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Fecal Incontinence: Etiology, Evaluation, and Treatment
23 February 2011 (online)
Fecal incontinence is a debilitating problem facing ∼2.2% of the U.S. general population over 65 years of age. Etiologic factors include traumatic, neurologic, congenital, and iatrogenic. Most commonly, obstetric trauma causes fecal incontinence as well as poorly performed anorectal surgery or pelvic radiation. Several severity scores and quality of life indexes have been developed to quantify incontinent symptoms. There are several nonsurgical and surgical options for the treatment of fecal incontinence. Biofeedback is among the most successful nonoperative strategies. Depending on the cause, anal sphincter repair, artificial bowel sphincter, and sacral nerve stimulation are used to treat fecal incontinence with some success. Unfortunately, fecal incontinence is an extremely difficult problem to manage: there has not been one, single treatment option that has proven to be both safe and effective in long-term studies.
Fecal incontinence - anal sphincter repair - sacral nerve stimulation - artificial bowel sphincter - biofeedback
- 1 Zutshi M, Salcedo L, Hammel J, Hull T. Anal physiology testing in fecal incontinence: is it of any value?. Int J Colorectal Dis. 2010; 25 (2) 277-282
- 2 Wexner S D, Coller J A, Devroede G et al.. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010; 251 (3) 441-449
- 3 Baeten C G, Kuijpers H C. Incontinence. In: Wolff B G, Fleshman J W, Beck D E, Pemberton J H, Wexner S D, eds. The ASCRS Textbook of Colon and Rectal Surgery. New York, NY: Springer; 2007: 653-664
- 4 Poirier M, Abcarian H. Fecal incontinence. In: Cameron J L, ed. Current Surgical Therapy. Philadelphia, PA: Mosby Elsevier; 2008: 285-291
- 5 Corman M L. Anal incontinence. In: Corman M L, ed. Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins; 2005: 347-425
- 6 Wexner S D, Jin H Y, Weiss E G, Nogueras J J, Li V K. Factors associated with failure of the artificial bowel sphincter: a study of over 50 cases from Cleveland Clinic Florida. Dis Colon Rectum. 2009; 52 (9) 1550-1557
- 7 Brouwer R, Duthie G. Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum. 2010; 53 (3) 273-278
- 8 Norton C, Whitehead W E, Bliss D Z, Harari D, Lang J. Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence . Management of fecal incontinence in adults. Neurourol Urodyn. 2010; 29 (1) 199-206
- 9 Boselli A S, Pinna F, Cecchini S et al.. Biofeedback therapy plus anal electrostimulation for fecal incontinence: prognostic factors and effects on anorectal physiology. World J Surg. 2010; 34 (4) 815-821
- 10 Zutshi M, Tracey T H, Bast J, Halverson A, Na J. Ten-year outcome after anal sphincter repair for fecal incontinence. Dis Colon Rectum. 2009; 52 (6) 1089-1094
- 11 Zufferey G, Perneger T, Robert-Yap J, Rubay R, Lkhagvabayar B, Roche B. Measure of the voluntary contraction of the puborectal sling as a predictor of successful sphincter repair in the treatment of anal incontinence. Dis Colon Rectum. 2009; 52 (4) 704-710
- 12 Malouf A J, Vaizey C J, Nicholls R J, Kamm M A. Permanent sacral nerve stimulation for fecal incontinence. Ann Surg. 2000; 232 (1) 143-148
- 13 Baeten C G, Geerdes B P, Adang E M et al.. Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med. 1995; 332 (24) 1600-1605
- 14 Ruiz Carmona M D, Alós Company R, Roig Vila J V, Solana Bueno A, Pla Martí V. Long-term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?. Colorectal Dis. 2009; 11 (8) 831-837
- 15 Frudinger A, Kölle D, Schwaiger W, Pfeifer J, Paede J, Halligan S. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010; 59 (1) 55-61
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