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Assmann SL, Keszthelyi D, Breukink SO, Kimman ML. Living with faecal incontinence: a qualitative investigation of patient experiences and preferred outcomes through semi-structured interviews. Qual Life Res 2024:10.1007/s11136-024-03756-3. [PMID: 39143448 DOI: 10.1007/s11136-024-03756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Faecal incontinence (FI) is a prevalent and debilitating anorectal problem causing embarrassment, anxiety, and social isolation, diminishing quality of life. At present there is no optimal treatment option for FI. Consequently, treatments primarily focus on symptom reduction and improving quality of life. Understanding patient experiences and outcomes they seek from treatment is crucial for improving care. This study aims to explore how FI impacts patients' lives and identify important treatment outcomes as part of the development of a Core Outcome Set (COS). METHODS Patients with FI were recruited from outpatient clinics in the Netherlands. Semi-structured interviews were performed, audio recorded, transcribed per verbatim and coded. Thematic analysis was performed to identify (sub)themes and categories relevant to the patients. RESULTS Twelve interviews were conducted before saturation was reached (75% female, 25% male, mean age 63, range 39-83 year). Four main themes emerged 'Physical symptoms', 'Impact on daily life', 'Emotional impact' and 'Coping'. Patients expressed how FI severely limits daily activities and emotional wellbeing. Treatment priorities centred on resuming normal activities rather than solely on symptom reduction. CONCLUSION The impact of FI extends far beyond uncontrolled loss of faeces, affecting psychological, emotional, and social wellbeing. Patients prioritise outcomes focussed on reclaiming normalcy and independence rather than focusing on physical symptoms alone. Integrating these patient-centered outcomes in future studies could enhance treatment satisfaction and patient-perceived treatment success. Furthermore, the outcomes identified in this study can be included in a Delphi survey alongside other relevant outcomes, paving the way for the development of a COS.
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Affiliation(s)
- S L Assmann
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Department of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Research Institute of Nutrition and Translational Research in Metabolism Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - D Keszthelyi
- Department of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Research Institute for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health, Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
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Deprez J, Ohde N, Eilegård Wallin A, Bååth C, Hommel A, Hultin L, Josefson A, Kottner J, Beeckman D. Prognostic factors for the development of incontinence-associated dermatitis (IAD): A systematic review. Int Wound J 2024; 21:e14962. [PMID: 39016196 PMCID: PMC11253026 DOI: 10.1111/iwj.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.
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Affiliation(s)
- Julie Deprez
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Nils Ohde
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Alexandra Eilegård Wallin
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Carina Bååth
- Department of Health SciencesFaculty of Health, Science and Technology, Karlstad UniversityKarlstadSweden
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
| | - Ami Hommel
- Department of Care ScienceMalmö UniversityMalmöSweden
| | - Lisa Hultin
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Anna Josefson
- School of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Department of DermatologyÖrebro University HospitalÖrebroSweden
| | - Jan Kottner
- Institute of Clinical Nursing ScienceCharité UniversitätsmedizinBerlinGermany
| | - Dimitri Beeckman
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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Assmann SL, Mulders E, Kimman ML, Keszthelyi D, Breukink SO. Toward a core outcome set for faecal incontinence-A systematic review of outcomes reported in the literature. Colorectal Dis 2024. [PMID: 38923161 DOI: 10.1111/codi.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/25/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
AIM Faecal incontinence (FI) is a prevalent issue which can have a detrimental impact on the patient's quality of life. Current international guidelines lack strong treatment recommendations due to few studies in the field, in combination with the heterogeneity in outcome reporting. To address this, a core outcome set (COS) is proposed to standardize outcome reporting in FI studies, facilitating meta-analyses and enhancing therapeutic recommendations. Through several steps outlined by COMET 'what' to measure will be determined prior to determining 'how' to measure these outcomes. This systematic review aims to identify 'what' outcomes have been used in FI intervention studies so far in adult patients as a starting phase for the development of a future COS for FI. METHOD Medline, Embase and the Cochrane library were searched to identify all outcomes reported in comparative effectiveness trials assessing one or more treatment option in adult patients suffering from FI. The outcomes were categorized according to the Core Outcome Measurement in Effectiveness Trials (COMET) taxonomy to standardize outcome terminology, assess completeness, and inform subsequent steps in COS development. RESULTS A total of 109 studies were included, which revealed 51 unique outcomes classified into 38 domains within four core areas. On average four outcomes were reported per study (range 1-11). The most commonly reported outcomes were "severity of FI" (83%), "quality of life" (64%), "number of FI episodes" (40%), "anorectal motor function" (39%), and "frequency of bowel movements" (16%). CONCLUSION This systematic review offers an overview of outcomes reported in FI studies, highlighting the heterogeneity between studies. This heterogeneity emphasizes the need for standardizing outcome reporting which can be established through the creation of a COS.
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Affiliation(s)
- Sadé L Assmann
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Evy Mulders
- Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Department of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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ten Hoor MB, Trzpis M, Broens PM. The Severity of Fecal Problems Is Negatively Associated With Quality of Life in a Dutch Population Without Bowel Function Comorbidities. Dis Colon Rectum 2024; 67:448-456. [PMID: 37962140 PMCID: PMC10846588 DOI: 10.1097/dcr.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Constipation and fecal incontinence negatively influence quality of life. The association between the severity of fecal problems and quality of life has not been investigated in the general population without bowel function comorbidities. OBJECTIVE To investigate the association between the severity of constipation and fecal incontinence and quality of life in patients without comorbidities influencing bowel function. DESIGN A population-based, cross-sectional study. SETTINGS The study involved 3668 Dutch study participants. PATIENTS A survey company conducted a population-wide study of the general Dutch population. Altogether, 5000 Dutch citizens completed the Groningen Defecation and Fecal Continence and Short Form-36 questionnaires. The data on 3668 respondents without comorbidities that could influence bowel function were included for analysis (study group). MAIN OUTCOME MEASURES The severity of constipation (Agachan score) and fecal incontinence (Wexner score) in relation to the quality-of-life scores. RESULTS In the study group (n = 3668), 487 had constipation (13.3%), 116 had fecal incontinence (3.2%), and 64 had 2 coexisting fecal problems (1.7%). In the multivariable analysis, all quality-of-life domains were negatively associated with the severity of constipation and fecal incontinence. The associations between the severity of constipation and quality of life were stronger (highest: ß = -2.413; 95% CI, -2.681 to -2.145; p < 0.001) than those of fecal incontinence (highest: ß = -1.280; 95% CI, -1.681 to -.880; p < 0.001). We also found that a longer duration of bowel complaints coincided with higher severity scores, especially for constipation. Respondents mostly rated their defecation health as positive, regardless of the severity of their fecal problems. LIMITATIONS Cross-sectional design. CONCLUSIONS The severity of constipation and fecal incontinence is significantly associated with reduced quality of life, with the severity of constipation having stronger associations than fecal incontinence. Given respondents' unawareness of their fecal problems and the progressive character, timely intervention is advocated. See Video Abstract . LA GRAVEDAD DE LOS PROBLEMAS FECALES SE ASOCIA NEGATIVAMENTE CON LA CALIDAD DE VIDA EN UNA POBLACIN HOLANDESA SIN COMORBILIDADES DE LA FUNCIN INTESTINAL ANTECEDENTES:El estreñimiento y la incontinencia fecal influyen negativamente en la calidad de vida. La asociación entre la gravedad de los problemas fecales y la calidad de vida no se ha investigado en la población general sin comorbilidades de la función intestinal.OBJETIVO:Investigar la asociación entre la gravedad del estreñimiento y la incontinencia fecal y la calidad de vida en la población holandesa general sin comorbilidades que influyan en la función intestinal.DISEÑO:Estudio transversal de base poblacional.ENTORNO CLINICO:El estudio involucró a 3668 participantes holandeses.PACIENTES:Una empresa de encuestas realizó un estudio poblacional de la población holandesa en general. En total, 5.000 ciudadanos holandeses completaron los cuestionarios Groningen Defecation and Fecal Continence y Short-Form 36. Se incluyeron para el análisis los datos de 3668 encuestados sin comorbilidades que pudieran influir en la función intestinal (grupo de estudio).PRINCIPALES MEDIDAS DE RESULTADO:La gravedad del estreñimiento (puntuación de Agachan) y la incontinencia fecal (puntuación de Wexner) en relación con las puntuaciones de calidad de vida.RESULTADOS:En el grupo de estudio (n = 3668), 487 tenían estreñimiento (13,3%), 116 tenían incontinencia fecal (3,2%) y 64 tenían 2 problemas fecales coexistentes (1,7%). En el análisis multivariable, todos los dominios de calidad de vida se asociaron negativamente con la gravedad del estreñimiento y la incontinencia fecal. Las asociaciones entre la gravedad del estreñimiento y la calidad de vida fueron más fuertes (más alta: ß = -2,413; IC del 95 %, -2,681 a -2,145; p < 0,001) que las de la incontinencia fecal (más alta: ß = -1,280; 95 IC %: -1,681 a -0,880; p < 0,001). También encontramos que una mayor duración de las molestias intestinales coincidió con puntuaciones de gravedad más altas, especialmente para el estreñimiento. La mayoría de los encuestados calificaron su salud en la defecación como positiva, independientemente de la gravedad de sus problemas fecales.LIMITACIONES:Diseño transversal.CONCLUSIONES:La gravedad del estreñimiento y la incontinencia fecal se asocia significativamente con una calidad de vida reducida; la gravedad del estreñimiento tiene asociaciones más fuertes que la incontinencia fecal. Dado el desconocimiento de los encuestados sobre sus problemas fecales y el carácter progresivo, se recomienda una intervención oportuna. (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Maaike B.C. ten Hoor
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Liptak P, Duricek M, Banovcin P. Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step. World J Gastroenterol 2024; 30:516-522. [PMID: 38463021 PMCID: PMC10921147 DOI: 10.3748/wjg.v30.i6.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024] Open
Abstract
The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023; 29: 4593-4603. This original research presents a new scoring system for fecal incontinence. Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients. Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further mismanagement or non-existent management of the disease. An important fact is that patients are often unable to describe their condition when not asked precisely defined questions. This problem is partially resolved by scoring questionnaires. Several scoring systems are commonly used; however, each of them has their shortcomings. For example, the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity. Therefore, there has long been a call for a more precise scoring system. The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option. This editorial describes fecal incontinence, its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.
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Affiliation(s)
- Peter Liptak
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
| | - Martin Duricek
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
| | - Peter Banovcin
- Clinic of Internal Medicine- Gastroenterology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University, Martin 03601, Slovakia
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Tahmasbi F, Mosaddeghi-Heris R, Soleimanzadeh F, Ghaderpanah R, Sadrian S, Hajebrahimi S, Salehi-Pourmehr H. Effects of Posterior Tibial Nerve Stimulation on Fecal Incontinence: An Umbrella Review. Neuromodulation 2024; 27:229-242. [PMID: 37452797 DOI: 10.1016/j.neurom.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study aimed to summarize relevant data from previous systematic reviews (SRs) and conduct comprehensive research on the clinical effects of posterior tibial nerve stimulation (PTNS), via the transcutaneous posterior tibial nerve stimulation (TPTNS) or percutaneous posterior tibial nerve stimulation (PPTNS) method on fecal incontinence (FI). MATERIALS AND METHODS In adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search was conducted on PubMed, Embase, Scopus, and Web of Science databases. We included English-language, full-text SRs reporting outcomes for FI following either PPTNS or TPTNS. The quality of included studies was assessed using the Joanna Briggs Institute checklist. In addition, reanalyzing the meta-analyses was conducted using Comprehensive Meta-Analysis (CMA) software version 3.0 to achieve effect sizes and the level of statistical significance was set at p ≤ 0.05. RESULTS From a total of 835 citations, 14 SRs met our inclusion criteria. Four of these also conducted a meta-analysis. Most SRs reported an overall improvement in different study parameters, including bowel habits and quality of life. However, there were major inconsistencies across the results. The most studied outcome was FI episodes, followed by incontinence score. The summary outcomes showed no statistically significant changes in comparing PTNS with sham or sacral nerve stimulation (SNS) for FI (p > 0.05). However, the results of subgroup analysis based on the type of intervention in the control group revealed that FI episodes were significantly fewer than in the PTNS arm, whereas PTNS led to fewer episodes of FI than did the sham. In terms of incontinence score, the results showed that PTNS compared with sham did not change the incontinence score; however, SNS improved the score significantly in one eligible study for reanalysis when compared with PTNS (p < 0.001). CONCLUSIONS The findings of the current umbrella review suggest that PTNS can potentially benefit patients with FI. However, this is concluded from studies with a limited population, disregarding the etiology of FI and with limited follow-up duration. Therefore, caution must be taken in contemplating the results.
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Affiliation(s)
- Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzin Soleimanzadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rezvan Ghaderpanah
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SeyedHassan Sadrian
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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Spampinato S, Rancati T, Waskiewicz JM, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Cante D, Girelli G, Gatti M, Noris Chiorda B, Rago L, Ferrari P, Piva C, Pavarini M, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Kirchheiner K, Fiorino C, Cozzarini C. Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors. Acta Oncol 2023; 62:1440-1450. [PMID: 37801288 DOI: 10.1080/0284186x.2023.2259597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). MATERIALS AND METHODS Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. RESULTS The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. CONCLUSIONS The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
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Affiliation(s)
- Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Tiziana Rancati
- Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Adriana Faiella
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Elisa Villa
- Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Magli
- Department of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Domenico Cante
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Giuseppe Girelli
- Department of Radiotherapy, Ospedale degli Infermi, Biella, Italy
| | - Marco Gatti
- Department of Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Barbara Noris Chiorda
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciana Rago
- Department of Radiotherapy, IRCCS CROB, Rionero in Vulture, Italy
| | - Paolo Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Cristina Piva
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Fernando Munoz
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute and Università Vita Salute San Raffaele, Milan, Italy
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Deprez J, Kottner J, Eilegård Wallin A, Ohde N, Bååth C, Hommel A, Hultin L, Josefson A, Beeckman D. What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e073115. [PMID: 37429690 DOI: 10.1136/bmjopen-2023-073115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research. METHODS AND ANALYSIS This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance. ETHICS AND DISSEMINATION No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Julie Deprez
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan Kottner
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany
| | - Alexandra Eilegård Wallin
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Ohde
- Institute of Clinical Nursing Science, Charité Universitätsmedizin, Berlin, Germany
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Faculty of Health, Welfare and Organisation, Østfold University College - Campus Frederikstad, Fredrikstad, Norway
| | - Ami Hommel
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Lisa Hultin
- Department of Public Health and Caring Sciences, Upsalla University, Upsalla, Sweden
- Upsalla University Hospital, Upsalla, Sweden
| | - Anna Josefson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Dermatology, Örebro University Hospital, Örebro, Sweden
| | - Dimitri Beeckman
- Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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9
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Goodoory VC, Ng CE, Black CJ, Ford AC. Prevalence and impact of faecal incontinence among individuals with Rome IV irritable bowel syndrome. Aliment Pharmacol Ther 2023; 57:1083-1092. [PMID: 36914979 DOI: 10.1111/apt.17465] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Little is known about faecal incontinence (FI) in individuals with irritable bowel syndrome (IBS). AIMS To compare characteristics of people with IBS reporting FI, compared with people with IBS who do not report FI. METHODS We collected demographic, gastrointestinal and psychological symptoms, healthcare usage, direct healthcare costs, impact on work and activities of daily living, and quality of life data from individuals with Rome IV-defined IBS. We asked participants about FI, assigning presence or absence according to Rome-IV criteria. RESULTS Of 752 participants with Rome IV IBS, 202 (26.9%) met Rome IV criteria for FI. Individuals with FI were older (p < 0.001), more likely to have IBS-D (47.0% vs. 39.0%, p = 0.008), and less likely to have attained a university or postgraduate level of education (31.2% vs. 45.6%, p < 0.001), or to have an annual income of ≥£30,000 (18.2% vs. 32.9%, p < 0.001). They were more likely to report urgency (44.6% vs. 19.1%, p < 0.001) as their most troublesome symptom and a greater proportion had severe IBS symptom scores, abnormal depression scores, higher somatic symptom-reporting scores or higher gastrointestinal symptom-specific anxiety scores (p < 0.01 for trend for all analyses). Mean health-related quality of life scores were significantly lower among those with, compared with those without, FI (p < 0.001). Finally, FI was associated with higher IBS-related direct healthcare costs (p = 0.002). CONCLUSIONS Among individuals with Rome IV IBS, one-in-four repo rted FI according to Rome IV criteria. Physicians should ask patients with IBS about FI routinely.
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Affiliation(s)
- Vivek C Goodoory
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Cho E Ng
- County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Christopher J Black
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
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10
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Yates A. Identification, assessment and treatment of urinary incontinence and bowel control issues. Nurs Stand 2023; 38:75-82. [PMID: 36794519 DOI: 10.7748/ns.2023.e11977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 02/17/2023]
Abstract
Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.
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Affiliation(s)
- Ann Yates
- Cardiff and Vale University Health Board, St David's Hospital, Cardiff, Wales
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11
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Cunich M, Barakat-Johnson M, Lai M, Arora S, Church J, Basjarahil S, Campbell JL, Disher G, Geering S, Ko N, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: A systematic review. Int J Nurs Stud 2022; 129:104216. [PMID: 35364428 DOI: 10.1016/j.ijnurstu.2022.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Incontinence-associated dermatitis is a common, under-recognized painful skin condition associated with poorer quality of life, increased nurse workloads, and costs. OBJECTIVE To systematically review economic evidence for the prevention and treatment of incontinence-associated dermatitis. DESIGN Systematic review of quantitative research. DATA SOURCES PubMed, MEDLINE, EMBASE, Cochrane Library, York Centre for Reviews and Dissemination database, Econlit, Tufts' Cost-Effectiveness Analysis Registry, and Web of Science. REVIEW METHODS A comprehensive search for studies on resource use (costs), health outcomes, and cost-effectiveness of interventions for incontinence-associated dermatitis was conducted. Screening, data extraction, and initial quality assessment were conducted independently by two reviewers, with disagreements/queries regarding quality settled through consensus with the larger team. Quality evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist and results narratively arranged. FINDINGS Seventeen studies (10 for prevention, one for treatment and six for both prevention and treatment) included. All studies measured resource use from a healthcare provider perspective; 14 quantified resources in monetary terms. Considerable variation existed in the resource use data primarily due to differences in the type of resources counted, selected time horizons, valuation methods, and reporting approaches. Ten studies provided evidence of their intervention to be cost saving (or at least cost avoiding). Five studies on barrier products provided evidence to be cost saving: three for prevention, one for treatment, and one for both prevention and treatment. Two studies of cleanser and barrier products provided evidence to be cost saving for the prevention and treatment of incontinence-associated dermatitis. One study found a cleanser to be a cost saving preventative intervention. One bowel management system was found to be cost saving over time only, and one nurse education intervention was found to be cost saving for preventing and treating incontinence-associated dermatitis. One barrier product was found to be cost-effective for preventing and treating the condition. Finally, one study found a cleanser and barrier product was time saving for prevention. None of the studies incorporated a multi-attribute quality of life measure; however, two studies included person-reported outcome measures for pain. A narrow range of resources (mainly products) were considered, and there was limited information on how they were counted and valued. Analyses relating to heterogeneity among patients/hospital wards or health facilities and uncertainty were lacking. CONCLUSIONS Barrier products are possibly a more cost-effective treatment than others; however, this evidence lacks certainty. Structured health economic evaluations are required for a reliable evidence-base on the interventions for incontinence-associated dermatitis. TWEETABLE ABSTRACT Most incontinence-associated dermatitis studies lack person-reported outcomes, costs beyond product/staff time, and economic evaluation.
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Affiliation(s)
- Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, New South Wales, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Sydney Health Economics Collaborative, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia.
| | - Michelle Barakat-Johnson
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Michelle Lai
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Jody Church
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Jayne L Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia.
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, Sydney, New South Wales, Australia.
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia.
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia.
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Joan Walsh
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Cancer Care Research Unit, Sydney Local Health District, Sydney, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, New South Wales, Australia.
| | - Fiona Coyer
- Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
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12
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Walter S, Jones MP, Sjödahl J, Stjernman H, Hjortswang H, Andreasson A. Measuring the impact of gastrointestinal inconvenience and symptoms on perceived health in the general population - validation of the Short Health Scale for gastrointestinal symptoms (SHS-GI). Scand J Gastroenterol 2021; 56:1406-1413. [PMID: 34521305 DOI: 10.1080/00365521.2021.1974087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) symptoms are intimately related to our wellbeing. The Short Health Scale for GI symptoms (SHS-GI) is a simple questionnaire to measure the impact of GI inconvenience and symptoms on quality of life. The aim was to validate the SHS-GI in a general population sample and to compare it with SHS-data across different patient groups. METHOD A subsample of 170 participants from a population-based colonoscopy study completed the Rome II questionnaire, GI diaries, psychological questionnaire (hospital anxiety and depression scale) and SHS-GI at follow-up investigation. Psychometric properties of SHS-GI as an overall score were determined by performing a confirmatory factor analysis (CFA). Spearman correlation between SHS total score and symptoms was calculated in the general population sample. SHS-GI data was compared with SHS data from patients with inflammatory bowel disease (IBD) and fecal incontinence (FI). RESULTS As expected, the general population rated their impact of GI inconvenience on quality of life as better than the patient populations in terms of all aspects of the SHS-GI. The CFA showed a good model fit meeting all fit criteria in the general population. Cronbach's alpha for the total scale was 0.80 in the general population sample and ranged from 0.72 in the FI sample to 0.88 and 0.89 in the IBD samples. CONCLUSIONS SHS-GI demonstrated appropriate psychometric properties in a sample of the normal population. We suggest that SHS-GI is a valid simple questionnaire suitable for measuring the impact of GI symptoms and inconvenience on quality of life in both general and patient populations.
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Affiliation(s)
- Susanna Walter
- Department of Biomedical and Clinical Sciences (BKV), Division of Inflammation and Infection, Linkoping University, Linkoping, Sweden.,Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, Australia
| | - Jenny Sjödahl
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Ryhov Hospital Jönköping, Jönköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Anna Andreasson
- School of Psychological Sciences, Macquarie University, North Ryde, Australia.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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13
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Lucente G, Corral J, Rodríguez-Esparragoza L, Castañer S, Ortiz H, Piqueras A, Broto J, Hernández-Pérez M, Domenech S, Martinez-Piñeiro A, Serra J, Almendrote M, Parés D, Millán M. Current Incidence and Risk Factors of Fecal Incontinence After Acute Stroke Affecting Functionally Independent People. Front Neurol 2021; 12:755432. [PMID: 34790163 PMCID: PMC8591097 DOI: 10.3389/fneur.2021.755432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke. Methods: We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged >18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected. Results: Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14-22) vs. 5 (3-13), p < 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7-60.1) adjusted for covariates. Conclusions: At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.
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Affiliation(s)
- Giuseppe Lucente
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Javier Corral
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis Rodríguez-Esparragoza
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Castañer
- Institut de Diagnostic per Imatge (IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Hector Ortiz
- Department of Project and Construction Engineering (EPC), Universitat Politècnica de Catalunya, Barcelona, Spain
- Department of Engineering Design, Universitat Politècnica de Barcelona, Barcelona, Spain
| | - Anna Piqueras
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquim Broto
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - María Hernández-Pérez
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sira Domenech
- Institut de Diagnostic per Imatge (IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alicia Martinez-Piñeiro
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Serra
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Miriam Almendrote
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - David Parés
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mònica Millán
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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14
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Emile SH, El-Said M. End-to-end anal Sphincter Repair in Treatment of Post-traumatic Fecal Incontinence. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1735543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe present report describes the end-to-end technique of anal sphincter repair in a 36-year-old female patient with post-vaginal delivery fecal incontinence (FI). The patient had a history of two vaginal deliveries and the symptoms of FI were observed after the second delivery. On assessment of the severity of FI using the Wexner incontinence score, the patient had a score of 12. Endoanal ultrasonography revealed an anterior defect of the external anal sphincter extending from 11 to 3 o'clock. The patient had no previous anal surgery and did not have any medical comorbidities.The operation time was 45 minutes. No intraoperative complications were recorded. At 12 months of follow-up, the patient showed significant improvement in the continence state, with her Wexner score dropping to 4. No postoperative complications were recorded. We can conclude that end-to-end anal sphincter repair is a technically feasible operation that confers satisfactory improvement in the continence state without imposing much tension on the site of sphincter repair.
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Affiliation(s)
- Sameh Hany Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - Mohamed El-Said
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
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15
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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16
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Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study. Geriatr Nurs 2021; 42:433-439. [PMID: 33684628 DOI: 10.1016/j.gerinurse.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 01/02/2023]
Abstract
Although incontinence is common in hospital, the prevalence and predictors of continence aid use (continence wear and catheters) are poorly described. A one-day cross-sectional study was conducted in a large university hospital assessing consecutive inpatients (≥55) for their pre-admission and current use of continence aids. Barthel Index, Clinical Frailty Scale and Charlson Co-morbidity scores were recorded. Appropriateness was defined by local guidelines. 355 inpatients, median age 75±17 years, were included; 53% were male. Continence aid use was high; prevalence was 46% increasing to 58% for those ≥75. All-in-one pads were the most common, an overall prevalence of 31%. Older age, lower Barthel and higher frailty scores were associated with continence aid use in multivariate analysis. Inappropriate use of aids was high at 45% with older age being the only independent predictor. Continence aids are often used inappropriately during hospitalisation by older patients. Concerted efforts are required to address this issue.
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17
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Assmann S, Keszthelyi D, Kleijnen J, Kimman M, Anastasiou F, Bradshaw E, Carrington E, Chiarioni G, Maeda Y, Muris J, Pohl D, Rydningen M, Vaizey C, Breukink S. The development of a faecal incontinence core outcome set: an international Delphi study protocol. Int J Colorectal Dis 2021; 36:617-622. [PMID: 33532899 PMCID: PMC7895769 DOI: 10.1007/s00384-021-03865-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Faecal incontinence (FI) is estimated to affect around 7.7% of people. There is a lack of uniformity in outcome definitions, measurement and reporting in FI studies. Until now, there is no general consensus on which outcomes should be assessed and reported in FI research. This complicates comparison between studies and evidence synthesis, potentially leading to recommendations not evidence-based enough to guide physicians in selecting an FI therapy. A solution for this lack of uniformity in reporting of outcomes is the development of a Core Outcome Set (COS) for FI. This paper describes the protocol for the development of a European COS for FI. METHODS Patient interviews and a systematic review of the literature will be performed to identify patient-, physician- and researcher-oriented outcomes. The outcomes will be categorised using the COMET taxonomy and put forward to a group of patients, physicians (i.e. colorectal surgeons, gastroenterologists and general practitioners) and researchers in a Delphi consensus exercise. This exercise will consist of up to three web-based rounds in which participants will prioritise and condense the list of outcomes, which is expected to result in consensus. A consensus meeting with participants from all stakeholder groups will take place to reach a final agreement on the COS. DISCUSSION This study protocol describes the development of a European COS to improve reliability and consistency of outcome reporting in FI studies, thereby improving evidence synthesis and patient care. TRIAL REGISTRATION This project has been registered in the COMET database on the 1st of April 2020, available at http://www.comet-initiative.org/Studies/Details/1554 . The systematic review has been registered on the PROSPERO database on the 31st of August 2020, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=202020&VersionID=1381336 .
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Affiliation(s)
- Sadé Assmann
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Jos Kleijnen
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Foteini Anastasiou
- 4rth TOMY - Academic Primary Care Unit Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | - Elissa Bradshaw
- Community Gastroenterology Specialist Nurse, Royal Free Hospital, London, England
| | - Emma Carrington
- Surgical Professorial Unit, Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, AOUI Verona, Verona, Italy
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yasuko Maeda
- Department of Surgery and Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Jean Muris
- Department of General Practice, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Daniel Pohl
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Mona Rydningen
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, Tromsø, Norway
| | | | - Stephanie Breukink
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
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Grott M, Rickert A, Hetjens S, Kienle P. Clinical outcome and quality of life after gracilis muscle transposition for fistula closure over a 10-year period. Int J Colorectal Dis 2021; 36:569-580. [PMID: 33386945 DOI: 10.1007/s00384-020-03825-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options have failed. There is little evidence on the success rate of this procedure in the long term. METHODS This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function. RESULTS Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (n = 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months). CONCLUSION GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.
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Affiliation(s)
- M Grott
- Department of Thoracic Surgery, Thoraxklinik Heidelberg University, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - A Rickert
- Department of Surgery, St. Josefskrankenhaus Heidelberg, Akademisches Lehrkrankenhaus der Medizinischen Fakultät Mannheim der Universität Heidelberg, Landhausstraße 25, 69115, Heidelberg, Germany
| | - S Hetjens
- Department for Medical Statistics and Biomathematics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberg University, Bassermannstraße 1, 68165, Mannheim, Germany.
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Barakat-Johnson M, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Lai M, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Implementing best available evidence into practice for incontinence-associated dermatitis in Australia: A multisite multimethod study protocol. J Tissue Viability 2021; 30:67-77. [PMID: 33158742 DOI: 10.1016/j.jtv.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Abstract
AIMS Incontinence-associated dermatitis (IAD) is an insidious and under-reported hospital-acquired complication which substantially impacts on patients' quality of life. A published international guideline and the Ghent Global IAD Categorisation Tool (GLOBIAD) outline the best available evidence for the optimal management of IAD. This study aims to implement theguideline and the GLOBIAD tool and evaluate the effect on IAD occurrences and sacral pressure injuries as well as patient, clinician and cost-effectiveness outcomes. MATERIALS AND METHODS The study will employ a multi-method design across six hospitals in five health districts in Australia, and will be conducted in three phases (pre-implementation, implementation and post-implementation) over 19 months. Data collection will involve IAD and pressure injury prevalence audits for patient hospital admissions, focus groups with, and surveys of, clinicians, patient interviews, and collection of the cost of IAD hospital care and patient-related outcomes including quality of life. Eligible participants will be hospitalised adults over 18 years of age experiencing incontinence, and clinicians working in the study wards will be invited to participate in focus groups and surveys. CONCLUSION The implementation of health district-wide evidence-based practices for IAD using a translational research approach that engages key stakeholders will allow the standardisation of IAD care that can potentially be applicable to a range of settings. Knowledge gained will inform future practice change in patient care and health service delivery and improve the quality of care for patients with IAD. Support at the hospital, state and national levels, coupled with a refined stakeholder-inclusive strategy, will enhance this project's success, sustainability and scalability beyond this existing project.
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Affiliation(s)
- Michelle Barakat-Johnson
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Jayne Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, Ground Floor, Officers Quarters, James Fletcher Campus, 72 Watt Street, Newcastle, New South Wales, 2300, Australia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2006, Australia; Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, New South Wales, 2050, Australia
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, 1 Reserve Road, St Leonards, New South Wales, 2065, Australia
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, Eastern Campus, Liverpool Hospital, Scrivener Street, Warrick Farm, New South Wales, 2170, Australia
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Level 4, Building 75, Hospital Road, Concord, New South Wales, 2139, Australia
| | - Michelle Lai
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, Building 3, Bloomfield Campus, Forest Road, Orange, New South Wales, 2800, Australia
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Level 7, King George V Building, 83-117 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Joan Walsh
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Kate White
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Fiona Coyer
- School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Clinical Outcomes, Safety and Implementation Research Program, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
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20
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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21
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Tejedor P, Bodega-Quiroga I, Plaza J, Ortega López M, Gutierrez C, García Olmo D, Pastor C. Quality of life and 3D-EUS assessment for anal incontinence after childbirth. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:453-459. [PMID: 31021166 DOI: 10.17235/reed.2019.6040/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth. METHODS a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS. RESULTS a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8). CONCLUSIONS AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.
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Affiliation(s)
- Patricia Tejedor
- Department of Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Javier Plaza
- Department of Gynaecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Mario Ortega López
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Damian García Olmo
- Cirugía General y Digestivo, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Carlos Pastor
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
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22
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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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23
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Dadhich P, Bohl JL, Tamburrini R, Zakhem E, Scott C, Kock N, Mitchell E, Gilliam J, Bitar KN. BioSphincters to treat Fecal Incontinence in Nonhuman Primates. Sci Rep 2019; 9:18096. [PMID: 31792260 PMCID: PMC6888838 DOI: 10.1038/s41598-019-54440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023] Open
Abstract
Loss of anorectal resting pressure due to internal anal sphincter (IAS) dysfunctionality causes uncontrolled fecal soiling and leads to passive fecal incontinence (FI). The study is focused on immediate and long-term safety and potential efficacy of bioengineered IAS BioSphincters to treat passive FI in a clinically relevant large animal model of passive FI. Passive FI was successfully developed in Non-Human Primates (NHPs) model. The implantation of autologous intrinsically innervated functional constructs resolved the fecal soiling, restored the resting pressure and Recto Anal Inhibitory Reflex (RAIR) within 1-month. These results were sustained with time, and efficacy was preserved up to 12-months. The histological studies validated manometric results with the regeneration of a well-organized neuro-muscular population in IAS. The control groups (non-treated and sham) remained affected by poor anal hygiene, lower resting pressure, and reduced RAIR throughout the study. The pathological assessment of implants, blood, and the vital organs confirmed biocompatibility without any adverse effect after implantation. This regenerative approach of implanting intrinsically innervated IAS BioSphincters has the potential to offer a better quality of life to the patients suffering from FI.
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Affiliation(s)
- Prabhash Dadhich
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
- Program in Neuro-Gastroenterology and Motility, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jaime L Bohl
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Riccardo Tamburrini
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Elie Zakhem
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
- Program in Neuro-Gastroenterology and Motility, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Christie Scott
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Nancy Kock
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Erin Mitchell
- Animal Resources Program, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - John Gilliam
- Section on Gastroenterology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Khalil N Bitar
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA.
- Program in Neuro-Gastroenterology and Motility, Wake Forest School of Medicine, Winston Salem, NC, USA.
- Section on Gastroenterology, Wake Forest School of Medicine, Winston Salem, NC, USA.
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA.
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24
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Gallo G, Sammarco G. Functional Assessment on IBD Patients: Is It A Must or Is It A Dust? J INVEST SURG 2019; 34:554-555. [PMID: 31661329 DOI: 10.1080/08941939.2019.1679294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
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25
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Mundet L, Cabib C, Ortega O, Rofes L, Tomsen N, Marin S, Chacón C, Clavé P. Defective Conduction of Anorectal Afferents Is a Very Prevalent Pathophysiological Factor Associated to Fecal Incontinence in Women. J Neurogastroenterol Motil 2019; 25:423-435. [PMID: 31177647 PMCID: PMC6657934 DOI: 10.5056/jnm18196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/01/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Fecal incontinence (FI) is a prevalent condition among women. While biomechanical motor components have been thoroughly researched, anorectal sensory aspects are less known. We studied the pathophysiology of FI in community-dwelling women, specifically, the conduction through efferent/afferent neural pathways. Methods A cross-sectional study was conducted on 175 women with FI and 19 healthy volunteers. The functional/structural study included anorectal manometry/endoanal ultrasound. Neurophysiological studies including pudendal nerve terminal motor latency (PNTML) and sensory-evoked-potentials to anal/rectal stimulation (ASEP/RSEP) were conducted on all healthy volunteers and on 2 subgroups of 42 and 38 patients, respectively. Results The main conditions associated with FI were childbirth (79.00%) and coloproctological surgery (37.10%). Cleveland score was 11.39 ± 4.09. Anorectal manometry showed external anal sphincter and internal anal sphincter insufficiency in 82.85% and 44.00%, respectively. Sensitivity to rectal distension was impaired in 27.42%. Endoanal ultrasound showed tears in external anal sphincter (60.57%) and internal anal sphincter disruptions (34.80%). Abnormal anorectal sensory conduction was evidenced through ASEP and RSEP in 63.16% and 50.00% of patients, respectively, alongside reduced activation of brain cortex to anorectal stimulation. In contrast, PNTML was delayed in only 33.30%. Stools were loose/very loose in 56.70% of patients. Conclusions Pathophysiology of FI in women is mainly associated with mechanical sphincter dysfunctions related to either muscle damage or, to a lesser extent, impaired efferent conduction at pudendal nerves. Impaired conduction through afferent anorectal pathways is also very prevalent in women with FI and may play an important role as a pathophysiological factor and as a potential therapeutic target.
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Affiliation(s)
- Lluís Mundet
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - Christopher Cabib
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain
| | - Omar Ortega
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - Laia Rofes
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - Noemí Tomsen
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain
| | - Sergio Marin
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain
| | - Carla Chacón
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain
| | - Pere Clavé
- Unitat d'Exploracions Funcionals Digestives, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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26
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Petty RKH, Eugenicos MP, Hamilton MJ, Farrugia ME, Robb Y, Ballantyne R, Gregory H, McWilliam C, Longman C. The prevalence of faecal incontinence in myotonic dystrophy type 1. Neuromuscul Disord 2019; 29:562-566. [PMID: 31266721 DOI: 10.1016/j.nmd.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
Faecal incontinence is recognised as a feature of myotonic dystrophy along with other symptoms of bowel dysfunction, but its prevalence is poorly defined. We have surveyed 152 unselected myotonic dystrophy patients. We identified issues with bowel control in 104 (68% of the study population). Forty-eight (32%) reported faecal incontinence in the 4 weeks prior to completion of the questionnaire. Fifty-six patients (37%) reported having to change their lifestyle because of incontinence issues at some point in the prior 4 weeks. This study shows a high frequency of life-changing symptoms in a large unselected, cohort of patients with myotonic dystrophy type 1, and highlights lower gastrointestinal symptoms as an important issue for further research.
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Affiliation(s)
- R K H Petty
- South East of Scotland Clinical Genetic Services, Molecular Medicine Centre, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.
| | - M P Eugenicos
- Department of Gastroenterology, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
| | - M J Hamilton
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - M E Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Y Robb
- South East of Scotland Clinical Genetic Services, Molecular Medicine Centre, Western General Hospital, Edinburgh EH4 2XU, United Kingdom
| | - R Ballantyne
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - H Gregory
- Department of Medical Genetics, Grampian University Hospital, Aberdeen AB25 2ZA, United Kingdom
| | - C McWilliam
- Human Genetics Unit, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
| | - C Longman
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
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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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28
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Meinds RJ, van der Steeg AFW, Sloots CEJ, Witvliet MJ, de Blaauw I, van Gemert WG, Trzpis M, Broens PMA. Long-term functional outcomes and quality of life in patients with Hirschsprung's disease. Br J Surg 2019; 106:499-507. [PMID: 30653654 PMCID: PMC6590339 DOI: 10.1002/bjs.11059] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND It is unclear whether functional outcomes improve or deteriorate with age following surgery for Hirschsprung's disease. The aim of this cross-sectional study was to determine the long-term functional outcomes and quality of life (QoL) in patients with Hirschsprung's disease. METHODS Patients with pathologically proven Hirschsprung's disease older than 7 years were included. Patients with a permanent stoma or intellectual disability were excluded. Functional outcomes were assessed according to the Rome IV criteria using the Defaecation and Faecal Continence questionnaire. QoL was assessed by means of the Child Health Questionnaire Child Form 87 or World Health Organization Quality of Life questionnaire 100. Reference data from healthy controls were available for comparison. RESULTS Of 619 patients invited, 346 (55·9 per cent) responded, with a median age of 18 (range 8-45) years. The prevalence of constipation was comparable in paediatric and adult patients (both 22·0 per cent), and in patients and controls. Compared with controls, adults with Hirschsprung's disease significantly more often experienced straining (50·3 versus 36·1 per cent; P = 0·011) and incomplete evacuation (47·4 versus 27·2 per cent; P < 0·001). The prevalence of faecal incontinence, most commonly soiling, was lower in adults than children with Hirschsprung's disease (16·8 versus 37·6 per cent; P < 0·001), but remained higher than in controls (16·8 versus 6·1 per cent; P = 0·003). Patients with poor functional outcomes scored significantly lower in several QoL domains. CONCLUSION This study has shown that functional outcomes are better in adults than children, but symptoms of constipation and soiling persist in a substantial group of adults with Hirschsprung's disease. The persistence of defaecation problems is an indication that continuous care is necessary in this specific group of patients.
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Affiliation(s)
- R. J. Meinds
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - A. F. W. van der Steeg
- Department of Paediatric SurgeryEmma Children's Hospital, Academic Medical Centre and VU University Medical CentreAmsterdamthe Netherlands
- Centre of Research on Psychology in Somatic DiseasesTilburg UniversityTilburgthe Netherlands
| | - C. E. J. Sloots
- Department of Paediatric SurgeryErasmus Medical Centre, Sophia Children's HospitalRotterdamthe Netherlands
| | - M. J. Witvliet
- Department of Paediatric SurgeryWilhelmina Children's Hospital, University Medical Centre UtrechtUtrechtthe Netherlands
| | - I. de Blaauw
- Division of Paediatric Surgery, Department of SurgeryRadboudumc–Amalia Children's HospitalNijmegenthe Netherlands
| | - W. G. van Gemert
- Department of Paediatric SurgeryUniversity Medical Centre Maastricht, University of MaastrichtMaastrichtthe Netherlands
| | - M. Trzpis
- Anorectal Physiology Laboratory, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - P. M. A. Broens
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
- Anorectal Physiology Laboratory, Department of SurgeryUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
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Alwerdt J, Small BJ. Fecal incontinence as a moderator between dietary intake and depressive symptoms among a sample of older adults obtained from the National Health and Nutrition Examination Survey (NHANES). Aging Ment Health 2019; 23:222-232. [PMID: 29171958 DOI: 10.1080/13607863.2017.1399348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Many studies have established a relationship between diet and mental health, as well as the importance of bowel health. Further, with increased evidence of a gut-brain bidirectional relationship, an indication of dysbiosis as a potential moderator between diet and depression may be a viable target for future interventions. The current study investigated the relationship between diet and depressive symptoms (DS) among older adults, as well as gender, and whether a symptom of dysbiosis, fecal incontinence severity (FIS), moderated this relationship. METHOD Using moderated regressions, we examined whether FIS moderates the relationship between diet and DS while controlling for covariates in the overall sample (N = 1918), as well as among the male (n = 841) and female sample (n = 1077). The dietary variables were reduced using a factor analysis. RESULTS Results indicated significant moderating effects of FIS between Component 4 and polyunsaturated fatty acids (PFA) in the overall sample. Component 4, protein, carbohydrates, and alcohol were significant in males only while PFA only in females. Further analysis of protein/carbohydrate ratio groups indicated significant differences within males. Higher scores of FIS were related to higher DS and less consumption of Component 4 nutrients, PFA, and protein. Males that consumed higher protein and carbohydrates resulted in lower DS with increased FIS. CONCLUSION Outcomes from the current study provide further evidence of the importance of healthy bowel function and the potential of modifying the diet to improve DS in older adults.
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Affiliation(s)
- J Alwerdt
- a Center For Healthy Aging , The Pennsylvania State University , University Park , PA , USA.,b School of Aging Studies , The University of South Florida , Tampa , FL , USA
| | - B J Small
- b School of Aging Studies , The University of South Florida , Tampa , FL , USA
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Lin H, Zhang Z, Hu G, Wang X, Lin C, Chen Y. Acupuncture for fecal incontinence: Protocol for a systematic review and data mining. Medicine (Baltimore) 2019; 98:e14482. [PMID: 30762773 PMCID: PMC6408071 DOI: 10.1097/md.0000000000014482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fecal incontinence is a socially and emotionally destructive condition that has a negative impact on personal image, self-confidence, and quality of life. Acupuncture is commonly used to treat chronic conditions, including fecal incontinence. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of acupuncture on fecal incontinence. METHODS We will identify relevant randomized controlled trials (RCTs) from the Cochrane Library, Medline, Embase, PubMed, Springer, Web of Science, China National Knowledge Infrastructure, VIP Chinese Science and Technology Journals Database, Wanfang database, and clinical trial registration center from their inception to February 28, 2019. The primary outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. Publication bias will be assessed by funnel plots, Egger test, and Begg test using the Stata software. Acupoints characteristics will be analyzed by Traditional Chinese Medicine inheritance support system. RESULTS This study will analyze the clinical effective rate, functional outcomes, quality of life, daily average number of fecal incontinence, and effective prescriptions of acupuncture for patients with fecal incontinence. CONCLUSION Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupuncture for patients with fecal incontinence. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019119680.
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Affiliation(s)
| | - Zhiqing Zhang
- South China Research Center for Acupuncture and Moxibustion
- Medical School of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou
| | - Guijuan Hu
- Medical School of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou
| | - Xiaotong Wang
- South China Research Center for Acupuncture and Moxibustion
- Medical School of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou
| | - Chunni Lin
- School of Foreign Languages, Xinhua College of Sun Yat-sen University, Dongguan, People's Republic of China
| | - Yongjun Chen
- South China Research Center for Acupuncture and Moxibustion
- Medical School of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou
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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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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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Bardsley A. Assessment, prevention and treatment of faecal incontinence in older people. Nurs Older People 2018; 30:39-47. [PMID: 30230289 DOI: 10.7748/nop.2018.e1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Faecal incontinence is an impaired ability to control the passage of stool, often described as involuntary loss of solid or liquid stool, and the symptom of an underlying diagnosis. It is a common problem in older adults. Although not a life-threatening condition, it can have a significant negative effect on an individual's quality of life and adverse medical, social and economic consequences. Due to the taboo and stigmatising nature of the condition many individuals do not seek assistance. Healthcare professionals should take every opportunity to ask about faecal incontinence symptoms so that symptomatic relief and treatment interventions can be initiated. There are several conservative approaches available for the treatment of faecal incontinence, which should be considered as first line to target symptomatic relief.
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Kobal J, Matej K, Koželj M, Podnar S. Anorectal Dysfunction in Presymptomatic Mutation Carriers and Patients with Huntington’s Disease. J Huntingtons Dis 2018; 7:259-267. [DOI: 10.3233/jhd-170280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jan Kobal
- Department of Neurology, Division of Neurology, University Medical Center Ljubljana, Slovenia
| | - Kolenc Matej
- Department of Neurology, General Hospital Novo mesto, Slovenia
| | - Matic Koželj
- Clinical Department for Gastroenterology, University Medical Center Ljubljana, Slovenia
| | - Simon Podnar
- Department of Neurology, Division of Neurology, University Medical Center Ljubljana, Slovenia
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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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Menees SB, Almario CV, Spiegel BM, Chey WD. Prevalence of and Factors Associated With Fecal Incontinence: Results From a Population-Based Survey. Gastroenterology 2018; 154:1672-1681.e3. [PMID: 29408460 PMCID: PMC6370291 DOI: 10.1053/j.gastro.2018.01.062] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/17/2018] [Accepted: 01/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) is characterized by uncontrolled passage of solid or liquid stool. We aimed to determine the prevalence and severity of FI in a large sample of US residents. METHODS We recruited a representative sample of patients in October 2015 to complete the National Gastrointestinal (GI) Survey; a mobile app called MyGiHealth was used to systematically collect data on GI symptoms. FI was defined as accidental leakage of solid or liquid stool. Severity of FI was determined by responses to the National Institutes of Health FI Patient Reported Outcomes Measurement Information System questionnaire. Multivariable regression models were used to identify factors associated with FI prevalence and severity. RESULTS Among 71,812 individuals who completed the National GI Survey, 14.4% reported FI in the past; of these, 33.3% had FI within the past 7 days. Older age, male sex, and Hispanic ethnicity increased the likelihood of having FI within the past week. Individuals with Crohn's disease, ulcerative colitis, celiac disease, irritable bowel syndrome, or diabetes were more likely to report FI. Non-Hispanic black and Hispanic individuals and individuals with Crohn's disease, celiac disease, diabetes, human immunodeficiency virus/acquired immunodeficiency syndrome, or chronic idiopathic constipation had more severe symptoms of FI than individuals without these features. CONCLUSIONS In a large population-based survey, 1 in 7 people reported previous FI. FI is age-related and more prevalent among individuals with inflammatory bowel disease, celiac disease, irritable bowel syndrome, or diabetes than people without these disorders. Proactive screening for FI among these groups is warranted.
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Affiliation(s)
- Stacy B. Menees
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI,Division of Gastroenterology, Department of Internal Medicine, Ann
Arbor Veterans Affairs Medical Center, Ann Arbor, MI
| | - Christopher V. Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),
Los Angeles, CA,Division of Digestive and Liver Diseases, Cedars-Sinai Medical
Center, Los Angeles, CA,Division of Health Services Research, Cedars-Sinai Medical Center,
Los Angeles, CA,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles,
CA
| | - Brennan M.R. Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),
Los Angeles, CA,Division of Digestive and Liver Diseases, Cedars-Sinai Medical
Center, Los Angeles, CA,Division of Health Services Research, Cedars-Sinai Medical Center,
Los Angeles, CA,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles,
CA
| | - William D. Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI
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Kanavin ØJ, Fjermestad KW. Gastrointestinal and urinary complaints in adults with hereditary spastic paraparesis. Orphanet J Rare Dis 2018; 13:58. [PMID: 29661209 PMCID: PMC5902872 DOI: 10.1186/s13023-018-0804-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hereditary spastic paraparesis (HSP) is a group of rare genetic disorders affecting the central nervous system. Pure HSP is limited to lower limb spasticity and urinary voiding dysfunction. Complex HSP involves additional neurological features. Beyond the described core symptoms, knowledge about the burden of disease for adults with HSP is limited, particularly regarding gastrointestinal functions, fecal incontinence, and urinary symptoms. METHODS We conducted a cross-sectional self-report survey with 108 adult HSP patients (Mage = 57.7 years, SD = 11.5, range 30 to 81; 54.2% females) recruited from a national HSP user group association and a national (non-clinical) advisory unit for rare disorders. HSP data was compared to data from a Norwegian population study, HUNT-3 (N = 46,293). RESULTS The HSP group reported more gastrointestinal and urinary complaints compared to controls. Gastrointestinal complaints included at least "much" complaints with constipation (14.6%) and alternating constipation/diarrhea (8.0%), and at least daily uncontrollable flatulence (47.6%), fecal incontinence (11.6%), and inability to hold back stools (38.5%). Urinary complaints included frequent urination (27.4% > 8 times daily), sudden urge (51.9%) and urinary incontinence (30.5% at least daily/nightly). CONCLUSION This survey of adults with HSP recruited from non-clinical settings showed constipation, alternate constipation and diarrhea, fecal incontinence, and voiding dysfunction represent considerable problems for many persons with HSP. Health care providers should screen and manage often unrecognized gastrointestinal and fecal incontinence complaints among HSP patients.
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Affiliation(s)
- Øivind J Kanavin
- Frambu Centre for Rare Disorders, Sandbakkveien 18, 1404, Siggerud, Norway.
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Efficacy of FemiScan Pelvic Floor Therapy for the Treatment of Anal Incontinence. Female Pelvic Med Reconstr Surg 2018; 24:367-370. [DOI: 10.1097/spv.0000000000000467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Fecal incontinence has a great impact on daily life, and many patients are reluctant to report it. OBJECTIVE The purpose of this study was to estimate the prevalence of fecal incontinence in patients with Crohn's disease, validate risk factors, and relate outcome with quality of life. DESIGN The design was cross-sectional. SETTINGS The study was conducted at an academic tertiary center. PATIENTS Consecutive patients with Crohn's disease treated between 2003 and 2013 were included in this study. MAIN OUTCOME MEASURES A questionnaire was sent out in October 2013 to evaluate perianal disease, current symptoms of fecal incontinence, and its impact on quality of life (Fecal Incontinence Quality of Life questionnaire). Risk factors were validated with univariate and multivariate analyses. RESULTS The questionnaire was responded by 325 (62%) of 528 patients. Median age was 42 years (range, 18-91 y), 215 (66%) were women, and a diagnosis of Crohn's disease was established for a median period of 12 years (interquartile range, 6-21 y). Fecal incontinence was reported by 65 patients (20%). Fecal incontinence was associated with liquid stools (p = 0.0001), previous IBD-related bowel resections (p = 0.001), stricturing behavior of disease (p = 0.02), and perianal disease (p = 0.03). Quality of life (lifestyle, coping, depression, and embarrassment) was poor in patients with fecal incontinence, particularly in patients with more frequent episodes of incontinence. LIMITATIONS There was no correction for disease activity in the multivariate regression analysis. CONCLUSIONS The prevalence of fecal incontinence in a tertiary population with Crohn's disease is substantially higher than in the community-dwelling population. Considering the reduced quality of life in incontinent patients, active questioning to identify fecal incontinence is recommended in those with liquid stools, perianal disease, or previous (intestinal or perianal) surgery. See Video Abstract at http://journals.lww.com/dcrjournal/Pages/videogallery.aspx.
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Ussing A, Dahn I, Due U, Sørensen M, Petersen J, Bandholm T. Supervised pelvic floor muscle training versus attention-control massage treatment in patients with faecal incontinence: Statistical analysis plan for a randomised controlled trial. Contemp Clin Trials Commun 2017; 8:192-202. [PMID: 29696209 PMCID: PMC5898528 DOI: 10.1016/j.conctc.2017.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Faecal incontinence affects approximately 8–9% of the adult population. The condition is surrounded by taboo; it can have a devastating impact on quality of life and lead to major limitations in daily life. Pelvic floor muscle training in combination with information and fibre supplements is recommended as first-line treatment for faecal incontinence. Despite this, the effect of pelvic floor muscle training for faecal incontinence is unclear. No previous trials have investigated the efficacy of supervised pelvic floor muscle training in combination with conservative treatment and compared this to an attention-control massage treatment including conservative treatment. The aim of this trial is to investigate if 16 weeks of supervised pelvic floor muscle training in combination with conservative treatment is superior to attention-control massage treatment and conservative treatment in patients with faecal incontinence. Design Randomised, controlled, superiority trial with two parallel arms. Methods 100 participants with faecal incontinence will be randomised to either (1) individually supervised pelvic floor muscle training and conservative treatment or (2) attention-control massage treatment and conservative treatment. The primary outcome is participants' rating of symptom changes after 16 weeks of treatment using the Patient Global Impression of Improvement Scale. Secondary outcomes are the Vaizey Incontinence Score, the Fecal Incontinence Severity Index, the Fecal Incontinence Quality of Life Scale, a 14-day bowel diary, anorectal manometry and rectal capacity measurements. Follow-up assessment at 36 months will be conducted. Discussion This paper describes and discusses the rationale, the methods and in particular the statistical analysis plan of this trial.
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Affiliation(s)
- Anja Ussing
- Department of Physiotherapy-and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark.,Optimed, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark
| | - Inge Dahn
- Department of Surgical and Medical Gastroenterology, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark
| | - Ulla Due
- Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.,Department of Occupational and Physical Therapy, Herlev Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Michael Sørensen
- Department of Surgical and Medical Gastroenterology, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark
| | - Janne Petersen
- Optimed, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Physiotherapy-and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark.,Optimed, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark.,Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark
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Bohl JL, Zakhem E, Bitar KN. Successful Treatment of Passive Fecal Incontinence in an Animal Model Using Engineered Biosphincters: A 3-Month Follow-Up Study. Stem Cells Transl Med 2017; 6:1795-1802. [PMID: 28678378 PMCID: PMC5689776 DOI: 10.1002/sctm.16-0458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/17/2017] [Indexed: 12/20/2022] Open
Abstract
Fecal incontinence (FI) is the involuntary passage of fecal material. Current treatments have limited successful outcomes. The objective of this study was to develop a large animal model of passive FI and to demonstrate sustained restoration of fecal continence using anorectal manometry in this model after implantation of engineered autologous internal anal sphincter (IAS) biosphincters. Twenty female rabbits were used in this study. The animals were divided into three groups: (a) Non‐treated group: Rabbits underwent IAS injury by hemi‐sphincterectomy without treatment. (b) Treated group: Rabbits underwent IAS injury by hemi‐sphincterectomy followed by implantation of autologous biosphincters. (c) Sham group: Rabbits underwent IAS injury by hemi‐sphincterectomy followed by re‐accessing the surgical site followed by immediate closure without implantation of biosphincters. Anorectal manometry was used to measure resting anal pressure and recto‐anal inhibitory reflex (RAIR) at baseline, 1 month post‐sphincterectomy, up to 3 months after implantation and post‐sham. Following sphincterectomy, all rabbits had decreased basal tone and loss of RAIR, indicative of FI. Anal hygiene was also lost in the rabbits. Decreases in basal tone and RAIR were sustained more than 3 months in the non‐treated group. Autologous biosphincters were successfully implanted into eight donor rabbits in the treated group. Basal tone and RAIR were restored at 3 months following biosphincter implantation and were significantly higher compared with rabbits in the non‐treated and sham groups. Histologically, smooth muscle reconstruction and continuity was restored in the treated group compared with the non‐treated group. Results in this study provided promising outcomes for treatment of FI. Results demonstrated the feasibility of developing and validating a large animal model of passive FI. This study also showed the efficacy of the engineered biosphincters to restore fecal continence as demonstrated by manometry. Stem Cells Translational Medicine2017;6:1795–1802
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Affiliation(s)
- Jaime L Bohl
- Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, USA
| | - Elie Zakhem
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Department of Molecular Medicine and Translational Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Khalil N Bitar
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Department of Molecular Medicine and Translational Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston Salem, North Carolina, USA.,Section on Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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"It's just horrible": a qualitative study of patients' and carers' experiences of bowel dysfunction in multiple sclerosis. J Neurol 2017; 264:1354-1361. [PMID: 28550483 DOI: 10.1007/s00415-017-8527-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
Around 50% of people with multiple sclerosis (MS) experience neurogenic bowel dysfunction (constipation and/or faecal incontinence), reducing quality of life and increasing carer burden. No previous qualitative studies have explored the experiences of bowel problems in people with MS, or the views of their family carers. This study sought to understand 'what it is like' to live with bowel dysfunction and the impact this has on people with MS and carers. Using exploratory qualitative methods, 47 semi-structured interviews were conducted with participants recruited from specialist hospital clinics and community sources using purposive and chain-referral sampling. Data were analysed using a pragmatic inductive-deductive method. Participants identified multiple psychological, physical and social impacts of bowel dysfunction. Health care professional support ranged from empathy and appropriate onward referral, to lack of interest or not referring to appropriate services. Participants want bowel issues to be discussed more openly, with clinicians instigating a discussion early after MS diagnosis and repeating enquiries regularly. Bowel dysfunction impacts on the lives of people with MS and their carers; their experience with care services is often unsatisfactory. Understanding patient and carer preferences about the management of bowel dysfunction can inform clinical care and referral pathways.
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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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Timmermans SL. Eliciting Help-Seeking Behaviors in Patients With Fecal Incontinence: Supporting Timely Access to Treatment. Home Healthc Now 2016; 34:424-433. [PMID: 27580281 DOI: 10.1097/nhh.0000000000000445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People with fecal incontinence (FI) symptoms often do not report their symptoms to their care providers, which may adversely impact their quality of life. Although the differential diagnosis for the cause of an individual's FI symptoms can be done by a family doctor, nurse practitioner, or a specialist, many other healthcare professionals have the training and education to competently screen patients for FI risk factors. Those individuals identified with FI symptoms can be supported to disclose this information to their healthcare professional in a timely manner. Healthcare professionals have a responsibility to encourage patients to seek medical treatment in order to ensure an accurate diagnosis for their FI symptoms, and to support clients through the process of managing symptoms including adhering to care plans to mitigate modifiable causes of FI. When clients actively seek medical help, it is referred to as help-seeking behavior. Given the sensitive nature of FI, with the associated stigma and taboo surrounding the topic, healthcare providers must conscientiously work to support each client with sensitivity and self-awareness.
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Affiliation(s)
- S Lana Timmermans
- S. Lana Timmermans, MN, RN, is a Case Management Practice Lead, Calgary, Alberta, Canada
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Subasinghe D, Navarathna NMM, Samarasekera DN. Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia. World J Gastrointest Pharmacol Ther 2016; 7:447-452. [PMID: 27602247 PMCID: PMC4986393 DOI: 10.4292/wjgpt.v7.i3.447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/20/2016] [Accepted: 04/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients.
METHODS: All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21.
RESULTS: There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P < 0.001). QOL in our cohort of patients was significantly affected by FI.
CONCLUSION: In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.
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Hsu LF, Hung CL, Kuo LJ, Tsai PS. An abbreviated Faecal Incontinence Quality of Life Scale for Chinese-speaking population with colorectal cancer after surgery: cultural adaptation and item reduction. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/28/2022]
Affiliation(s)
- L.-F. Hsu
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - C.-L. Hung
- Department of Radiation Oncology; Cardinal Tien Hospital; New Taipei City Taiwan
| | - L.-J. Kuo
- Division of Colorectal Surgery; Department of Surgery; Taipei Medical University Hospital; Taipei Taiwan
| | - P.-S. Tsai
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
- Department of Nursing; Taipei Medical University-Municipal Wan Fang Hospital; Taipei Taiwan
- Sleep Science Center; Taipei Medical University Hospital; Taipei Taiwan
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Johannessen HH, Wibe A, Stordahl A, Sandvik L, Mørkved S. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. BJOG 2016; 124:686-694. [PMID: 27272501 DOI: 10.1111/1471-0528.14145] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI). DESIGN A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity. SETTING Ano-rectal specialist out-patient clinics at two hospitals in Norway. POPULATION One hundred and nine postpartum women with AI at baseline. METHODS The intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind. MAIN OUTCOME MEASURES The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction. RESULTS There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (-2.1 versus -0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on un-imputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did. CONCLUSIONS Our results indicate that individually adapted PFME reduces postpartum AI symptoms. TWEETABLE ABSTRACT Performing regular pelvic floor muscle exercises may be an effective treatment for postpartum anal incontinence.
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Affiliation(s)
- H H Johannessen
- Department of Physiotherapy, Østfold Hospital Trust, Grålum, Norway
| | - A Wibe
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A Stordahl
- Department of Surgery, Østfold Hospital Trust, Grålum, Norway
| | - L Sandvik
- Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Siproudhis L, Graf W, Emmanuel A, Walker D, Shing RNK, Pediconi C, Pilot J, Wexner S, Scholefield J. Libertas: a phase II placebo-controlled study of NRL001 in patients with faecal incontinence showed an unexpected and sustained placebo response. Int J Colorectal Dis 2016; 31:1205-16. [PMID: 27075314 PMCID: PMC4867152 DOI: 10.1007/s00384-016-2585-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Faecal incontinence (FI) is distressing, significantly reduces quality of life (QoL) and has few pharmacological treatments. The α1-adrenoceptor agonist NRL001 (1R,2S-methoxamine hydrochloride) improves anal sphincter tone. NRL001 efficacy was evaluated by changes in Wexner scores at week 4 vs. baseline in NRL001-treated patients compared with placebo. Impact of NRL001 on QoL and safety were also assessed. METHODS Four hundred sixty-six patients received NRL001 (5, 7.5 or 10 mg) or placebo as suppository, once daily over 8 weeks. Wexner score, Vaizey score and QoL were analysed at baseline, week 4 and week 8. FI episodes and adverse events were recorded in diaries. RESULTS At week 4, mean reductions in Wexner scores were -3.0, -2.6, -2.6 and -2.4 for NRL001 5, 7.5, 10 mg and placebo, respectively. All reduced further by week 8. As placebo responses also improved, there was no significant treatment effect at week 4 (p = 0.6867) or week 8 (p = 0.5005). FI episode frequency improved for all patients, but not significantly compared with placebo (week 4: p = 0.2619, week 8: p = 0.5278). All patients' QoL improved, but not significantly for all parameters (p > 0.05) except depression/self-perception at week 4 (p = 0.0102) and week 8 (p = 0.0069), compared with placebo. Most adverse events were mild and judged probably or possibly related to NRL001. CONCLUSIONS All groups demonstrated improvement in efficacy and QoL compared with baseline. NRL001 was well-tolerated without serious safety concerns. Despite the improvement in all groups, there was no statistically significant treatment effect, underlining the importance of relating results to a placebo arm.
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Affiliation(s)
| | - W Graf
- Institution of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, 75185, Uppsala, Sweden
| | - A Emmanuel
- University College Hospital, 235 Euston Road, London, UK
| | - D Walker
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK.
| | - R Ng Kwet Shing
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - C Pediconi
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - J Pilot
- Norgine Ltd, Norgine House, Widewater Place, Moorhall Road, Uxbridge, UB9 6NS, UK
| | - S Wexner
- Cleveland Clinic Florida, Weston, FL, USA
| | - J Scholefield
- Division of Surgery, University Hospital Nottingham, Nottingham, UK
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‘t Hoen LA, Utomo E, Schouten WR, Blok BF, Korfage IJ. The fecal incontinence quality of life scale (FIQL) and fecal incontinence severity index (FISI): Validation of the Dutch versions. Neurourol Urodyn 2016; 36:710-715. [DOI: 10.1002/nau.23003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/09/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Lisette A. ‘t Hoen
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | - Elaine Utomo
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willem R. Schouten
- Department of Surgery; Erasmus Medical Center; Rotterdam The Netherlands
| | - Bertil F.M. Blok
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | - Ida J. Korfage
- Department of Public Health; Erasmus Medical Center; Rotterdam The Netherlands
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50
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Mundet L, Ribas Y, Arco S, Clavé P. Quality of Life Differences in Female and Male Patients with Fecal Incontinence. J Neurogastroenterol Motil 2015; 22:94-101. [PMID: 26486375 PMCID: PMC4699726 DOI: 10.5056/jnm15088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/08/2015] [Accepted: 09/13/2015] [Indexed: 12/13/2022] Open
Abstract
Background/Aims To explore and compare quality of life (QoL) differences in female and male patients with fecal incontinence. Methods Ninety-one patients with fecal incontinence (60 women, mean (SD) age 64.13 (9.72) years; 31 men, mean (SD) age 63.61 (13.33) years) were assessed for pathophysiology (anorectal manometry and ultrasound), clinical severity (Wexner and Vaizey scales), QoL (Fecal Incontinence Quality of Life Score [FIQL]) and health status (EQ-5D). Results External and internal anal sphincter impairment rates were 96.5% and 70.2%, respectively, in women, compared to 30% and 43.3% respectively in men (P < 0.05). Clinical severity was similar in both sexes, with mean (SD) Wexner scores of 10.95 (4.35) for women and 9.81 (4.30) for men, and mean (SD) Vaizey scores of 13.27 (4.66) for women and 11.90 (5.22) for men. Scores for women were significantly lower for all FIQL depression and coping subscales (P < 0.001) and the EQ-5D depression subscale (P < 0.01). EQ-5D index was 0.687 (0.20) for women and 0.835 (0.15) for men (P < 0.001). QoL was negatively affected by female gender (−1.336), anxiety/depression (−1.324) and clinical severity (−0.302), whereas age had a positive impact (0.055 per year) (P < 0.01). Conclusions The pathophysiology of fecal incontinence differed between the sexes. For similar severity scores, impact on QoL was higher in women. Gender had the highest impact on QoL compared to other factors. QoL measurements should be part of assessment and treatment protocols.
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Affiliation(s)
- Lluís Mundet
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Yolanda Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Sandra Arco
- Department of Nursing, Badalona Serveis Assistencials, Badalona, Spain.,Escola Superior de Ciències de la Salut, Tecnocampus, Mataró, Spain
| | - Pere Clavé
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
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