Abstract
Anal continence is assured by the activity of complex anatomical and physiological structures (anal sphincters, pelvic floor musculature, rectal curvatures, transverse rectal folds, rectal reservoir, rectal sensation). It is dependent also on numerous other factors, such as stool consistency, patient’s mental faculties and mobility, and social convenience. Only if there is an effective, coordinated integration between these elements can defecation proceed normally. On the other hand, fecal incontinence (FI) is the result of disruption of one or several of these different entities: frequently, it can be due to a multifactorial pathogenesis, and in many cases, it is not secondary to sphincter tears. The disruption could lie in alterations intrinsic to the anorectal neuromuscular structures of continence control or be extrinsic to them, involving extrapelvic control mechanisms. The primary aim of an effective therapeutic approach must be the improvement-better, the resolution-of this distressing condition. Different forms of therapy are now available so that physicians must select the best option for each patient.
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References
Bharucha AE, Zinsmeister AR, Locke GR et al (2005) Prevalence and burden of fecal incontinence: a population based study in women. Gastroenterology 129:42–49
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Pescatori M, Anastasio G, Bottini C (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35:482–487
Ware JE Jr, Sherbourne CD (1992) The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16
Donovan J, Bosch R, Gotoh M et al (2005) Symptom and quality of life assessment. In: Abrams P, Cardozo L, Khoury S, Wein AJ (eds), Incontinence, vol. 1. Health Publications, Plymouth, pp 267–316
Barnett JL, Hasler WL, Camilleri M (1999) American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association. Gastroenterology 116:732–760
Simpson RR, Kennedy ML, Hung Nguyen M et al (2006) Anal manometry: a comparison of techniques. Dis Colon Rectum 49:1033–1038
Bharucha AE (2006) Update of tests of colon and rectal structure and function. J Clin Gastroenterol 40:96–103
Kaur G, Gardiner A, Duthie GS (2006) A new method of assessing anal sphincter integrity using inverted vectormanometry. Dis Colon Rectum 49:1160–1166
West RL, Felt-Bersma RJ, Hansen BE et al (2005) Volume measurements of the anal sphincter complex in healthy controls and fecal-incontinent patients with a three-dimensional reconstruction of endoanal ultrasonography images. Dis Colon Rectum 48:540–548
Morren GL, Walter S, Lindehammar H et al (2001) Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence. Dis Colon Rectum 44:167–172
Jost WH, Schimrigk K (1994) A new method to determine pudendal nerve motor latency and central motor conduction time to the external anal sphincter. Electroencephalogr Clin Neurophysiol 93:237–239
Loening-Baucke V, Read NW, Yamada T, Barker AT (1994) Evaluation of the motor and sensory components of the pudendal nerve. Electroencephalogr Clin Neurophysiol 93:35–41
Sato T, Konishi F, Minakami H et al (2001) Pelvic floor disturbance after childbirth: vaginal delivery damages the upper levels of sphincter innervation. Dis Colon Rectum 44:1155–1161
Lefaucheur JP (2005) Intrarectal ground electrode improves the reliability of motor evoked potentials recorded in the anal sphincter. Muscle Nerve 32:110–112
Jost WH, Loch EG, Muller-Lobeck H (1998) Electro-physiologic studies of fecal incontinence in the woman. Zentralbl Gynakol 120:153–159
Uher EM, Swash M (1998) Sacral reflexes: physiology and clinical application. Dis Colon Rectum 41:1165–1177
Lefaucheur JP (2006) Neurophysiological testing in anorectal disorders. Muscle Nerve 33:324–333
Rao SS, Ozturk R, Stessman M (2004) Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 99:2204–2209
Hussain SM, Stoker J, Lameris JS (1995) Anal sphincter complex: endoanal MR imaging of normal anatomy. Radiology 197:671–677
Terra MP, Beets-Tan RG, van Der Hulst VP et al (2005) Anal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging. Radiology 236:886–895
Williams AB, Malouf AJ, Bartram CI et al (2001) Assessment of external anal sphincter morphology in idiopathic fecal incontinence with endocoil magnetic resonance imaging. Dig Dis Sci 46:1466–1471
Terra MP, Beets-Tan RG, van der Hulst VP et al (2006) MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol 187:991–999
Cazemier M, Terra MP, Stoker J et al (2006) Atrophy and defects detection of the external anal sphincter: comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum 49:20–27
Terra MP, Stoker J (2006) The current role of imaging techniques in faecal incontinence. Eur Radiol 16:1727–1736
Hetzer FH, Andreisek G, Tsagari C et al (2006) MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology 240:449–457
Liberman H, Faria J, Ternent CA et al (2001) A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence. Dis Colon Rectum 44:1567–1574
Bharucha AE (2006) Pro: Anorectal testing is useful in fecal incontinence. Am J Gastroenterol 101:2679–2681
Wald A (2006) Con: Anorectal manometry and imaging are not necessary in patients with fecal incontinence. Am J Gastroenterol 101:2681–2683
Rao SS (2006) A balancing view: fecal incontinence: test or treat empirically-which strategy is best? Am J Gastroenterol 101:2683–2684
Deutekom M, Terra MP, Dijkgraaf MG et al (2006) Patients’ perception of tests in the assessment of faecal incontinence. Br J Radiol 79:94–100
Matzel K, Stadelmaier M, Hohenfellner FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127
Ganio E, Realis Luc A, Ratto C et al (2005) Sacral nerve modulation for fecal incontinence: functional results and assessment of the quality of life, http://www.colorep.it/Rivista%20CEC/sacral_nerve_modulation_for_feca.htm. Cited 28 Nov 2005
Jarrett ME, Varma JS, Duthie GS et al (2004) Sacral nerve stimulation for faecal incontinence in the UK. Br J Surg 91:755–761
Bernstein AJ, Peters KM (2005) Expanding indications for neuromodulation. Urol Clin North Am 32:59–63
Jarrett ME, Matzel KE, Christiansen J et al (2005) Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse. Br J Surg 92:734–739
Kenefick NJ, Vaizey CJ, Nicholls RJ et al (2002) Sacral nerve stimulation for faecal incontinence due to systemic sclerosis. Gut 51:881–883
Matzel K, Stadelmaier U, Hohenfellner M et al (2001) Chronic sacral spinal nerve Stimulation for faecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44:59–66
Malouf AJ, Vaizey CJ, Nicholls RJ et al (2000) Permanent sacral nerve stimulation for faecal incontinence. Ann. Surg 232:143–148
Leroi AM, Michot F, Grise P et al (2001) Effect of sacral nerve stimulation in patients with faecal and urinary incontinence. Dis Colon Rectum 44:779–789
Jarrett ME, Matzel KE, Stosser M et al (2005) Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon Rectum 48:1243–1248
Matzel KE, Stadelmaier U, Bittorf B et al (2002) Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis 17:430–434
Ratto C, Grillo E, Parello A et al (2005) Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum 48:1027–1036
Jarrett ME, Matzel KE, Stosser M et al (2005) Sacral nerve stimulation for faecal incontinence following a rectosigmoid resection for colorectal cancer. Int J Colorectal Dis 20:446–451
Hallan RI, Marzouk DE, Waldron DJ et al (1989) Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 76:973–975
Rao SS, Ozturk R, Stessman M (2004) Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 99:2204–2209
Bharucha AE, Fletcher JG, Harper CM et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic fecal incontinence. Gut 54:546–555
Sun WM, Donnelly TC, Read NW (1992) Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of ‘idiopathic’ faecal incontinence. Gut 33:807–813
Chiarioni G, Bassotti G, Stanganini S et al (2002) Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97:109–117
Siproudhis L, El Abkari M, El Alaoui M et al (2005) Low rectal volumes in patients suffering from fecal incontinence: What does it mean? Aliment Pharmacol Ther 22:989–996
Felt-Bersma RJ, van Baren R, Koorevaar M et al (1995) Unsuspected sphincter defects shown by anal endosonography after anorectal surgery. A prospective study. Dis Colon Rectum 38:249–253
Stoker J, Halligan S, Bartram CI (2001) Pelvic floor imaging. Radiology 218:621–641
Bharucha AE, Fletcher JG, Scide B et al (2005) Phenotypic variation in functional disorders of defecation. Gastroenterology 128:1199–1210
Malouf AJ, Norton CS, Engel AF et al (2000) Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 355:260–265
Ricciardi R, Mellgren AF, Madoff RD et al (2006) The utility of pudendal nerve terminal motor latencies in idiopathic incontinence. Dis Colon Rectum 49:852–857
References
Bannister JJ, Gibbons C, Read NW (1987) Preservation of faecal continence during rises in intra-abdominal pressure: is there a role for the flap-valve? Gut 28:1242–1244
Mavrantonis C, Wexner SD (1998) A clinical approach to fecal incontinence. J Clin Gastrol 27(2):108–121
Dobben AC, Terra MP, Deutekom M et al (2006) Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis (Epub ahead of print)
Woods R, Voyvodic F, Schloithe AC et al (2003) Anal sphincter tears in patients with rectal prolapse and faecal incontinence. Colorectal Dis 5(6):544–548
Steele SR, Lee PY, Mullenix PS et al (2006) Is there a role for concomitant pelvic floor repair in patients with sphincter defects in the treatment of fecal incontinence? Int J Colorectal Dis 21:508–514
Hetzer FH, Andreisek G, Tsagari C et al (2006) MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology 240(2):449–457
Conaghan P, Farouk R (2005) Sacral nerve stimulation can be successful in patients with ultrasound evidence of external anal sphincter disruption. Dis Colon Rectum 48(8):1610–1614
Rasmussen OO, Buntzen S, Sorensen M et al (2004) Sacral nerve stimulation in fecal incontinence. Dis Colon Rectum 47(7):1158–1161
Tjandra JJ, Lim JF, Hiscock R, Rajendra P (2004) Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum 47(12):2138–2146
Malouf AJ, Vaizey CJ, Norton CS, Kamm MA (2001) Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial. Dis Colon Rectum 44(4):595–600
Barisic GI, Krivokapic ZV, Markovic VA, Popovic MA (2006) Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis 21(l):52–56
Londono-Schimmer EE, Garcia-Guperly R, Nicholls RJ et al (1994) Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five-year follow-up of functional results. Int J Colorectal Dis 9:100–103
Yoshioka K, Keighley MR (1989) Sphincter repair for fecal incontinence. Dis Colon Rectum 32:39–42
Maslekar S, Gardiner AB, Duthie GS (2007) Anterior anal sphincter repair for fecal incontinence: Good long-term results are possible. J Am Coll Surg 204(l):40–46
Bravo Gutierrez A, Madoff RD, Lowry AC Et al (2004) Long-term results of anterior sphincteroplasty. Dis Colon Rectum 47(5):727–731; discussion 731–732
Cali RL, Blatchfored GJ, Perry RE et al (1992) Normal variation in anorectal manometry. Dis Colon Rectum 35:1161–1164
Emblem R, Dhaenens G, Stien R et al (1994) The importance of anal endosonography in the evaluation of idiopathic fecal incontinence. Dis Colon Rectum 37:42–48
Hill K, Fanning S, Fennerty MB, Faigel DO (2006) Endoanal ultrasound compared to anorectal manometry for the evaluation of fecal incontinence: a study of the effect these tests have on clinical outcome. Dig Dis Sci 51(2):235–240
Roig JV, Villoslada C, Lledo S et al (1995) Prevalence of pudendal neuropathy in fecal incontinence. Results of a prospective study. Dis Colon Rectum 38(9):952–958
Chen AS, Luchtefeld MA, Senagore AJ et al (1998) Pudendal nerve latency. Does it predict outcome of anal sphincter repair? Dis Colon Rectum 41(8):1005–1009
Osterberg A, Graf W, Edebol Eeg-Olofsson K et al (2000) Results of neurophysiologic evaluation in fecal incontinence. Dis Colon Rectum 43(9):1256–1261
Ricciardi R, Mellgren AF, Madoff RD et al (2006) The utility of pudendal nerve terminal motor latencies in idiopathic incontinence. Dis Colon Rectum 49(6) 852–857
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Ratto, C. et al. (2007). Diagnostic Workup in Incontinent Patients: An Integrated Approach. In: Ratto, C., Doglietto, G.B., Lowry, A.C., PĂ¥hlman, L., Romano, G. (eds) Fecal Incontinence. Springer, Milano. https://doi.org/10.1007/978-88-470-0638-6_12
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DOI: https://doi.org/10.1007/978-88-470-0638-6_12
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