Surgically correctable fecal incontinence

A significant percentage of children who are fecally incontinent are so from improper operation or failure to recognize a surgically correctable problem. Over the past five years, we have managed ten children who had operations for anorectal problems and two with anterior anus. Seven were seen after poorly positioned pull-through procedures for imperforate anus and had anal repositioning, four successfully. Gracilis sling was successful in two of the other three. In two children overflow after a Duhamel operation for Hirschsprung's disease was corrected by division of a persistent anorectal septum. The third child with a disrupted Duhamel procedure was cured by anolevatorplasty. In two children an anterior ectopic anus was made continent by posterior anoplasty. Primary and secondary deviations from proper anatomy of the anorectal region will result in incontinence, which may be recognized by physical examination and defecograms. Proper operation usually produces acceptable continence.     

大便失禁治疗技术的研究进展

目的大便失禁是结直肠肛门疾病中的常见病和难治病,通常会给患者生活质量造成严重影响。目前针对大便失禁的治疗选择众多但尚缺乏统一规范,大便失禁的治疗一般先从非手术治疗开始,包括一般治疗、药物治疗、生物反馈治疗以及针灸治疗。当非手术治疗无效时选择手术治疗,常见的手术治疗包括：括约肌修补术、股薄肌转移成形术、人工括约肌植入术、磁性肛门括约肌、生物材料注射、骶神经调节术、肛门干细胞疗法及结肠造口。本文就大便失禁的治疗技术做阐述,有助于肛肠科医生深入了解大便失禁的治疗并适当选择不同治疗技术在临床工作中开展。     

生物反馈电刺激仪治疗腹腔镜前列腺癌根治术后尿失禁

目的:应用生物反馈电刺激仪可以指导患者进行正确自主的盆底肌肉训练,观察其对腹腔镜前列腺癌根治术后控尿功能恢复的作用.方法:选择2005-07/2007-06中山大学附属第三医院泌尿外科收治腹腔镜前列腺癌根治术后尿失禁患者41例,轻度12例,中度23例,重度6例.采用加拿大Laborie公司生产的UROSTIM型盆腔生物反馈电刺激治疗仪电刺激联合盆底肌肉训练,生物反馈电刺激每日1次.5次为1个疗程,根据患者尿失禁程度分别治疗一两个疗程.疗效判定标准:治愈,自觉尿失禁症状消失、小便能自控,排尿正常,尿垫试验阴性;有效,自觉尿失禁次数明显减少、尿垫试验连续3次以上阴性;无效,尿失禁症状无明显改善,尿垫试验阳性.治疗结束后4周评价其治疗效果,追踪观察随访3～12个月.结果:41例术后不同程度尿失禁患者,治愈23例(56.1%),有效11例(26.9%),无效7例(17.0%),总有效率为83%.轻度尿失禁患者,治愈11例,有效1例;中度尿失禁患者,治愈11例,有效8例,无效3例;重度尿失禁患者,治愈1例,有效2例,无效3例.结论:应用生物反馈电刺激仪可促进前列腺癌根治术后患者控尿功能的恢复.     

Supplementation with dietary fiber improves fecal incontinence

BACKGROUND: Human studies have shown that dietary fiber affects stool composition and consistency. Because fecal incontinence has been shown to be exacerbated by liquid stools or diarrhea, management strategies that make stool consistency less loose or liquid may be useful. OBJECTIVE: To compare the effects of a fiber supplement containing psyllium, gum arabic, or a placebo in community-living adults who were incontinent of loose or liquid stools. Mechanisms underlying these effects (e.g., fermentation of the fibers and water-holding capacity of stools) were examined. METHODS: Thirty-nine persons with fecal incontinence of loose or liquid stools prospectively recorded diet intake and stool characteristics and collected their stools for 8 days prior to and at the end of a 31-day fiber supplementation period. During the fiber supplementation period, they ingested psyllium, gum arabic, or a placebo by random assignment. RESULTS: In the baseline period, the groups were comparable on all variables measured. In the fiber supplementation period, (a) the proportion of incontinent stools of the groups ingesting the fiber supplements was less than half that of the group ingesting the placebo, (b) the placebo group had the greatest percentage of stools that were loose/unformed or liquid, and (c) the psyllium group had the highest water-holding capacity of water-insoluble solids and total water-holding capacity. The supplements of dietary fiber appeared to be completely fermented by the subjects as indicated by nonsignificant differences in total fiber, short chain fatty acids and pH in stools among the groups in the baseline or fiber supplementation periods. CONCLUSIONS: Supplementation with dietary fiber from psyllium or gum arabic was associated with a decrease in the percentage of incontinent stools and an improvement of stool consistency. Improvements in fecal incontinence or stool consistency did not appear to be related to unfermented dietary fiber.     

New challenge for endorectal sonography: diagnosis of fecal incontinence

The puborectalis muscle is a major determinant in the control of fecal continence. With endorectal sonography puborectalis function was assessed by determining puborectalis length in the resting (D1) and contracted (D2) states and calculating the percentage of shortening (D1-D2/D1)(100). The puborectalis length was defined as the shortest distance between the symphysis pubis and the rectal mucosa. The mean puborectalis length at rest did not differ in control subjects (29.5 +/- 1.0 mm) and incontinent patients (29.0 +/- 2.9 mm). With voluntary contraction a statistically significant difference (P < 0.001) was seen in the percentage of shortening between control subjects (15.4 +/- 1.1%) and incontinent patients (4.7 +/- 2.8%). Endorectal ultrasonography is a useful method to diagnose fecal incontinence.     

Prospective assessment of interobserver agreement for endoanal MRI in fecal incontinence

BACKGROUND: Endoanal magnetic resonance (MR) imaging is a new technique for the assessment of anal sphincter integrity in fecal incontinence and an alternative to anal endosonography. The present study aimed to determine interobserver variation for assessment of anal sphincter integrity using endoanal MR imaging. METHODS: Fifty-two consecutive anally incontinent patients underwent MR imaging by using a purpose-built endoanal receiver coil and static 1.0-T magnet. T2-weighted axial, coronal, and sagittal scans were independently assessed by two radiologists who noted external and internal sphincter integrity. Findings were compared and agreement was assessed with the kappa statistic. RESULTS: There was disagreement in 18 of 49 technically adequate studies (37%; kappa = 0.46), indicating "moderate" agreement. Agreement was strongest if the sphincters were either both intact or both disrupted. Observers agreed in only one diagnosis of an isolated internal sphincter defect and in no diagnosis of an isolated external sphincter defect. CONCLUSION: The overall interobserver agreement for assessment of sphincter integrity using endoanal MR imaging is "moderate." Interobserver agreement using endoanal MR imaging is less than that reported for anal endosonography.     

The experience of community-living women managing fecal incontinence

Although many women suffer from fecal incontinence (FI), little is known about their day-to-day experiences. The aims of this phenomenological study were to understand the experience of women living with FI from their perspective and to elicit women's self-care and management strategies for FI. Ten women participated in audiotaped, unstructured interviews that were transcribed into a written text. The text was analyzed using Van Manen's approach for deriving themes. The findings display the women's experience of lived time, lived space, lived relationships, and lived body and the essential theme of "controlling the body out of control." The findings demonstrate that FI is a problem that affects women in all dimensions of their lifeworld experience and describes the continual attention and self-management FI requires.     

Diagnosis and conservative therapy of anal fecal incontinence

The main diagnostic tool for patients with anal incontinence is the anorectal physiology. The anorectal sphincter can be reliably tested. Due to the fact that an obstetric damage is the most common cause of anal incontinence, the transanal endosonography is the imaging method of choice for detecting a muscle defect. With high frequency ultrasound probes (preferable 10 Mhz) the pathomorphology of the sphincter can be studied in details. If conservative treatment is failing, the neurophysiology testing is helpful in deciding which surgical method (sphincter repair in case of an intact nervus pudendus, artificial sphincter or sacral stimulation in case of neuropathy). The conservative treatment includes increasing the internal sphincter muscle tonus by applying Phenylephrine locally or Loperamid per os. The biofeedback is basically a physical muscle training of the external sphincter with a visual or acoustic feedback of the muscle function to the patient. However, newer studies show that by this method the sensory function and the coordination of the anal sphincter are improving as well. With these conservative treatment options most of the patients suffering from anal incontinence can be treated satisfactorily.     

带囊气管导管在大便失禁病人中的应用

大便失禁在ICU危重病人中时有发生，给护理工作带来诸多困难，且易引起各种并发症。为此，我科2004年1月-2005年12月对大便失禁而发生肛周皮肤破损者采用肛门内留置带囊气管导管外接保鲜袋引流稀便的方法，取得满意效果。现报告如下。     

Endosonography for assessment of anorectal changes in patients with fecal incontinence.

Our aim was to evaluate the anorectal changes in patients with fecal incontinence by using different endoultrasound techniques. Eighteen females with fecal incontinence and 14 healthy controls (females) were examined. Rigid linear transducer and 10 MHz radial scanning miniprobe were used. Statistically significant difference was found in the mean percentage of decreasing of the anorectal angle during contraction between healthy subjects (21.4%) and incontinent patients (7.5%). The mean percentage of shortening of the puborectal muscle length during squeezing was significantly lower in patients (9.6%) than in controls (17.9%). By means of miniprobe the anal sphincter defects were clearly demonstrated. Endosonography with a radial scanning miniprobe and rigid linear transducer ensures complex morphological and functional assessment of the anorectal region.     

带囊气管导管在大便失禁病人中的应用

大便失禁在ICU危重病人中时有发生,给护理工作带来诸多困难,且易引起各种并发症.为此,我科2004年1月-2005年12月对大便失禁而发生肛周皮肤破损者采用肛门内留置带囊气管导管外接保鲜袋引流稀便的方法,取得满意效果.现报告如下.     

带囊气管测压导管在大便失禁病人中的应用

大便失禁易造成多种并发症,最常见的并发症是会阴部、骶尾部皮肤炎症及压力性溃疡(压疮)。大便失禁在老年人、危重病人及瘫痪卧床病人中发生率达46.0%～54.4%[1]。由于粪便的刺激,使会阴部皮肤经常处于潮湿和代谢产物的侵蚀状态,易发生皮肤红肿、溃烂,皮肤破溃感染可深及肌层或破溃延伸至阴囊、阴唇、腹股沟等;污染尿道口、阴道口引起逆行感染,不仅加重了病人的痛苦,亦给临床护理工作带来困难[2]。为有效控制重症监护病房(ICU)大便失禁病人大便污染,对2005年1月—2006年2月在我院ICU住院的43例大便失禁病人应用一次性带囊气管测压导管,有…     

带囊气管测压导管在大便失禁病人中的应用

大便失禁易造成多种并发症，最常见的并发症是会阴部、骶尾部皮肤炎症及压力性溃疡（压疮）。大便失禁在老年人、危再病人及瘫痪卧床病人中发生率达46．0％～54．4％。由于粪便的刺激，使会阴部皮肤经常处于潮湿和代谢产物的侵蚀状态，易发生皮肤红肿、溃烂，皮肤破溃感染可深及肌层或破溃延伸至阴囊、阴唇、腹股沟等；污染尿道口、阴道口引起逆行感染，不仅加重了病人的痛苦，亦给临床护理工作带来困难。为有效控制重症监护病房（ICU）大便失禁病人大便污染，对2005年1月-2006年2月在我院ICU住院的43例大便失禁病人应用一次性带囊气管测压导管，有效地降低了ICU大便失禁病人并发症。现报告如下。     

Managing fecal incontinence: self-care practices of older adults

Little is known about the ways in which community-dwelling elderly individuals manage fecal incontinence (FI) in their daily lives. In this study, community-dwelling elderly individuals were surveyed at clinics of a health maintenance organization (HMO) to describe the self-care practices used to manage FI and to examine factors that influenced the number of self-care practices used and the reporting of FI to a health care practitioner. Responses of 242 elderly individuals who reported that they had FI several times per year were analyzed. The self-care practices used most commonly were changing diet, wearing a sanitary pad/brief, and reducing activity or exercise. Elderly women and those with a greater severity of FI and more chronic health problems engaged in more self-care practices. Factors associated with reporting FI to a clinician were considering FI to be a problem, uncertainty about the cause of FI, and changing diet to avoid FI. There is a need to promote effective management strategies for FI to older individuals living in the community.     

小儿神经源性排便失禁的外科治疗与术后康复协调训练

目的探讨小儿神经源性排便失禁的治疗方法及康复训练方法。方法176例全部采用双侧髂腰肌加强盆底肌直肠悬吊术治疗。36例术后3周开始进行长期康复功能训练。结果术后随访6个月～7年,排便控制术后明显改善140例,临床评分5～6分。36例坚持康复训练者中,24例半年内达到可接受的排便控制,12例于1年后达到排便控制。临床评分4～5分。结论双侧髂腰肌加强盆底肌直肠悬吊术是治疗小儿神经源性排便失禁的较好方法,康复协调训练也是治疗的重要措施。     

Perinatal urinary and fecal incontinence: suffering in silence

This article focuses on the prevention, identification, and management of urinary and fecal incontinence in the perinatal period. Both urinary and fecal incontinence are common concerns affecting women throughout pregnancy, intrapartum, and postpartum. These are the problems that are not approached by healthcare providers during the initial antepartal assessment, nor are they fully investigated after delivery. Many women hesitate to disclose this information. Women tend to consider this to be a minor discomfort of pregnancy and a consequence resulting from childbirth in the postpartum period. Intervention strategies and nursing care components in the perinatal period will be presented.