RSS-Feed abonnieren
DOI: 10.1055/s-2001-16553
Fecal Incontinence
Publikationsverlauf
Publikationsdatum:
22. August 2001 (online)

ABSTRACT
Fecal incontinence is a socially debilitating problem that affects an unknown number of people. Many factors have contributed to the problematic nature of estimating the gravity of this condition. They include a lack of standard definitions for the severity and frequency of incontinence, the variable patient populations sampled, the unwillingness of patients to report symptoms due to embarrassment, and the lack of awareness and understanding of the problem among medical providers. The etiology of fecal incontinence is frequently multifactorial. The history and physical exam are often adequate to determine the etiology of fecal incontinence. However, objective testing in an anorectal physiology laboratory can be beneficial in delineating the degree of impairment based on sphincter pressures, size of anatomic sphincter defects, and presence of pudendal neuropathy. Surgical therapy for sphincter defects can be quite successful. However, new therapies such as stimulated graciloplasty, artificial anal sphincters, and sacral nerve stimulation show promise for those without anatomic defects. The socioeconomic and psychosocial impact of fecal incontinence is enormous in both the community and nursing home population and is, therefore, an important concern for the colorectal surgeon.
KEYWORD
Fecal incontinence treatment - biofeedback - sphincteroplasty - sacral stimulation - artificial anal sphincter
REFERENCES
- 1 Sangwan Y P, Coller J A. Fecal incontinence. Surg Clin North Am . 1994; 74 1377-1398
- 2 Johanson J F, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol . 1996; 91 33-36
- 3 Soffer E E, Hull T. Fecal incontinence: a practical approach to evaluation and treatment. Am J Gastroenterol . 2000; 95 1873-1880
- 4 Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum . 1998; 41 1226-1229
- 5 Thomas T M, Egan M, Walgrove A, Meade T W. The prevalence of faecal and double incontinence. Commun Med . 1984; 6 216-220
- 6 Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. Jama . 1995; 274 559-561
- 7 Drossman D A, Li Z, Andruzzi E. U.S householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci . 1993; 38 1569-1580
- 8 Borrie M J, Davidson H A. Incontinence in institutions: costs and contributing factors. Canadian Medical Association Journal . 1992; 147 322-328
- 9 Johanson J F, Irizarry F, Doughty A. Risk factors for fecal incontinence in a nursing home population. Journal of Clinical Gastroenterology . 1997; 24 156-160
- 10 Madoff R D, Williams J G, Caushaj P F. Fecal incontinence. N Engl J Med . 1992; 326 1002-1007
- 11 Venkatesh K S, Ramanujam P S, Larson D M, Haywood M A. Anorectal complications of vaginal delivery. Dis Colon Rectum . 1989; 32 1039-1041
- 12 Sultan A H, Kamm M A, Hudson C N, Thomas J M, Bartram C I. Anal-sphincter disruption during vaginal delivery [see comments]. N Engl J Med . 1993; 329 1905-1911
- 13 Faltin D L, Boulvain M, Irion O, Bretones S, Stan C, Weil A. Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol . 2000; 95 643-647
- 14 Varma A, Gunn J, Gardiner A, Lindow S W, Duthie G S. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum . 1999; 42 1537-1543
- 15 Zetterström J, Mellgren A, Jensen L L. Effect of delivery on anal sphincter morphology and function. Dis Colon Rectum . 1999; 42 1253-1260
- 16 Varma A, Gunn J, Lindow S W, Duthie G S. Do routinely measured delivery variables predict anal sphincter outcome?. Dis Colon Rectum . 1999; 42 1261-1264
- 17 Garcia-Aguilar J, Belmonte C, Wong W D, Lowry A C, Madoff R D. Open versus closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum . 1996; 39 440-443
- 18 Nyam D C, Pemberton J H. Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum . 1999; 42 1306-1310
- 19 MacIntyre I M, Balfour T W. Results of the Lord non-operative treatment for haemorrhoids. Lancet . 1972; 1 1094-1095
- 20 Read M G, Read N W, Haynes W G, Donnelly T C, Johnson A G. A prospective study of the effect of haemorrhoidectomy on sphincter function and faecal continence. Br J Surg . 1982; 69 396-398
- 21 Otto I C, Ito K, Ye C. Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum . 1996; 39 1423-1427
- 22 Ho Y H, Tsang C, Tang C L, Nyam D, Eu K W, Seow-Choen F. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum . 2000; 43 169-173
- 23 Kiff E S, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg . 1984; 71 614-616
- 24 Laurberg S, Swash M, Snooks S J, Henry M M. Neurologic cause of idiopathic incontinence. Arch Neurol . 1988; 45 1250-1253
- 25 Rasmussen O O, Christiansen J, Tetzschner T, Sørensen M. Pudendal nerve function in idiopathic fecal incontinence. Dis Colon Rectum . 2000; 43 633-637
- 26 Brodén G, Dolk A, Holmström B. Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. Int J Colorectal Dis . 1988; 3 23-28
- 27 Corman M L. Gracilis muscle transposition for anal incontinence: late results. Br J Surg . 1985; 72 S21-S22
- 28 Holschneider A M. Treatment and functional results of anorectal continence in children with imperforate anus. Acta Chirurg Belg . 1983; 82 191-204
- 29 Jorge J M, Wexner S D. Etiology and management of fecal incontinence. Dis Colon Rectum . 1993; 36 77-97
- 30 Lunniss P J, Kamm M A, Phillips R K. Factors affecting continence after surgery for anal fistula. Br J Surg . 1994; 81 1382-1385
- 31 Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum . 1992; 35 482-487
- 32 Rudd W W. The transanal anastomosis: a sphincter-saving operation with improved continence. Dis Colon Rectum . 1979; 22 102-105
- 33 Rothenberger D A. Anal incontinence. In: Cameron J, ed. Current Surgical Therapy
Philadelphia, PA: BC Decker 1989: 85-194
Reference Ris Wihthout Link
- 34 Rainey J B, Donaldson D R, Thomson J P. Postanal repair: which patients derive most benefit?. J R Coll Surg Edinburgh . 1990; 35 101-105
- 35 Shelton A A, Madoff R D. Defining anal incontinence: establishing a uniform continence scale. Semin Colon Rectal Surg . 1997; 8 54-60
- 36 Womack N R, Morrison J F, Williams N S. Prospective study of the effects of postanal repair in neurogenic faecal incontinence. Br J Surg . 1988; 75 48-52
- 37 Miller R, Bartolo D C, Locke-Edmunds J C, Mortensen N J. Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg . 1988; 75 101-105
- 38 Buie W D, Lowry A C, Rothenberger D A, Madoff R D. Clinical rather than laboratory asssessment predicts continence following anterior sphincteroplasty. Dis Colon Rectum . 2001; In press
- 39 Rockwood T H, Church J M, Fleshman J W. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum . 1999; 42 1525-1532
- 40 Rockwood T H, Church J M, Fleshman J W. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum . 2000; 43 9-17
- 41 Reilly W T, Talley N J, Pemberton J H, Zinsmeister A R. Validation of a questionnaire to assess fecal incontinence and associated risk factors: Fecal Incontinence Questionnaire. Dis Colon Rectum . 2000; 43 146-153
- 42 Marcello P W, Barrett R C, Coller J A. Fatigue rate index as a new measurement of external sphincter function. Dis Colon Rectum . 1998; 41 336-343
- 43 Liberman H, Faria J, Ternent C A. A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence. Dis Colon Rectum . 2000; 43 A14
- 44 Wexner S D, Jorge J M. Colorectal physiological tests: use or abuse of technology?. Eur J Surg . 1994; 160 167-174
- 45 Rao S S, Patel R S. How useful are manometric tests of anorectal function in the management of defecation disorders [see comments]?. Am J Gastroenterol . 1997; 92 469-475
- 46 Felt-Bersma R J, Klinkenberg-Knol E C, Meuwissen S G. Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value. Dis Colon Rectum . 1990; 33 479-485
- 47 Sun W M, Donnelly T C, Read N W. Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of 'idiopathic' faecal incontinence. Gut . 1992; 33 807-813
- 48 Rogers J, Henry M M, Misiewicz J J. Combined sensory and motor deficit in primary neuropathic faecal incontinence. Gut . 1988; 29 5-9
- 49 Jameson J S, Speakman C T, Darzi A, Chia Y W, Henry M M. Audit of postanal repair in the treatment of fecal incontinence. Dis Colon Rectum . 1994; 37 369-372
- 50 Rasmussen O O. Anorectal function. Dis Colon Rectum . 1994; 37 386-403
- 51 Cheong D M, Vaccaro C A, Salanga V D. Electrodiagnostic evaluation of fecal incontinence [published erratum appears in Muscle Nerve 1995;18:1368]. Muscle Nerve . 1995; 18 612-619
- 52 Dhaenens G, Emblem R, Ganes T. Fibre density in idiopathic ano-rectal incontinence. Electromyogr Clin Neurophysiol . 1995; 35 285-290
- 53 Snooks S J, Swash M. Electromyography and nerve latency studies. In: Gooszen H, ed. Disordered Defecation
Dordrecht, The Netherlands: Mjhoff; 1987
Reference Ris Wihthout Link
- 54 Jensen L L, Lowry A C. Biofeedback improves functional outcome after sphincteroplasty. Dis Colon Rectum . 1997; 40 197-200
- 55 Leroi A M, Dorival M P, Lecouturier M F. Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum . 1999; 42 762-769
- 56 Karoui S, Leroi A M, Koning E, Menard J F, Michot F, Denis P. Results of sphincteroplasty in 86 patients with anal incontinence. Dis Colon Rectum . 2000; 43 813-820
- 57 Young C J, Mathur M N, Eyers A A, Solomon M J. Successful overlapping anal sphincter repair: relationship to patient age, neuropathy, and colostomy formation. Dis Colon Rectum . 1998; 41 344-349
- 58 Sitzler P J, Thomson J P. Overlap repair of damaged anal sphincter. A single surgeon's series. Dis Colon Rectum . 1996; 39 1356-1360
- 59 Londono-Schimmer E E, Garcia-Duperly R, Nicholls R J, Ritchie J K, Hawley P R, Thomson J P. Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five year follow-up functional results [see comments]. Int J Colorectal Dis . 1994; 9 110-113
- 60 Engel A F, Kamm M A, Sultan A H, Bartram C I, Nicholls R J. Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg . 1994; 81 1231-1234
- 61 Laurberg S, Swash M, Henry M M. Delayed external sphincter repair for obstetric tear. Br J Surg . 1988; 75 786-788
- 62 Gilliland R, Altomare D F, Moreira Jr H, Oliveira L, Gilliland J E, Wexner S D. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum . 1998; 41 1516-1522
- 63 Tjandra J J, Milsom J W, Schroeder T, Fazio V W. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects. Dis Colon Rectum . 1993; 36 689-692
- 64 Law P J, Kamm M A, Bartram C I. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum . 1990; 33 370-373
- 65 Zetterström J P, Mellgren A, Madoff R D, Kim D G, Wong W D. Perineal body measurement improves evaluation of anterior sphincter lesions during endoanal ultrasonography. Dis Colon Rectum . 1998; 41 705-713
- 66
Hallgren T, Fasth S, Delbro D S, Nordgren S, Oresland T, Hultén L.
Loperamide improves anal sphincter function and continence after restorative proctocolectomy.
Dig Dis Sci .
1994;
39
2612-2618
Reference Ris Wihthout Link
- 67 Sasse K C, Yip B, Barrett B S. Preliminary study of topical phenylephrine as a treatment for fecal incontinence. Dis Colon Rectum . 2000; 43 A1
- 68 Carapeti E A, Kamm M A, Phillips R K. Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence. Br J Surg . 2000; 87 38-42
- 69 Carapeti E A, Kamm M A, Nicholls R J, Phillips R K. Randomized, controlled trial of topical phenylephrine for fecal incontinence in patients after ileoanal pouch construction. Dis Colon Rectum . 2000; 43 1059-1063
- 70 Briel J W, Zimmerman D D, Schouten W R. Randomized clinical trial of topical phenylephrine in the treatment of faecal incontinence [letter]. Br J Surg . 2000; 87 965-966
- 71 Carapeti E A, Kamm M A, Evans B K, Phillips R K. Topical phenylephrine increases anal sphincter resting pressure. Br J Surg . 1999; 86 267-270
- 72 Kegel A H. Progressive resistance exercises in the functional restoration of the perineal muscles. Am J Obstet Gynecol . 1948; 56 238-248
- 73 Engel B T, Nikoomanesh P, Schuster M M. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med . 1974; 290 646-649
- 74 Enck P. Biofeedback training in disordered defecation. A critical review. Dig Dis Sci . 1993; 38 1953-1960
- 75 Ko C Y, Tong J, Lehman R E, Shelton A A, Schrock T R, Welton M L. Biofeedback is effective therapy for fecal incontinence and constipation. Arch Surg . 1997; 132 829-833
- 76 Norton C, Kamm M A. Outcome of biofeedback for faecal incontinence. Br J Surg . 1999; 86 1159-1163
- 77 Ryn A K, Morren G L, Hallböök O, Sjödahl R. Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum . 2000; 43 1262-1266
- 78 Sangwan Y P, Coller J A, Barrett R C, Roberts P L, Murray J J, Schoetz Jr J D. Can manometric parameters predict response to biofeedback therapy in fecal incontinence?. Dis Colon Rectum . 1995; 38 1021-1025
- 79 Norton C, Hosker G, Brazzelli M. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev . 2000; 374 CD002111
- 80 MacLeod J H. Management of anal incontinence by biofeedback. Gastroenterology . 1987; 93 291-294
- 81 Enck P, Däublin G, Lübke H J, Strohmeyer G. Long-term efficacy of biofeedback training for fecal incontinence. Dis Colon Rectum . 1994; 37 997-1001
- 82 Parks A G, McPartlin J F. Late repair of injuries of the anal sphincter. Proc R Soc Med . 1971; 64 1187-1189
- 83 Sangwan Y P, Coller J A, Barrett R C. Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum . 1996; 39 686-689
- 84
Malouf A J, Norton C S, Engel A F, Nicholls R J, Kamm M A.
Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma.
Lancet .
2000;
355
260-265
Reference Ris Wihthout Link
- 84a Thiersch C. Carl Thiersch 1822-1895. Concerning prolapse of the rectum with special emphasis on the operation by Thiersch (classic article). Dis Colon Rectum . 1988; 31 154-155
- 85 Fleshner P R, Roberts P L. Encirclement procedures for fecal incontinence. Perspect Colon Rectal Surg . 1991; 4 280-297
- 86 Christiansen J, Sørensen M, Rasmussen O O. Gracilis muscle transposition for faecal incontinence. Br J Surg . 1990; 77 1039-1040
- 87 Faucheron J L, Hannoun L, Thome C, Parc R. Is fecal continence improved by nonstimulated gracilis muscle transposition?. Dis Colon Rectum . 1994; 37 979-983
- 88 Christiansen J, Hansen C R, Rasmussen O. Bilateral gluteus maximus transposition for anal incontinence. Br J Surg . 1995; 82 903-905
- 89 Pearl R K, Prasad M L, Nelson R L, Orsay C P, Abcarian H. Bilateral gluteus maximus transposition for anal incontinence. Dis Colon Rectum . 1991; 34 478-481
- 90 Gierup J, Hakelius L. Free autogenous muscle transplantation in the treatment of anal incontinence. An Espan Pediatr . 1980; 13 339-340
- 91 Parks A G. Royal Society of Medicine, Section of Proctology; Meeting 27 November 1974. President's Address. Anorectal incontinence. Proc R Soc Med . 1975; 68 681-690
- 92 Matsuoka H, Mavrantonis C, Wexner S D. Postanal repair for fecal incontinence-is it worthwhile?. Dis Colon Rectum . 2000; 43 1561-1567
- 93 Baeten C G, Geerdes B P, Adang E M. Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med . 1995; 332 1600-1605
- 94 Baeten C G, Bailey H R, Bakka A. Safety and efficacy of dynamic graciloplasty for fecal incontinence: report of a prospective, multicenter trial. Dynamic Graciloplasty Therapy Study Group. Dis Colon Rectum . 2000; 43 743-751
- 95 Geerdes B P, Heineman E, Konsten J, Soeters P B, Baeten C G. Dynamic graciloplasty. Complications and management. Dis Colon Rectum . 1996; 39 912-917
- 96 Madoff R D, Rosen H R, Baeten C G. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology . 1999; 116 549-556
- 97 Christiansen J, Lorentzen M. Implantation of artificial sphincter for anal incontinence. Lancet . 1987; 2 244-245
- 98 Christiansen J, Rasmussen O O, Lindorff-Larsen K. Long-term results of artificial anal sphincter implantation for severe anal incontinence. Ann Surg . 1999; 230 45-48
- 99 Lehur P A, Michot F, Denis P. Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations [see comments]. Dis Colon Rectum . 1996; 39 1352-1355
- 100 Lehur P A, Roig J V, Duinslaeger M. Artificial anal sphincter: prospective clinical and manometric evaluation. Dis Colon Rectum . 2000; 43 1100-1106
- 101 O'Brien P E, Skinner S. Restoring control: the Acticon Neosphincter artificial bowel sphincter in the treatment of anal incontinence. Dis Colon Rectum . 2000; 43 1213-1216
- 102 Wong W D, Jensen L L, Bartolo D C, Rothenberger D A. Artificial anal sphincter [see comments]. Dis Colon Rectum . 1996; 39 1345-1351
- 103 Matzel K E, Stadelmaier U, Hohenfellner M, Hohenberger W. Chronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum . 2001; 44 59-66
- 104 Malouf A J, Vaizey C J, Nicholls R J, Kamm M A. Permanent sacral nerve stimulation for fecal incontinence. Ann Surg . 2000; 232 143-148
- 105 Matzel K E, Stadelmaier U, Hohenfellner M, Gall F P. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence [see comments]. Lancet . 1995; 346 1124-1127
- 106 Vaizey C J, Kamm M A, Roy A J, Nicholls R J. Double-blind crossover study of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum . 2000; 43 298-302
- 107 Vaizey C J, Kamm M A, Turner I C, Nicholls R J, Woloszko J. Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut . 1999; 44 407-412
- 108 Rieger N A, Wattchow D A, Saire R G. Prospective trial of pelvic floor retraining in patients with fecal incontinence. Dis Col Rectum . 1997; 40 821-826