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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This method of improving anal continence is recommended for patients with partial anal incontinence, in whom some functioning anal sphincter remains. It is particularly applicable for treating those patients who have sustained operative trauma, but is less helpful for those who have generalized sphincter weakness; however, any patient with some sphincter function may benefit. Emotionally unstable patients are less likely to benefit. Although the series was small, the results were considered sufficiently gratifying to justify a preliminary report.
Dis Colon Rectum 1979 Apr
PMID:Biofeedback in the management of partial anal incontinence: a preliminary report. 44 49

We report a case of traumatic anal incontinence successfully treated by the transplant of a gracilis muscle sling, using the technique described by Pickrell et al. in 1952. Although gracilis muscle transplant has been used in the treatment of congenital anal incontinence, its use in traumatic cases has not been widely accepted. Instead, many techniques offering uncertain results have been employed. We believe that Pickrell's technique is a worthwhile procedure in the presence of traumatic anal incontinence, particularly with noniatrogenic large perineal wounds, and that establishment of a temporary colostomy immediately after the injury, together with use of surgical steel sutures and antibiotics, is very helpful in averting posttransplant infection.
Dis Colon Rectum
PMID:Gracilis muscle transplant for correction of traumatic anal incontinence: Report of a case. 112 70

A series of 90 patients with intussusception of the rectum (internal procidentia) has been studied. In 11 per cent of the patients there was also an enterocele and in 3 per cent, a large proctocele. Forty patients were operated upon by the Ripstein procedure. Indications for operation were, in most cases, incontinence for gas and/or feces. Seventy-five per cent of the preoperatively incontinent patients were, at follow-up 2 to 10 years after operation, continent. When indications for surgery were pain and or a sensation of obstruction, the results were poor; most of these patients had unchanged symptoms postoperatively, and some even had increased symptoms. There was one postoperative death. Of 50 patients treated conservatively during a period of 2 to 10 years, only two had to be operated upon: one due to the development of a rectal prolapse and the other due to severe pain and an increased sensation of obstruction.
Dis Colon Rectum
PMID:Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. 114 81

The Teflon-sling method of repair of rectal prolapse in the Lahey Clinic experience has proved to be one of no mortality and low morbidity, with a recurrence rate of 7.3 per cent over an average follow-up period of nearly four years. Bowel management and incontinence are problems inherent in the pathogenesis of the problem and, though improved, necessitate long-term patient re-education and physiotherapy. More than 85 per cent of the patients were satisfied with the results of the procedure.
Dis Colon Rectum 1975 Sep
PMID:Symposium: Procidentia of the rectum: teflon sling repair of rectal prolapse, Lahey Clinic experience. 118 Nov 48

Twenty-four patients with obstructed defecation due to rectal intussusception diagnosed by defecography were treated with rectopexy either by the Wells technique (9 patients) or by Orr's operation (15 patients). After follow-up from one to eight years, defecography demonstrated disappearance of the intussusception in 22 patients. None of the patients were completely relieved of their symptoms. Nine (41 percent; 95 percent confidence limits: 21-64) were improved and 13 were unchanged (59 percent; 95 percent confidence limits: 36-79), with no difference between the two procedures. One patient with solitary rectal ulcer was improved, and the ulcer disappeared. Four patients with moderate preoperative incontinence became continent postoperatively, but obstructed defecation was only improved in two of these patients. It is concluded that rectal intussusception is probably a secondary phenomenon in patients with obstructed defecation and that a conservative attitude toward surgery should be adopted.
Dis Colon Rectum 1992 Nov
PMID:Internal rectal intussusception: results of surgical repair. 142 46

Fifty consecutive patients presenting with fecal incontinence were evaluated prospectively with anorectal manometry, defecography, and other tests of anorectal function to assess the clinical utility of defecography in fecal incontinence. Leakage of contrast at rest and failure to narrow the anorectal angle with pelvic squeezing were specific but not sensitive predictors of decreased sphincter pressures as determined by manometry. Thus, after manometry, defecography provided no additional information regarding sphincter strength. Retention of contrast in large rectoceles or incomplete rectal evacuation at defecography had excellent correlation with the presence of clinical symptoms of outlet obstruction constipation (present concurrently with incontinence) and indicated an etiology of outlet obstruction symptoms. Defecography may provide useful information in incontinent patients with outlet obstruction constipation symptoms but has little additive value to anorectal manometry in incontinent patients without such symptoms.
Dis Colon Rectum 1992 Nov
PMID:Combined anorectal manometry and defecography in 50 consecutive adults with fecal incontinence. 142 47

The aim of this work was to analyze clinical symptoms in light of anorectal manometry results. We compared the frequency of clinical symptoms in relation with the presence or absence of functional anomalies. Using this methodology, the following relationships may be suggested: the need to wear a pad, with a decreased resting pressure at the upper part of the anal canal; the inability to delay rectal evacuation, with decreased anal voluntary contraction; interference of incontinence with social activities, with decreased duration of anal voluntary contraction; urinary symptoms, with an increased threshold volume of rectal distention needed to elicit the rectoanal inhibitory reflex; and complete rectal prolapse, with reduced length of the anal canal.
Dis Colon Rectum 1992 Sep
PMID:Relationship between clinical symptoms of anal incontinence and the results of anorectal manometry. 151 44

Procedures for treating rectal prolapse may constitute some of the best applications for colorectal laparoscopic techniques. Although the condition is benign, rectal prolapse is often debilitating and frequently progressive in terms of functional limitations. Moreover, many patients are elderly, medically unfit, or both. A technique that afforded relief of prolapse and of incontinence by laparoscopic rectal sacropexy, performed without sutures, using a newly designed laparoscopic sacral tacker and laparoscopic staples, is described. Indications, contraindications, technical details, and surgical implications are discussed. Laparoscopic pelvic suspension procedures are presented as realistic and appropriate objectives for colon and rectal surgeons.
Dis Colon Rectum 1992 Jul
PMID:Sutureless laparoscopic rectopexy for procidentia. Technique and implications. 153 9

A grading system of anal incontinence (AI) is described that takes into account both degree and frequency of symptoms. A, B, and C indicate AI for flatus/mucus, liquid stool, and solid stool, respectively; 1, 2, and 3 indicate occasional, weekly, and daily AI. A scoring system, ranging from 0 (continence) to 6 (severe AI, i.e., daily AI for solid stool or C3) also is reported. Three hundred thirty-five patients have been evaluated by this method in our institution: 30 percent had severe AI, graded as C3; only 9 percent had mild symptoms graded as A. Both males and females could not control diarrhea (Grade B) in 44 percent of cases. Nearly half of the 110 patients who underwent surgery had a C3 incontinence before treatment. Positive results were achieved in 75 percent of cases after surgery: e.g., AI score significantly improved from 4.2 +/- 1.6 to 1.5 +/- 1.9 (P less than 0.001) in those with AI and rectal prolapse. Most of the failures were the patients with idiopathic C3 incontinence. In conclusion, this grading and scoring system allowed a satisfactory assessment of patients' AI before and after treatment. It may also be used to achieve an objective comparison between different series.
Dis Colon Rectum 1992 May
PMID:New grading and scoring for anal incontinence. Evaluation of 335 patients. 156 1

Surgeons have always been wary of performing abdominal colectomy and ileorectostomy in the older patient for fear of excessive stool frequency and fecal incontinence. Thirty-two patients, aged 60 years or over, underwent abdominal colectomy and ileorectostomy and were closely questioned regarding their preoperative, early postoperative, and late postoperative bowel habits. These patients were compared with a group of age- and sex-matched controls who had undergone right hemicolectomy. In both groups, the ileocecal valve had been resected, but only the ileorectostomy group had the entire colon resected. Immediately after ileorectostomy, patients underwent an average increase in bowel movements of 3.6 movements per day. This gradually decreased over time, so that, after five years, older patients with ileorectostomy had an average of 1.5 more bowel movements per day than they had had preoperatively. There were similar increases in the right hemicolectomy patient group: 0.9 bowel movements per day immediately after right hemicolectomy and 0.2 bowel movements per day after five years. Incontinence was an uncommon problem in both groups. This study suggests that elderly patients undergoing abdominal colectomy and ileorectostomy have an increase in daily bowel movements, which is not solely attributable to the loss of the right colon. However, it is a procedure that is well tolerated, with a low risk of incontinence and only a mild increase in stool frequency.
Dis Colon Rectum 1992 Apr
PMID:Ileorectostomy in the older patient. 158 48


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