Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29–74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.Presented at the XXIst congress of the Societé Internationale Francophone d'Urodynamique, Lisbon, Portugal, May 14 to 16, 1998.     

升阳举陷法艾灸在肾阳虚型压力性尿失禁老年女性患者中的应用研究

目的 评价升阳举陷法艾灸在肾阳虚型压力性尿失禁老年女性患者中的应用效果.方法 采用方便抽样法,选取2019年9月—2021年5月在杭州市某三级甲等医院就诊的肾阳虚型压力性尿失禁老年女性患者80例作为研究对象,采用随机数字表法,分为试验组和对照组,每组各40例,试验组在盆底肌功能训练和膀胱功能训练的基础上实施升阳举陷法艾...     

成人失禁患者一次性吸收型护理用品临床应用专家共识

目的 形成成人失禁患者一次性吸收型护理用品临床应用专家共识。方法 系统地查阅国内外文献,组织国内专家进行评议,通过专家会议法和德尔菲专家函询法,结合实验室数据及专家意见,对各条目进行修改、完善。结果 对成人失禁患者一次性吸收型护理用品的指标要求及临床应用2个方面、20个条目达成共识。结论 制定成人失禁患者一次性吸收型护理用品临床应用专家共识,可对成人失禁患者住院期间使用一次性吸收型护理用品提供指导,并为住院失禁患者的皮肤环境保护提供规范指引。     

Surgical repair and biological therapy for fecal incontinence in Crohn's disease involving both sphincter defects and complex fistulas

Background and aims

Surgeons have traditionally tried to avoid any complex surgical procedures in Crohn's patients with complex perianal diseases because of the fear of complications, worsening the patient's condition and risking an eventual proctectomy. The introduction of biological therapy has changed the management of Crohn's disease. This study assesses the long-term success of addressing defects in anal sphincter and complex fistula when patients receive anti-TNF-α antibodies.

Methods

Ten consecutive patients were prospectively scheduled for induction therapy with 5 mg/kg Infliximab at week 0, 2 and 6 and maintenance every 8 weeks associated with azathioprine. Elective surgery was performed conducting a simultaneous approach to the sphincter defect and fistula tracts. Outcomes were long-term continence, complications which were assessed by a Wexner's score along with a complementary questionnaire. Statistical analysis was performed using general linear model of repeated measures.

Results

Three patients had complications related to surgery: two abscesses and low intersphincteric fistula and one case of rectal stenosis causing fecal urgency. There was no suture dehiscence. Wexner's score improved at 12 months (10.0 ± 2.4 vs. 18.0 ± 2.6; p = 0.003) and over time (48 month 9.5 ± 2.8; p = 0.001). These scores were significantly worse when patients had urgency before treatment (12.8 ± 1.2 vs. 9.5 ± 2.8; p = 0.03) but not when the urgency appeared later. No patient remained incontinent to solid stools. Three patients had occasional incontinence to liquid stools associated to disease reactivation.

Conclusion

Surgical repair and immunomodulator therapy with infliximab could be an option in incontinent patients with Crohn's disease involving both a sphincter defect and severe or refractory fistulas.