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Clin Colon Rectal Surg 2007; 20(2): 118-124
DOI: 10.1055/s-2007-977490
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Fecal Incontinence

Tracy Hull1
  • 1Department of Colon and Rectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
09 May 2007 (online)

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ABSTRACT

Fecal incontinence is a devastating problem for those afflicted. It can lead to embarrassment and social isolation. Treating the problem begins with a thorough history and physical examination. Further testing (such as anal physiology testing or anal endosonography) depends on the examination and treatment plan. Conservative medical therapies (such as dietary manipulation, medication to slow the stool, and biofeedback) are usually tried first. Surgery includes sphincter repair, SECCA, artificial bowel sphincter, and stoma. New therapies continue to evolve with the intention of further improving quality of life for these afflicted patients.

KEYWORDS

Fecal incontinence - sphincteroplasty - artificial bowel sphincter - SECCA - anal physiology

REFERENCES

  • 1 Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence.  JAMA. 1995;  274 559-561
    CrossrefPubMedGoogle Scholar
  • 2 Nelson R L. Epidemiology of fecal incontinence.  Gastroenterology. 2004;  126 S3-S7
    CrossrefPubMedGoogle Scholar
  • 3 Faridi A, Willis S, Schelzig P, Siggelkow W, Schumpelick V, Rath W. Anal sphincter injury during vaginal delivery-an argument for cesarean section on request?.  J Perinat Med. 2002;  30 379-387
    CrossrefPubMedGoogle Scholar
  • 4 Counihan T C, Madoff R D. Fecal incontinence. In: Fazio VW, Church JM, Delaney CP Current Therapy in Colon and Rectal Surgery. 2nd ed. Philadelphia; Elsevier Mosby 2005: 105-112
    Google Scholar
  • 5 Jackson S L, Weber A M, Hull T L, Mitchinson A R, Walters M D. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse.  Obstet Gynecol. 1997;  89 423-427
    CrossrefPubMedGoogle Scholar
  • 6 Baxter N N, Rothenberger D A, Lowry A C. Measuring fecal incontinence.  Dis Colon Rectum. 2003;  46 1591-1605
    CrossrefPubMedGoogle Scholar
  • 7 Gearhart S, Hull T, Floruta C, Schroeder T, Hammel J. Anal manometric parameter: predictors of outcome following anal sphincter repair?.  J Gastrointest Surg. 2005;  9 115-120
    CrossrefPubMedGoogle Scholar
  • 8 Deen K I, Kumar D, Williams J G, Olliff J, Keighley M R. Anal sphincter defects: correlation between endoanal ultrasound and surgery.  Ann Surg. 1993;  218 201-205
    CrossrefPubMedGoogle Scholar
  • 9 Santoro G A, Eitan B Z, Pryde A, Bartolo D C. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence.  Dis Colon Rectum. 2000;  43 1676-1682
    CrossrefPubMedGoogle Scholar
  • 10 Norton C, Hosker G, Brazzelli M. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults.  Cochrane Database Syst Rev. 2000;  2 CD002111
    PubMedGoogle Scholar
  • 11 Pager C K, Solomon M J, Rex J, Roberts R A. Long-term outcomes of pelvic floor exercise and biofeedback treatment for patients with fecal incontinence.  Dis Colon Rectum. 2002;  45 997-1003
    CrossrefPubMedGoogle Scholar
  • 12 Jensen L L, Lowry A C. Biofeedback improves functional outcome after sphincteroplasty.  Dis Colon Rectum. 1997;  40 197-200
    CrossrefPubMedGoogle Scholar
  • 13 Davis K J, Kumar D, Poloniecki J. Adjuvant biofeedback following anal sphincter repair: a randomized study.  Aliment Pharmacol Ther. 2004;  20 539-549
    CrossrefPubMedGoogle Scholar
  • 14 Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm M A. Randomized controlled trial of biofeedback for fecal incontinence.  Gastroenterology. 2003;  125 1320-1329
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 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
    PubMedGoogle Scholar
  • 17 Halverson A L, Hull T L. Long-term outcome of overlapping anal sphincter repair.  Dis Colon Rectum. 2002;  45 345-348
    CrossrefPubMedGoogle Scholar
  • 18 Bravo Gutierrez A, Madoff R D, Lowry A C, Parker S C, Buie W D, Baxter N N. Long-term results of anterior sphincteroplasty.  Dis Colon Rectum. 2004;  47 727-732
    CrossrefPubMedGoogle Scholar
  • 19 Tjandra J J, Han W R, Goh J, Carey M, Dwyer P. Direct repair vs. overlapping sphincter repair: a randomized, controlled trial.  Dis Colon Rectum. 2003;  46 937-943
    CrossrefPubMedGoogle Scholar
  • 20 Giordano P, Renzi A, Efron J et al.. Previous sphincter repair does not affect the outcome of repeat repair.  Dis Colon Rectum. 2002;  45 635-640
    CrossrefPubMedGoogle Scholar
  • 21 O'Brien P E, Dixon J B, Skinner S, Laurie C, Khera A, Fonda D. A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence.  Dis Colon Rectum. 2004;  47 1852-1860
    CrossrefPubMedGoogle Scholar
  • 22 Lehur P A, Glemain P, Bruley des Varannes S, Buzelin J M, Leborgne J. Outcome of patients with an implanted artificial anal sphincter for severe faecal incontinence. A single institution report.  Int J Colorectal Dis. 1998;  13 88-92
    CrossrefPubMedGoogle Scholar
  • 23 Lehur P A, Roig J V, Duinslaeger M. Artificial anal sphincter: prospective clinical and manometric evaluation.  Dis Colon Rectum. 2000;  43 1100-1106
    CrossrefPubMedGoogle Scholar
  • 24 Lehur P A, Zerbib F, Neunlist M, Glemain P, Bruley des Varannes S. Comparison of quality of life and anorectal function after artificial bowel sphincter implantation.  Dis Colon Rectum. 2002;  45 508-513
    CrossrefPubMedGoogle Scholar
  • 25 Parker S C, Spencer M P, Madoff R D, Jensen L L, Wong W D, Rothenberger D A. Artificial bowel sphincter: long-term experience at a single institution.  Dis Colon Rectum. 2003;  46 722-729
    CrossrefPubMedGoogle Scholar
  • 26 Efron J E, Corman M L, Fleshman J et al.. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca® procedure) for the treatment of fecal incontinence.  Dis Colon Rectum. 2003;  46 1606-1618
    CrossrefPubMedGoogle Scholar
  • 27 Matsuoka H, Mavrantonis C, Wexner S D, Oliveira L, Gilliland R, Pikarsky A. Postanal repair for fecal incontinence-is it worthwhile?.  Dis Colon Rectum. 2000;  43 1561-1567
    CrossrefPubMedGoogle Scholar
  • 28 Abbas S M, Bissett I P, Neill M E, Parry B R. Long-term outcome of postanal repair in the treatment of faecal incontinence.  ANZ J Surg. 2005;  75 783-786
    CrossrefPubMedGoogle Scholar
  • 29 Healy J C, Halligan S, Bartram C I, Kamm M A, Phillips R KS, Reznek R. Dynamic magnetic resonance imaging evaluation of the structural and functional results of postanal repair for neuropathic fecal incontinence.  Dis Colon Rectum. 2002;  45 1629-1634
    CrossrefPubMedGoogle Scholar
  • 30 Ho Y H. Postanal sphincter repair for anterior resection anal sphincter injuries: report of three cases.  Dis Colon Rectum. 2001;  44 1218-1220
    CrossrefPubMedGoogle Scholar
  • 31 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 1600-1605
    PubMedGoogle Scholar
  • 32 Koch S M, Uludag O, Rongen M J, Baeten C G, van Gemert W. Dynamic graciloplasty in patients born with an anorectal malformation.  Dis Colon Rectum. 2004;  47 1711-1719
    CrossrefPubMedGoogle Scholar
  • 33 Chapman A E, Geerdes B, Hewett P et al.. Systematic review of dynamic graciloplasty in the treatment of faecal incontinence.  Br J Surg. 2002;  89 138-153
    PubMedGoogle Scholar
  • 34 Matzel K E, Stadelmaier U, Hohenberger W. Innovations in fecal incontinence: sacral nerve stimulation.  Dis Colon Rectum. 2004;  47 1720-1728
    CrossrefPubMedGoogle Scholar
  • 35 Davis K, Kumar D, Poloniecki J. Preliminary evaluation of an injectable anal sphincter bulking agent (Durasphere) in the management of faecal incontinence.  Aliment Pharmacol Ther. 2003;  18 237-243
    CrossrefPubMedGoogle Scholar
  • 36 Tjandra J J, Lim J F, Hiscock R, Rajendra P. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective.  Dis Colon Rectum. 2004;  47 2138-2146
    CrossrefPubMedGoogle Scholar

Tracy HullM.D. 

Department of Colon and Rectal Surgery, The Cleveland Clinic Foundation

9500 Euclid Ave., Desk A-30, Cleveland, OH 44195

Email: Hullt@ccf.org

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