Future Perspectives in Management and Research of Fecal Incontinence

  • Carlo Ratto
  • Angelo Parello
  • Lorenza Donisi
  • Francesco Litta
  • Giovanni B. Doglietto


As a common denominator of all the clinical aspects treated in this book, there is the awareness of potential benefits derived from rational management of fecal incontinence (FI) and the need for further efforts to improve the effectiveness of traditional and new treatments. Indeed, although progress made in this field during the last few decades has been significant, the lack of detailed knowledge in the physiology of fecal continence far too frequently makes the application of therapeutic procedures empiric and pragmatic. Moreover, there are discrepancies between countries and regions in referring patients to centers dedicated to FI management. This causes different attitudes in performing a homogeneous diagnostic workup, in application of similar strict selection criteria to the variety of available treatments, and in reporting results of the applied therapies. Worldwide, national institutes for health inadequately support medical research on FI treatment, even though the social, economic, and clinical importance of FI to society has been very well recognized. On the other hand, research into FI is all too frequently sponsored only by companies with a commercial interest in the subject.


Fecal Incontinence Anal Sphincter Sacral Nerve Stimulation Sphincter Defect Endoanal Ultrasound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Whitehead WE, Wald A, Norton NJ (2004) Priorities for treatment research from different professional perspectives. Gastroenterol 126:S180–S185CrossRefGoogle Scholar
  2. 2.
    Deutekom M, Dobben AC, Terra MP et al (2007) Clinical presentation of fecal incontinence and anorectal function: what is the relationship? Am J Gastroenterol 102:351–361PubMedCrossRefGoogle Scholar
  3. 3.
    Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126(1 Suppl l):S3–7PubMedCrossRefGoogle Scholar
  4. 4.
    Fitzgerald MP, Weber AM, Howden N et al (2007) Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol 109:29–34PubMedGoogle Scholar
  5. 5.
    Richter HE, Fielding JR, Bradley CS et al (2006) Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol 108:1394–1401PubMedGoogle Scholar
  6. 6.
    Thornton MJ, Lubowski DZ (2006) Obstetric-induced incontinence: a black hole of preventable morbidity. Aust NZ J Obstet Gynaecol 46:468–473CrossRefGoogle Scholar
  7. 7.
    Gourcerol G, Gallas S, Michot F et al (2006) Sacral nerve stimulation in fecal incontinence: are there factors associated with success? Dis Colon Rectum 49:1–10CrossRefGoogle Scholar
  8. 8.
    Trowbridge ER, Morgan D, Trowbridge MJ et al (2006) Sexual function, quality of life, and severity of anal incontinence after anal sphincteroplasty. Am J Obstet Gynecol 195:1753–1757PubMedCrossRefGoogle Scholar
  9. 9.
    Pla-Marti V, Moro-Valdezate D, Alos-Company R et al (2007) The effect of surgery on quality of life in patients with faecal incontinence of obstetric origin. Colorectal Dis 9:90–95PubMedCrossRefGoogle Scholar
  10. 10.
    Hetzer FH, Hahnloser D, clavien PA et al (2007) Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence. Arch Surg 142:8–13PubMedCrossRefGoogle Scholar
  11. 11.
    Rockwood TH (2004) Incontinence severity and QOL scales for fecal incontinence. Gastroenterology 126(1 Suppl l):S106–113PubMedCrossRefGoogle Scholar
  12. 12.
    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 43:9–16PubMedCrossRefGoogle Scholar
  13. 13.
    Rothbarth J, Bemelman WA, Meijerink WJ et al (2001) What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 44:67–71PubMedCrossRefGoogle Scholar
  14. 14.
    Eypasch E, Williams JI, Wood-Dauphinee S et al (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222PubMedCrossRefGoogle Scholar
  15. 15.
    Sakakibara R, Shinotoh H, Uchiyama T et al (2001) Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosi 92:76–85CrossRefGoogle Scholar
  16. 16.
    Wiesel PH, Norton C, Roy AJ et al (2000) Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 69:240–243PubMedCrossRefGoogle Scholar
  17. 17.
    Bai Y, Yuan Z, Wang W et al (2000) Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. J Pediatr Surg 35:462–464PubMedCrossRefGoogle Scholar
  18. 18.
    Bug GJ, Kiff ES, Hosker G (2001) A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG 108:1057–1067PubMedCrossRefGoogle Scholar
  19. 19.
    Sperber AD (2004) Translation and validation of study instruments for cross-cultural research. Gastroenterology 126(1 Suppl 1):S124–128PubMedCrossRefGoogle Scholar
  20. 20.
    Gearhart S, Hull T, Floruta C (2005) Anal manometric parameters: predictors of outcome following anal sphincter repair? J Gastrointest Surg 9:115–120PubMedCrossRefGoogle Scholar
  21. 21.
    Prott G, Hansen R, Badcock C et al (2005) What is the optimum methodology for the clinical measurement of resting anal sphincter pressure? Neurogastroenterol Motil 17:595–599PubMedCrossRefGoogle Scholar
  22. 22.
    Siprouidhis L, Al Abkari M, El Alaoui M et al (2005) Low rectal volumes in patients suffering from fecal incontinence: what does it mean? Aliment Pharmacol Ther 22:989–996CrossRefGoogle Scholar
  23. 23.
    Deutekom M, Terra MP, Dijkgraaf MGW et al (2006) Patients’ perception of tests in the assessment of faecal incontinence. Br J Radiol 79:94–100PubMedCrossRefGoogle Scholar
  24. 24.
    Rattan S (2005) The internal anal sphincter: regulation of smooth muscle tone and relaxation. Neurogastroenterol Motil 17(Suppl l):50–59PubMedCrossRefGoogle Scholar
  25. 25.
    Enck P, Hinninghofen H, Merlett R et al (2005) The external anal sphincter and the role of surface electromyography. Neurogastroenterol Motil 17(Suppl 1): 60–67PubMedCrossRefGoogle Scholar
  26. 26.
    Azpiroz F, Fernandez-Fraga X, Merlett R et al (2005) The puborectalis muscle. Neurogastroenterol Motil 17(Suppl l):68–72PubMedCrossRefGoogle Scholar
  27. 27.
    Saranovic D, Barisic G, Krivokapic Z et al (2007) Endoanal ultrasound of anorectal diseases and disorders: technique, indications, results and limitations. Eur J Radiol 61:480–489PubMedCrossRefGoogle Scholar
  28. 28.
    Mortele KJ, Fairhurst J (2007) Dynamic MR defecography of the posterior compartment: indications, techniques and MRI features. Eur J Radiol 61:462–472PubMedCrossRefGoogle Scholar
  29. 29.
    Maglinte DDT, Bartram C (2007) Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations. Eur J Radiol 61:454–461PubMedCrossRefGoogle Scholar
  30. 30.
    Dobben AC, Terra MP, Berghmans B et al (2006) Functional changes after physiotherapy in fecal incontinence. Int J Colorectal Dis 21:515PubMedCrossRefGoogle Scholar
  31. 31.
    Maeda Y, Vaizey CJ, Kamm MA (2007) Long-term results of perianal silicone injection for faecal incontinence. Colorectal Dis 9:357–361PubMedCrossRefGoogle Scholar
  32. 32.
    Ratto C, Parello A, Donisi L et al (2007) Anal Gatekeeper: a new bulking agent for patients with fecal incontinence. Abstract PI8. In: Proceedings ASCRS 2007 Annual Meeting, June 2–6, Cervantes Convention Center at America’s Center, St. Louis, MO, USAGoogle Scholar
  33. 33.
    Schrag HJ, Ruthmann O, Doll A et al (2006) Development of a novel, remote-controlled artificial bowel sphincter through microsystems technology. Artif Organs 30:855–862PubMedCrossRefGoogle Scholar
  34. 34.
    Tillin T, Gannon K, Feldman RA et al (2006) Third-party prospective evaluation of patient outcomes after dynamic graciloplasty. Br J Surg 93:1402–1410PubMedCrossRefGoogle Scholar
  35. 35.
    Ruthmann O, Fisher A, Hopt UT et al (2006) Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence. Chirurg 77:926–938PubMedCrossRefGoogle Scholar
  36. 36.
    Maslekar S, Gardiner AB, Duthie GS (2007) Anterior anal sphincter repair for fecal incontinence: good long-term results are possible. J Am Coll Surg. 204:40–46PubMedCrossRefGoogle Scholar
  37. 37.
    Barisic GI, Krivokapic ZV, Markovic VA et al (2006) Outcome of overlapping anal sphincter repair after 3 months and after a mean of 80 months. Int J Colorectal Dis 21:52–56PubMedCrossRefGoogle Scholar
  38. 38.
    Oberwalder M, Dinnewitzer A, Baig MK et al (2006) Do internal anal sphincter defects decrease the success rate of anal sphincter repair? Tech Coloproctol 10:94–97PubMedCrossRefGoogle Scholar
  39. 39.
    Hayes J, Shatari T, Toozs-Hobson P et al (2006) Early results of immediate repair of obstetric third-degree tears: 65% are completely asymptomatic despite persistent sphincter defects in 61%. Colorectal Dis 9:332–336CrossRefGoogle Scholar
  40. 40.
    Kairaluoma MV, Raivio P, Aarnio MT et al (2004) Immediate repair of obstetric anal sphincter rupture: medium-term outcome of the overlap technique. Dis Colon Rectum 47:1358–1363PubMedCrossRefGoogle Scholar
  41. 41.
    Steele SR, Lee P, 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: 508–514PubMedCrossRefGoogle Scholar
  42. 42.
    Kapoor DS, Thakar R, Sultan AH (2005) Combined urinary and faecal incontinence. Int Urogynecol J 16:321–328CrossRefGoogle Scholar
  43. 43.
    Soligo M, Salvatore S, Milani R et al (2003) Double incontinence in urogynecologic practice: a new insight. Am J Obstet Gynecol 189:438–443PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Carlo Ratto
  • Angelo Parello
  • Lorenza Donisi
  • Francesco Litta
  • Giovanni B. Doglietto

There are no affiliations available

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