tolerated and may improve symptoms of fecal incontinence. This technique offers an additional noninvasive, less expensive form of treatment.
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Affiliation(s)
- Georgia Dedemadi
- Surgeon in the Department of Functional Anorectal Disorders at Coloproctology Center Takano Hospital in Kumamoto City, Japan, and a Surgeon in the Department of Surgery at Sismanoglio-Amalia Fleming Hospital in Athens, Greece.
| | - Shota Takano
- Surgeon in the Department of Functional Anorectal Disorders at Coloproctology Center Takano Hospital in Kumamoto City, Japan.
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74
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Kirss J, Pinta T, Varpe P, Rautio T, Kairaluoma M, Hyöty M, Hurme S, Böckelman C, Kairaluoma V, Salmenkylä S, Victorzon M. Outcomes of treatment of faecal incontinence with sacral nerve stimulation - a Finnish multicentre study. Colorectal Dis 2019; 21:59-65. [PMID: 30192431 DOI: 10.1111/codi.14406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim of this multicentre study is to report the results of sacral nerve stimulation (SNS) treatment for faecal incontinence (FI) in Finland and determine factors that could influence SNS treatment outcomes. METHOD This is a national multicentre study, involving all patients tested for SNS implantation in Finland from 1999 to 2017. Data were collected retrospectively from electronic patient archives and analysed for possible effects on treatment outcome. RESULTS Of the 432 patients with FI tested for SNS, 365 were women. Three hundred and thirteen (72.5%) of the tested patients advanced to permanent implantation of a stimulator. A successful final treatment outcome, with subjective alleviation of FI, was reported by 59.3% of the patients at the end of follow-up (mean 2.4 years, range 8 days to 13.3 years). Patients with obstetric sphincter injury and idiopathic FI had more permanent stimulator implantations than patients with iatrogenic injury (P = 0.012). Male patients had significantly worse test phase outcomes than female patients (P < 0.001). Age did not influence treatment outcome (P = 0.446) CONCLUSION: Subjective final success of SNS treatment for FI was achieved in 59.3% of patients at a mean of 2.4 years. Gender and the aetiology of FI influenced the test phase and final treatment outcome of SNS treatment.
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Affiliation(s)
- J Kirss
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
| | - T Pinta
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - P Varpe
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - T Rautio
- Oulu University Hospital, Oulu, Finland
| | - M Kairaluoma
- Central Finland Central Hospital, Jyväskylä, Finland
| | - M Hyöty
- Tampere University Hospital, Tampere, Finland
| | - S Hurme
- University of Turku, Turku, Finland.,Department of Biostatistics, University of Turku, Turku, Finland
| | - C Böckelman
- Helsinki University Hospital, Helsinki, Finland
| | | | | | - M Victorzon
- University of Turku, Turku, Finland.,Department of Surgery, Vaasa Central Hospital, Vaasa, Finland
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Abstract
Faecal incontinence (FI) is a hidden problem that is under-diagnosed, under-investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8-6.2%. Recent North American research indicates a prevalence of 8.3% in adults living in the community. This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.
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Affiliation(s)
- Linda Nazarko
- Consultant nurse, physical healthcare, West London Mental Health Trust
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76
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Kirss J, Pinta T, Rautio T, Varpe P, Kairaluoma M, Hyöty M, Hurme S, Böckelman C, Kairaluoma V, Salmenkylä S, Victorzon M. Impact of sphincter lesions and delayed sphincter repair on sacral neuromodulation treatment outcomes for faecal incontinence: results from a Finnish national cohort study. Int J Colorectal Dis 2018; 33:1709-1714. [PMID: 30203319 DOI: 10.1007/s00384-018-3161-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this multicentre study was to analyse the effects of patent sphincter lesions and previous sphincter repair on the results of sacral neuromodulation (SNM) treatment on patients with faecal incontinence (FI). METHODS Patients examined by endoanal ultrasound (EAUS) with FI as the indication for SNM treatment were included in the study. Data was collected from all the centres providing SNM treatment in Finland and analysed for differences in treatment outcomes. RESULTS A total of 237 patients treated for incontinence with SNM had been examined by EAUS. Of these patients, 33 had a history of previous delayed sphincter repair. A patent sphincter lesion was detected by EAUS in 128 patients. The EAUS finding did not influence the SNM test phase outcome (p = 0.129) or the final treatment outcome (p = 0.233). Patient's history of prior sphincter repair did not have a significant effect on the SNM test (p = 0.425) or final treatment outcome (p = 0.442). CONCLUSIONS Results of our study indicate that a sphincter lesion or previous sphincter repair has no significant effect on the outcome of SNM treatment. Our data suggests that delayed sphincter repair prior to SNM treatment initiation for FI is not necessary.
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Affiliation(s)
- Jaan Kirss
- Turku University Hospital, Turku, Finland. .,University of Turku, Turku, Finland.
| | - Tarja Pinta
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | | | | | - Marja Hyöty
- Tampere University Hospital, Tampere, Finland
| | | | - Camilla Böckelman
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sinikka Salmenkylä
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikael Victorzon
- University of Turku, Turku, Finland.,Vaasa Central Hospital, Vaasa, Finland
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77
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A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth. Int Urogynecol J 2018; 30:869-879. [DOI: 10.1007/s00192-018-3819-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/08/2018] [Indexed: 12/18/2022]
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78
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Conservative treatment of severe defecatory urgency and fecal incontinence: minor strategies with major impact. Tech Coloproctol 2018; 22:673-682. [PMID: 30251126 DOI: 10.1007/s10151-018-1855-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 09/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bowel disturbances have been identified as the most important risk factor for fecal incontinence (FI). However, few studies have evaluated the impact of fiber supplementation. Our aim was to assess the correlation between the improvement in stool consistency by fiber supplementation and the changes in urgency and number of FI episodes and in the QoL of patients with FI. METHODS Eighty-three patients who came to our institution with FI and/or fecal urgency associated with loose stools or diarrhea were prospectively included in the study The intervention included dietary advice and methylcellulose 500 mg every 8 h for 6 weeks. All assessments were carried out at baseline and 6 weeks after the start of the intervention, and included a Bristol Stool Scale, a 3-week bowel diary, the St Mark's score, the Fecal Incontinence Quality of Life scale (FIQL) and a bowel satisfaction score. RESULTS Sixty-one patients completed the study. At baseline 50 reported episodes of urge incontinence, while 11 did not report FI episodes because they rarely left home to avoid leakage. The Bristol score improved to normal stools in 65.6% of patients after treatment. Bowel diaries showed a statistically significant reduction in the number of bowel movements, urge episodes, urge fecal incontinence episodes and soiling per week. The St Mark's score and the bowel satisfaction score significantly improved after methylcellulose and overall deferment time also increased. FIQL significantly improved in two subdomains (lifestyle, coping/behavior). Thirty-one patients (51.7%) were discharged with methylcellulose as the only treatment. CONCLUSIONS FI may significantly improve with methylcellulose in selected cases. Assessment of fecal consistency and initial treatment with methylcellulose could be started at primary care level to reduce the need for specialist referral.
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79
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Barbosa AMP, Parizotto NA, Pedroni CR, Avila MA, Liebano RE, Driusso P. How to report electrotherapy parameters and procedures for pelvic floor dysfunction. Int Urogynecol J 2018; 29:1747-1755. [PMID: 30143853 DOI: 10.1007/s00192-018-3743-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022]
Abstract
Electrical stimulation is widely used for pelvic floor muscle dysfunctions (PFMDs), but studies are not always clear about the parameters used, jeopardizing their reproduction. As such, this study aimed to be a reference for researchers and clinicians when using electrical stimulation for PFMD. This report was designed by experts on electrophysical agents and PFMD who determined all basic parameters that should be described. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. Electrical stimulation parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, a description of patient and electrode positioning was added. A consensus-based guideline on how to report electrical stimulation parameters for PFMD treatment was developed to help both clinicians and researchers.
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Affiliation(s)
- Angélica Mércia Pascon Barbosa
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, CEP:17.525-900, Brazil.
| | - Nivaldo Antonio Parizotto
- Post-Graduate Program of Biotechnology on Regenerative Medicine and Medical Chemistry, University of Araraquara, (UNIARA), Araraquara, SP, Brazil.,Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Cristiane Rodrigues Pedroni
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, CEP:17.525-900, Brazil
| | - Mariana Arias Avila
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Richard Eloin Liebano
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Patricia Driusso
- Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.,Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos - NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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80
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Gu P, Kuenzig ME, Kaplan GG, Pimentel M, Rezaie A. Fecal Incontinence in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2018; 24:1280-1290. [PMID: 29617820 DOI: 10.1093/ibd/izx109] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding of the prevalence, pathophysiology, and management of fecal incontinence (FI) in inflammatory bowel disease (IBD) patients without an ileal pouch anal anastomosis (IPAA) is suboptimal. We conducted a systematic review and meta-analysis on the prevalence, pathophysiology, and management of primary FI in IBD patients without IPAA. METHODS We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (1966 through March 2017) for studies on the prevalence, physiology, or management of FI in IBD patients without IPAA. A random effects model was used to calculate pooled prevalence rates and odds ratio (OR) with 95% confidence interval (CI). Heterogeneity was assessed with I2 statistics, Cochran Q statistic, and sensitivity analyses. RESULTS Seventeen studies were included. Six studies evaluated the prevalence of FI in 4671 IBD patients. There was significant heterogeneity among the studies, but the pooled prevalence of FI among case-control studies was homogeneous at 24% (95% CI 18%-30%, I2 = 50.6%, P = 0.16). FI was more common among IBD patients than non-IBD controls (OR = 7.73; 95% CI 6.26 to 9.84). Therapeutic options were poorly evaluated in uncontrolled studies. Surgery was effective in 70% of patients (7/10), sacral nerve stimulation was effective in 100% of patients (5/5), and 41.6% of patients (5/12) reported subjective improvement in FI with percutaneous tibial nerve stimulation. CONCLUSIONS FI is prevalent in IBD patients without IPAA, and more common than non-IBD controls. Additional controlled studies are warranted to further identify effective therapeutic interventions for FI in IBD. 10.1093/ibd/izx109_video1izx109_Video_15760611117001.
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Affiliation(s)
- Phillip Gu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - M Ellen Kuenzig
- Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada.,CHEO Research Institute, Ottawa, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology, Department of Medicine, University of Calgary, AB, Canada
| | - Mark Pimentel
- Division of Gastroenterology, Department of Medicine, University of Calgary, AB, Canada.,Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ali Rezaie
- Division of Gastroenterology, Department of Medicine, University of Calgary, AB, Canada.,Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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81
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Bock D, Angenete E, Gonzales E, Heath J, Haglind E. Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study. BMJ Open 2018; 8:e021974. [PMID: 29730632 PMCID: PMC5942440 DOI: 10.1136/bmjopen-2018-021974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population. DESIGN A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent. MAIN OUTCOME MEASURES Measures of urinary, bowel, sexual function and quality of life. RESULTS The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women. CONCLUSIONS In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women. TRIAL REGISTRATION NUMBER NCT02392923; Results.
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Affiliation(s)
- David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Elisabeth Gonzales
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Jane Heath
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Scandinavian Surgical Outcomes Research Group (SSORG), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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82
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Lin AY, Dinning PG, Milne T, Bissett IP, O'Grady G. The "rectosigmoid brake": Review of an emerging neuromodulation target for colorectal functional disorders. Clin Exp Pharmacol Physiol 2018; 44:719-728. [PMID: 28419527 DOI: 10.1111/1440-1681.12760] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/09/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
The regulation of gastrointestinal motility encompasses several overlapping mechanisms including highly regulated and coordinated neurohormonal circuits. Various feedback mechanisms or "brakes" have been proposed. While duodenal, jejunal, and ileal brakes are well described, a putative distal colonic brake is less well defined. Despite the high prevalence of colonic motility disorders, there is little knowledge of colonic motility owing to difficulties with organ access and technical difficulties in recording detailed motor patterns along its entire length. The motility of the colon is not under voluntary control. A wide range of motor patterns is seen, with long intervals of intestinal quiescence between them. In addition, the use of traditional manometric catheters to record contractile activity of the colon has been limited by the low number of widely spaced sensors, which has resulted in the misinterpretation of colonic motor patterns. The recent advent of high-resolution (HR) manometry is revolutionising the understanding of gastrointestinal motor patterns. It has now been observed that the most common motor patterns in the colon are repetitive two to six cycles per minute (cpm) propagating events in the distal colon. These motor patterns are prominent soon after a meal, originate most frequently in the rectosigmoid region, and travel in the retrograde direction. The distal prominence and the origin of these motor patterns raise the possibility of them serving as a braking mechanism, or the "rectosigmoid brake," to limit rectal filling. This review aims to describe what is known about the "rectosigmoid brake," including its physiological and clinical significance and potential therapeutic applications.
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Affiliation(s)
- Anthony Y Lin
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Phil G Dinning
- Department of Gastroenterology and Surgery, Flinders Medical Centre, and the Discipline of Human Physiology, Flinders University, Bedford Park, South Australia, Australia
| | - Tony Milne
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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83
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Abstract
The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρs = 73; IAS: ρs = 81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.
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Affiliation(s)
- Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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84
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Jeganathan AN, Bleier JI. Patient selection and preoperative evaluation for fecal incontinence. SEMINARS IN COLON AND RECTAL SURGERY 2017. [DOI: 10.1053/j.scrs.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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85
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Ramos Fernández M, Jiménez-Rodríguez RM, Perea Del Pozo E, Palacios González C, de la Portilla F. Anal encirclement: a surgical technique for faecal incontinence in patients who are not good candidates for more invasive surgery - a video vignette. Colorectal Dis 2017; 19:1117. [PMID: 29053205 DOI: 10.1111/codi.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023]
Affiliation(s)
- M Ramos Fernández
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - R M Jiménez-Rodríguez
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - E Perea Del Pozo
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - C Palacios González
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - F de la Portilla
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
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86
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Lin AY, Du P, Dinning PG, Arkwright JW, Kamp JP, Cheng LK, Bissett IP, O'Grady G. High-resolution anatomic correlation of cyclic motor patterns in the human colon: Evidence of a rectosigmoid brake. Am J Physiol Gastrointest Liver Physiol 2017; 312:G508-G515. [PMID: 28336544 PMCID: PMC5451563 DOI: 10.1152/ajpgi.00021.2017] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/31/2023]
Abstract
Colonic cyclic motor patterns (CMPs) have been hypothesized to act as a brake to limit rectal filling. However, the spatiotemporal profile of CMPs, including anatomic origins and distributions, remains unclear. This study characterized colonic CMPs using high-resolution (HR) manometry (72 sensors, 1-cm resolution) and their relationship with proximal antegrade propagating events. Nine healthy volunteers were recruited. Recordings were performed over 4 h, with a 700-kcal meal given after 2 h. Propagating events were visually identified and analyzed by pattern, origin, amplitude, extent of propagation, velocity, and duration. Manometric data were normalized using anatomic landmarks identified on abdominal radiographs. These were mapped over a three-dimensional anatomic model. CMPs comprised a majority of detected propagating events. Most occurred postprandially and were retrograde propagating events (84.9 ± 26.0 retrograde vs. 14.3 ± 11.8 antegrade events/2 h, P = 0.004). The dominant sites of initiation for retrograde CMPs were in the rectosigmoid region, with patterns proximally propagating by a mean distance of 12.4 ± 0.3 cm. There were significant differences in the characteristics of CMPs depending on the direction of travel and site of initiation. Association analysis showed that proximal antegrade propagating events occurred independently of CMPs. This study accurately characterized CMPs with anatomic correlation. CMPs were unlikely to be triggered by proximal antegrade propagating events in our study context. However, the distal origin and prominence of retrograde CMPs could still act as a mechanism to limit rectal filling and support the theory of a "rectosigmoid brake."NEW & NOTEWORTHY Retrograde cyclic motor patterns (CMPs) are the dominant motor patterns in a healthy prepared human colon. The major sites of initiation are in the rectosigmoid region, with retrograde propagation, supporting the idea of a "rectosigmoid brake." A significant increase in the number of CMPs is seen after a meal. In our study context, the majority of CMPs occurred independent of proximal propagating events, suggesting that CMPs are primarily controlled by external innervation.
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Affiliation(s)
- Anthony Y. Lin
- 1Department of Surgery, University of Auckland, Auckland, New Zealand;
| | - Peng Du
- 3Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand;
| | - Philip G. Dinning
- 4Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia; and
| | - John W. Arkwright
- 5Computer Science, Engineering and Mathematics, Flinders University, Bedford Park, South Australia, Australia
| | - Jozef P. Kamp
- 1Department of Surgery, University of Auckland, Auckland, New Zealand;
| | - Leo K. Cheng
- 3Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand;
| | - Ian P. Bissett
- 1Department of Surgery, University of Auckland, Auckland, New Zealand; ,2Surgery, Auckland City Hospital, Auckland, New Zealand;
| | - Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand; .,Surgery, Auckland City Hospital, Auckland, New Zealand
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87
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Ribas Y, Coll M, Espina A, Jiménez C, Chicote M, Torné M, Modolell I. Initiative to improve detection of faecal incontinence in primary care: The GIFT Project. Fam Pract 2017; 34:175-179. [PMID: 28201584 DOI: 10.1093/fampra/cmx004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Faecal incontinence (FI) is a distressing condition with a significant impact on quality of life. The true prevalence of FI is unknown but probably underestimated. Identifying patients affected is of key importance because a significant proportion may improve with conservative treatments, and there are a number of other treatments available. OBJECTIVES The aim of our project was to improve detection of FI in our primary care setting. METHODS A multidisciplinary working group was created in order to raise awareness and educate health professionals about FI. We designed a simple protocol and organized educational meetings at 7 primary care centres. The usual diagnostic computer-based tools used by nurses were modified, so that FI was systematically asked about. A proactive attitude among doctors and midwives regarding FI was recommended for high-risk patient groups. RESULTS The project was implemented in October 2014. Before the intervention, only 250 (<1%) patients with a diagnosis of FI were identified from the primary care register out of a population over 165000 people. Between October 2014 and February 2016, 17370 patients were questioned about anal continence in routine follow-ups. Of those questioned, 829 (4.8%) disclosed suffering from FI. Mean age was 78.5 ± 14 years (16-104), 565 (68.2%) were females, and 264 (31.8%) were males. The percentage of patients with FI increased with age and was higher in women. CONCLUSION Our results show that a proactive approach with direct questions on FI may lead to a significant increase in FI detection in primary care.
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Affiliation(s)
- Yolanda Ribas
- Department of Surgery (Coloproctology), Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Meritxell Coll
- Primary Care Nurse, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Avelina Espina
- Primary Care Doctor, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Concepció Jiménez
- Primary Care Nurse, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Montserrat Chicote
- Primary Care Nurse, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Marta Torné
- Primary Care Doctor, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - Ines Modolell
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
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