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Soligo M, Roberti Maggiore UL, Oprandi NC, Nelva Stellio L, De Ponti E, Del Popolo G, Finazzi Agrò E, Ferrazzi E. Electronic Personal Assessment Questionnaire-Pelvic Floor: Italian cultural adaptation and face validity. Urologia 2019; 86:86-92. [PMID: 30983546 DOI: 10.1177/0391560319840196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Electronic questionnaires offer invaluable advantages over paper-based ones. The aims of this study were to make available to Italian clinicians a culturally adapted version of the multidimensional electronic Personal Assessment Questionnaire-Pelvic Floor and to test face validity and factorial analysis for the Urinary section. METHODS The original English-language version of electronic Personal Assessment Questionnaire-Pelvic Floor was cross-culturally adapted to the Italian language. At the Urogynaecology Unit of Buzzi Hospital in Milan, the Urinary section of the Italian version was completed by women symptomatic for pelvic floor dysfunction. Time to questionnaire completion was recorded, and a nine-item paper questionnaire about the questionnaire was completed. Descriptive analysis to define patient population characteristics and nine-item paper questionnaire analysis were performed. Factorial analyses on the Urinary section of the questionnaire and on the nine-item paper questionnaire were performed, and internal reliability was assessed using Cronbach's alpha. RESULTS A culturally adapted Italian version of electronic Personal Assessment Questionnaire-Pelvic Floor was provided. In total, 95 women complaining of pelvic floor dysfunction took part in the study. Mean time to electronic questionnaire completion was 9 min (range: 5-17), with 95% of patients completing within 15 min. More than 95% of women considered the Italian version of electronic Personal Assessment Questionnaire-Pelvic Floor helpful, relevant, easy to use and comprehensive and would be happy to use it again. The questionnaire being overly long was an issue for 17% of women. The internal consistency of items in the nine-item paper questionnaire was confirmed with Cronbach's alpha scores > 0.8 for both the 'Value' and 'Burden' domains. DISCUSSION Our Italian cultural adaptation of electronic Personal Assessment Questionnaire-Pelvic Floor was well accepted by an appropriate target population. A full psychometric validation is now warranted.
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Affiliation(s)
- Marco Soligo
- 1 Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | | - Nadia C Oprandi
- 3 Department of Human Sciences, University of Verona, Verona, Italy
| | - Leonardo Nelva Stellio
- 1 Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | | | | | | - Enrico Ferrazzi
- 7 Obstetrics and Gynecology Clinic, Luigi Mangiagalli Institute, University of Milan, Milan, Italy
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Functional and histologic effects after implanting pluripotent stem cells in a murine model with sphincterotomy. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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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Pandeva I, Biers S, Pradhan A, Verma V, Slack M, Thiruchelvam N. The impact of pelvic floor multidisciplinary team on patient management: the experience of a tertiary unit. J Multidiscip Healthc 2019; 12:205-210. [PMID: 30936714 PMCID: PMC6422421 DOI: 10.2147/jmdh.s186847] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Pelvic floor dysfunction is a common and heterogenous condition with numerous clinical manifestations, making the optimal management challenging. The traditional single-specialty approach may fail to address its complex nature. Currently, there are no published data on the impact of joint pelvic floor multidisciplinary team (MDT) meetings on patient management. Patients and methods This study represents a retrospective analysis of prospectively collected data on female patients discussed at a joint pelvic floor MDT over a 12-month period in a tertiary referral center. Results One hundred fifty-two cases were included with a median age of 55 years (range 18-83) and a BMI of 32 kg/m2 (range 17-58). Lower urinary tract dysfunction was the predominant symptom in 75% (114/152). The pelvic organ prolapse symptom of a vaginal bulge was present in 11% (17/152). All cases of vaginal prolapse were accompanied by either urinary incontinence, 59% (10/17), or obstructive defecation, 41% (7/17). Fecal incontinence was recorded in 10% (15/152). Mesh-related complications were reported in 3% (4/152). The MDT recommended a change in the initial management plan in 20% (31/152) of cases, of whom 80% (25/31) were patients with complex urinary incontinence. The MDT agreed a change in the primary care team in 16% (25/152) of cases. Conclusion There is an increasing regulatory requirement for patients with pelvic floor dysfunction to be discussed in an MDT setting. Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.
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Affiliation(s)
- Ivilina Pandeva
- Department of Urogynecology, Addenbrooke's Hospital, Cambridge, UK,
| | - Suzanne Biers
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Ashish Pradhan
- Department of Urogynecology, Addenbrooke's Hospital, Cambridge, UK,
| | - Vandna Verma
- Department of Urogynecology, Addenbrooke's Hospital, Cambridge, UK,
| | - Mark Slack
- Department of Urogynecology, Addenbrooke's Hospital, Cambridge, UK,
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Episcissors-60™ and obstetrics anal sphincter injury: a systematic review and meta-analysis. Int Urogynecol J 2019; 31:605-612. [DOI: 10.1007/s00192-019-03901-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/05/2019] [Indexed: 12/31/2022]
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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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Lal N, Simillis C, Slesser A, Kontovounisios C, Rasheed S, Tekkis PP, Tan E. A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults. Acta Chir Belg 2019; 119:1-15. [PMID: 30644337 DOI: 10.1080/00015458.2018.1549392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To perform a review of the literature reporting on randomised controlled trials (RCTs) comparing treatments for faecal incontinence (FI) in adults. METHODS A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify RCTs reporting on treatments for FI. RESULTS The review included 60 RCTs reporting on 4838 patients with a mean age ranging from 36.8 to 88 years. From the included RCTs, 32 did not identify a significant difference between the treatments compared. Contradictory results were identified in RCTs comparing percutaneous posterior tibial nerve stimulation and transcutaneous tibial nerve stimulation versus sham stimulation, biofeedback-pelvic floor muscle training (BF-PFMT) versus PFMT, and between bulking agents such as PTQTM versus Durasphere®. In two separate RCTs, combination treatment of amplitude-modulated medium frequency stimulation and electromyography-biofeedback (EMG-BF), was noted to be superior to EMG-BF and low-frequency electrical stimulation alone. Combination of non-surgical treatments such as BF with sphincteroplasty significantly improved continence scores compared to sphincteroplasty alone. Surgical treatments were associated with higher rates of serious adverse events compared to non-surgical interventions. CONCLUSIONS The current evidence has not identified significant differences between treatments for FI, and where differences were identified, the results were contradictory between RCTs.
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Affiliation(s)
- Nikhil Lal
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Constantinos Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Alistair Slesser
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shahnawaz Rasheed
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Paris P. Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Emile Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Ferdinande K, Dorreman Y, Roelens K, Ceelen W, De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Colorectal Dis 2018; 20:1109-1116. [PMID: 29972721 DOI: 10.1111/codi.14324] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim was to determine the prevalence and risk factors of anal symptoms prepartum and postpartum. METHOD A prospective observational cohort study was carried out in Ghent University Hospital, Belgium. Ninety-four pregnant women between their 19th and 25th week of pregnancy were included. An anal symptom questionnaire was filled in at four different times: in the second and third trimester, immediately postpartum and 3 months postpartum. Descriptive data were obtained from patient files. A proctological diagnosis was presumed on the basis of combined symptoms (i.e. rectal bleeding, anal pain and swelling). Constipation was defined by the Rome III criteria. Risk factors were identified using multivariate analysis. RESULTS Sixty-eight per cent of the patients developed anal symptoms. The most prevalent symptom was anal pain. Constipation was reported by 60.7% during the study period. Seven women (7.9%) suffered from faecal incontinence. The most prevalent diagnoses were haemorrhoidal thrombosis (immediately postpartum), haemorrhoidal prolapse (in the third trimester and immediately postpartum) and anal fissure (not episode related). The two independent risk factors for anal complaints were constipation, with a 6.3 odds ratio (95% CI 2.08-19.37), and a history of anal problems, with a 3.9 odds ratio (95% CI 1.2-13). The Bristol Stool Chart was shown to be a reliable indicator in pregnancy and postpartum as significant correlations were observed in all study periods. CONCLUSION Two-thirds of pregnant women have anal symptoms during pregnancy and postpartum, especially haemorrhoidal complications and anal fissure. The most important risk factor is constipation. The prevention of constipation in pregnant women is therefore highly recommended.
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Affiliation(s)
- K Ferdinande
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
| | - Y Dorreman
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - K Roelens
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - W Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent University, Gent, Belgium
| | - D De Looze
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
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Frudinger A, Marksteiner R, Pfeifer J, Margreiter E, Paede J, Thurner M. Skeletal muscle-derived cell implantation for the treatment of sphincter-related faecal incontinence. Stem Cell Res Ther 2018; 9:233. [PMID: 30213273 PMCID: PMC6136163 DOI: 10.1186/s13287-018-0978-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/21/2022] Open
Abstract
Background In an earlier pilot study with 10 women, we investigated a new approach for therapy of faecal incontinence (FI) due to obstetric trauma, involving ultrasound-guided injection of autologous skeletal muscle-derived cells (SMDC) into the external anal sphincter (EAS), and observed significant improvement. In the current study, we tested this therapeutic approach in an extended patient group: male and female patients suffering from FI due to EAS damage and/or atrophy. Furthermore, feasibility of lower cell counts and cryo-preserved SMDC was assessed. Methods In this single-centre, explorative, baseline-controlled clinical trial, each patient (n = 39; mean age 60.6 ± 13.81 years) received 79.4 ± 22.5 × 106 cryo-preserved autologous SMDC. Changes in FI parameters, Fecal Incontinence Quality of Life (FIQL), anorectal manometry and safety from baseline to 1, 6 and 12 months post implantation were evaluated. Results SMDC used in this trial contained a high percentage of myogenic-expressing (CD56+) and muscle stem cell marker-expressing (Pax7+, Myf5+) cells. Intervention was well tolerated without any serious adverse events. After 12 months, the number of weekly incontinence episodes (WIE, primary variable), FIQL and patient condition had improved significantly. In 80.6% of males and 78.4% of females, the WIE frequency decreased by at least 50%; Wexner scores and severity of FI complaints decreased significantly, independent of gender and cause of FI. Conclusions Injection of SMDCs into the EAS effectively improved sphincter-related FI due to EAS damage and/or atrophy in males and females. When confirmed in a larger, placebo-controlled trial, this minimal invasive procedure has the potential to become first-line therapy for FI. Trial registration EU Clinical Trials Register, EudraCT 2010-023826-19 (Date of registration: 08.11.2010).
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Affiliation(s)
- Andrea Frudinger
- Department of Obstetrics and Gynaecology, Division of Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | | | - Johann Pfeifer
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Eva Margreiter
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Johannes Paede
- B-K Ultrasound, Pascalkehre 13, 25451, Quickborn, Germany
| | - Marco Thurner
- Innovacell Biotechnologie AG, Science Park, Innsbruck, Austria
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Vázquez-Zapién GJ, Ordoñez-Gutiérrez ME, Minero-Alfaro JI, Guerrero-Guerrero VH, Mora-Mendoza I, Mata-Miranda MM. Functional and histologic effects after implanting pluripotent stem cells in a murine model with sphincterotomy. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 84:165-173. [PMID: 29954618 DOI: 10.1016/j.rgmx.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/17/2018] [Accepted: 03/27/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND AIMS Fecal incontinence is a disabling condition with devastating consequences for the patients. Medical and surgical options are not very satisfactory, reason by which regenerative medicine has been considered in this field. In the present research, we analyzed functional and histologic effects after implanting pluripotent stem cells (PSCs) in a murine model with sphincterotomy. MATERIALS AND METHODS Female Wistar rats were subjected to sphincterotomy and divided into three groups. Group 1 (control group) was treated with 300μL of balanced saline solution and group 2 (late treatment) and group 3 (early treatment) received 50,000 PSCs resuspended in 300μL of balanced saline solution. All animals were evaluated through high-resolution anorectal manometry 24hours before and after sphincterotomy and every month for three months. Finally, the rats were euthanized and histopathologic sections from the anal canal were obtained. RESULTS All groups showed a decrease in resting anal pressure and squeeze anal pressure 24hours after sphincterotomy. At the third month, higher anal pressures in the groups treated with PSCs were detected. Regarding the histologic effects, the microscopic architecture was restored and there was a significant decrease in the inflammatory response in the groups treated with PSCs. CONCLUSION PSCs implantation improves anal tone, as well as histologic structure, presenting better regenerative results when implanted as early treatment.
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Affiliation(s)
- G J Vázquez-Zapién
- Escuela Militar de Medicina, Centro Militar de Ciencias de la Salud, Secretaría de la Defensa Nacional, Ciudad de México, México
| | - M E Ordoñez-Gutiérrez
- Hospital Central Militar, Secretaría de la Defensa Nacional, Ciudad de México, México
| | - J I Minero-Alfaro
- Hospital Central Militar, Secretaría de la Defensa Nacional, Ciudad de México, México
| | - V H Guerrero-Guerrero
- Hospital Central Militar, Secretaría de la Defensa Nacional, Ciudad de México, México
| | - I Mora-Mendoza
- Hospital Central Militar, Secretaría de la Defensa Nacional, Ciudad de México, México
| | - M M Mata-Miranda
- Escuela Militar de Medicina, Centro Militar de Ciencias de la Salud, Secretaría de la Defensa Nacional, Ciudad de México, México.
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Chughtai B, Thomas D, Russell D, Phongtankuel V, Bowles K, Prigerson H. Prevalence and Risk Factors for Fecal Incontinence in Home Hospice. Am J Hosp Palliat Care 2018; 36:33-37. [DOI: 10.1177/1049909118784891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: We sought to determine the prevalence and risk factors associated with fecal incontinence (FI) in the home hospice setting. Methods: We conducted a retrospective cohort study of patients served by a hospice agency. Data on patient characteristics were extracted from hospice medical records. The primary outcome, FI, was assessed routinely during clinical visits to the patient’s home. Descriptive statistics were used to summarize patient characteristics. A Cox proportional hazards regression model was estimated for FI to examine associations with sociodemographic and clinical characteristics of patients. Results: A total of 15 432 patients were eligible. Patients were female (59.0%) and 75 years or older (23.5% were 75-84; 39.9% were 85+). Most patients with FI indicated incontinence at the time of hospice admission (64.5%; n = 4314), with the average onset period being approximately 18 days from admission (mean = 17.9, standard deviation = 50.6). Increasing age represented a risk factor for FI (hazard ratio [HR] = 1.01 [confidence interval, CI = 1.01-1.01]). The absence of a health-care proxy was associated with an increased risk of FI (HR = 1.11 [CI = 1.04-1.19]). Greater risk of FI was observed among patients with dementia (HR = 1.34 [1.24-1.46]) and stroke (HR = 1.42 [1.26-1.60]) compared to patients with cancer. Patients referred to hospice from settings other than the hospital also had a greater risk of FI compared to those referred from the hospital (HR = 1.17 [1.11-1.23]). Conclusion: Fecal incontinence is a highly prevalent condition among home hospice patients and most patients indicated FI upon admission (median time to detection = 18 days). Further studies are needed to identify modifiable risk factors for FI detection and its symptom management in this patient population.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York– Presbyterian Hospital, New York, NY, USA
| | - Dominique Thomas
- Department of Urology, Weill Cornell Medical College, New York– Presbyterian Hospital, New York, NY, USA
| | - David Russell
- Visiting Nurse Service of New York (VNSNY), New York, NY, USA
| | - Veerawat Phongtankuel
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
| | - Kathryn Bowles
- Visiting Nurse Service of New York (VNSNY), New York, NY, USA
- The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Holly Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
- Center for Research on End of Life Care, Weill Cornell Medicine/New York–Presbyterian Hospital, New York, NY, USA
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Bedard K, Heymen S, Palsson OS, Bharucha AE, Whitehead WE. Relationship between symptoms and quality of life in fecal incontinence. Neurogastroenterol Motil 2018; 30:10.1111/nmo.13241. [PMID: 29094789 PMCID: PMC5869683 DOI: 10.1111/nmo.13241] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most measures of fecal incontinence (FI) severity assess the frequency of solid and liquid FI, but may incorporate other features. We compared two scales-the Fecal Incontinence Severity Score (FISS) and Fecal Incontinence Severity Index (FISI)-to determine which questionnaire and which individual questions predict FI Quality of Life (FIQOL). METHODS A national sample of American adults completed a health questionnaire, and 234 with monthly FI were selected. Participants completed assessments of FI severity, FIQOL, and somatization. Stepwise linear regression models evaluated whether FISS and FISI total scores, or individual items on the FISS and FISI predicted FIQOL after adjusting for gender, age, income, and somatization (Brief Symptom Inventory-18). KEY RESULTS Reliable responses were provided by 186. Age was 49 years, and 52% were women. The mean FISS score was 8.4 (95% confidence interval [CI] 8.0-8.9, 13 questions) and mean FISI was 29.9 (95% CI 27.4-32.4, 62 questions), indicating moderate FI severity. The mean FIQOL was 2.6 (95% CI 2.4-2.7, 5 questions). Lower income, greater somatization, and total FISS and FISI scores explained 69% of FIQOL; and total FISS and FISI scores were independent predictors. On the FISS, frequency, amount, and urgency to defecate were independently associated with FIQOL. After adding somatization, all but amount remained significant. For the FISI scale, solid and liquid FI and gas were significant predictors, but adjusting for somatization excluded solid FI. CONCLUSIONS AND INFERENCES Five variables independently explained FIQOL: overall frequency of FI, frequency of liquid and gas leakage, urgency, and somatization.
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Affiliation(s)
| | - Steve Heymen
- Division of Gastroenterology and Hepatology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Olafur S. Palsson
- Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - William E. Whitehead
- Division of Gastroenterology and Hepatology, Center for Functional GI & Motility Disorders, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Nguyen LN, Han E, Wilson A, Gilleran JP. Clinical Factors to Decide Between Sacral Neuromodulation and Onabotulinum Toxin—When Is One Clearly Better? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kadam-Halani PK, Arya LA, Andy UU. Clinical anatomy of fecal incontinence in women. Clin Anat 2017; 30:901-911. [PMID: 28699286 DOI: 10.1002/ca.22951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
Abstract
Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901-911, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Priyanka K Kadam-Halani
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Fecal incontinence is a common disorder, but its pathophysiology is not completely understood. OBJECTIVE The aim of this review is to present animal models that have a place in the study of fecal incontinence. DATA SOURCES A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed in August 2016 revealed 50 articles of interest. Search terms included fecal/faecal incontinence and animal model or specific species. STUDY SELECTION Articles not describing an animal model, in vitro studies, veterinary literature, reviews, and non-English articles were excluded. MAIN OUTCOME MEASURES The articles described models in rats (n = 31), dogs (n = 8), rabbits (n = 7), and pigs (n = 4). RESULTS Different fecal incontinence etiologies were modeled, including anal sphincter lesions (33 articles) ranging from a single anal sphincter cut to destruction of 50% of the anal sphincter by sharp dissection, electrocautery, or diathermy. Neuropathic fecal incontinence (12 articles) was achieved by complete or incomplete pudendal, pelvic, or inferior rectal nerve damage. Mixed fecal incontinence (5 articles) was modeled either by the inflation of pelvic balloons or an array of several lesions including nervous and muscular damage. Anal fistulas (2 articles), anal sphincter resection (3 articles), and diabetic neuropathy (2 articles) were studied to a lesser extent. LIMITATIONS Bias may have arisen from the authors' own work on fecal incontinence and the absence of blinding to the origins of articles. CONCLUSIONS Validated animal models representing the main etiologies of fecal incontinence exist, but no animal model to date represents the whole pathophysiology of fecal incontinence. Therefore, the individual research questions still dictate the choice of model and species.
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Ramage L, Yen C, Qiu S, Simillis C, Kontovounisios C, Tekkis P, Tan E. Functional and quality of life outcomes following obstetric anal sphincter injury (OASI): does the grade of injury affect outcomes? Int Urogynecol J 2017; 28:1709-1717. [PMID: 28523401 PMCID: PMC5655560 DOI: 10.1007/s00192-017-3334-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis The aim of this study was to compare functional and quality of life data in patients with increasing grades of obstetric anal sphincter injury (OASI) presenting to a tertiary colorectal pelvic floor clinic within 24 months of delivery. Methods Prospective data were collected from the patients for the period 2009–2016 and included data on functional outcomes and motor anorectal manometry parameters. The instruments used for the evaluation of functional outcomes were the Birmingham Bowel and Urinary Symptoms Questionnaire, the Wexner Incontinence Score, Short Form 36, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. OASI grade of injury was based on the postdelivery endoanal ultrasound scan. Data from patients with a grade 3a, 3b, 3c or 4 OASI were compared using one-way ANOVA for parametric data and the Kruskal-Wallis test for nonparametric data overall and for separate time periods (3–6 months, 6–12 months, 12–24 months). Results Functional patient data were available in 177 patients: 29 with grade 3a, 55 with grade 3b, 77 with grade 3c and 16 with grade 4 OASI. There was no discernible trend in worsening function with increasing severity of OASI overall, nor for the specified time periods of 3–6 months 58 patients), 6–12 months (85 patients) or 12–24 months (18 patients). Conclusions Our series demonstrated no significant differences in functional outcomes or quality of life in patients with different OASI grades. Longer-term follow-up is required to ascertain any later functional differences which may become apparent with time.
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Affiliation(s)
- Lisa Ramage
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Clarence Yen
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Shengyang Qiu
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Constantinos Simillis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK.
- Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Paris Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
- Department of Colorectal Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Emile Tan
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London NHS Trust, 369 Fulham Road, London, SW10 9NH, UK
- Department of Colorectal Surgery, Singapore General Hospital, Bukit Merah, Republic of Singapore
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67
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Saldana Ruiz N, Kaiser AM. Fecal incontinence - Challenges and solutions. World J Gastroenterol 2017; 23:11-24. [PMID: 28104977 PMCID: PMC5221273 DOI: 10.3748/wjg.v23.i1.11] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
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Saldana Ruiz N, Kaiser AM. Fecal incontinence - Challenges and solutions. World J Gastroenterol 2017; 23:11-24. [PMID: 28104977 DOI: 10.3748/wjg.v23.i1.11] [citation(s)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 08/16/2024] Open
Abstract
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient's self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
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Affiliation(s)
- Nallely Saldana Ruiz
- Nallely Saldana Ruiz, Andreas M Kaiser, Department of Surgery, Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Andreas M Kaiser
- Nallely Saldana Ruiz, Andreas M Kaiser, Department of Surgery, Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
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Sokol ER. Management of fecal incontinence - focus on a vaginal insert for bowel control. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:85-91. [PMID: 27274318 PMCID: PMC4869843 DOI: 10.2147/mder.s86483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence, also referred to as accidental bowel leakage, is a debilitating condition that impacts quality of life in a significant number of women. Current treatments for fecal incontinence include behavioral modification, biofeedback, drug therapy, and invasive surgical procedures. However, these treatments have suboptimal efficacy due to patient adherence, variability of presentation across patients, cost, and additional health risks. A vaginal bowel control system (Eclipse™ System) was developed to offer a low-risk, effective, and patient-managed approach to treating accidental bowel leakage. The vaginal bowel control system consists of a vaginal insert and user-controlled, pressure-regulated pump. Once inflated, the balloon of the vaginal insert is directed posteriorly to occlude the rectum, allowing the woman to immediately regain control of bowel function. This article will introduce the design evolution and feasibility studies of the Eclipse System. In addition, this review will discuss the results from a recent clinical trial that demonstrated the safety and efficacy of the vaginal bowel control system in managing fecal incontinence and other symptoms of bowel dysfunction.
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Affiliation(s)
- Eric R Sokol
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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