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

This paper presents the application of a classification of anal fistulas to an unselected consecutive series of 793 patients treated for this condition at St Mark's Hospital from 1968 to 1973 inclusive. The fistulas were divided into five categories on their anatomical relationships: superficial (16 per cent), intersphincteric (54 per cent), trans-sphincteric (21 per cent), suprasphincteric (3 per cent) and extrasphincteric (3 per cent), with the remaining cases multiple or unclassified (3 per cent). There was good correlation between the categories and presentation, physical signs and treatment of the fistulas. Two hundred and forty-nine patients had potentially difficult fistulas. Follow-up of these patients revealed healing of almost all the fistulas, but the functional results were less satisfactory (incontinence of loose stool in 17 per cent and of flatus in 25 per cent, soiling in 31 per cent).
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PMID:Anal fistulas at St Mark's Hospital. 89 Feb 52

In 32 female patients with severe constipation subtotal (n = 27) or partial (n = 5) colectomy was performed. In 8 cases slow transit constipation was preexistent, 24 patients had a megacolon/dolichocolon. Ileosigmoid anastomosis was found to show the most favourable results. None of these patients complained of constipation postoperatively and all of them reported regular (daily) bowel movements. Incontinence for flatus and/or liquid stools was less likely to occur with ileosigmoid than with rectal anastomosis (29 versus 46%).
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PMID:[Functional results of subtotal and partial colectomy in therapy-resistant chronic constipation. A follow-up study of 32 patients]. 139 78

Long-term results of postanal repair are poor. Many patients with neuropathic incontinence have evidence of anterior pelvic floor weakness. A more comprehensive surgical repair has therefore been developed that involves postanal repair, anterior levatorplasty, and external sphincter plication. Primary total pelvic floor repair was performed in 22 women with neuropathic fecal incontinence. Fourteen patients who remained incontinent after conventional postanal repair underwent secondary anterior levatorplasty and external sphincter plication (two stages). Neither resting nor squeeze anal pressures were influenced by any of these procedures. However, pelvic floor descent at rest and straining was significantly decreased following primary total pelvic floor repair and secondary pelvic floor repair (p less than 0.05) but not by postanal repair. Complete continence for liquids, solids, and flatus was achieved in 41% of patients after primary total pelvic floor repair and in 14% after secondary anterior levatorplasty and external sphincter plication, but in only 4% after postanal repair. Only one patient after primary total pelvic floor repair and one after secondary anterior levatorplasty and external sphincter plication had persistent incontinence compared with 18 (38%) after postanal repair.
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PMID:Total pelvic floor repair for the treatment of neuropathic fecal incontinence. 153 70

Twelve patients with anal incontinence due to neurologic disease or failure of previous incontinence surgery underwent implantation of an artificial anal sphincter. The system used was a modification of the AMS 800 artificial urinary sphincter. In two patients, infection necessitated removal of the system, and in four patients, eight revisional procedures had to be performed because of mechanical failure. After various modifications of the system, especially reinforcement of the closing mechanism of the cuff, only one case of mechanical failure has occurred. Erosion through the anal canal did not occur. Among 10 patients with the system in function for more than 6 months, the result was considered excellent in 5, with only occasional leakage of flatus, good in 3, who occasionally leaked liquid feces and flatus, and acceptable in 2, in whom the cuff obstructed defecation. It is concluded that implantation of an artificial anal sphincter is a valid alternative to permanant colostomy in patients with anal incontinence due to neurologic disorders and in patients in whom other types of incontinence surgery have failed.
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PMID:Treatment of anal incontinence by an implantable prosthetic anal sphincter. 845 10

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.
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PMID:New grading and scoring for anal incontinence. Evaluation of 335 patients. 156 1

Static anal manometry has proved itself a reliable, reproducible and objective assessment of sphincter function in the investigation of disorders of defecation and continence. Despite this, it gives only very limited information on sphincter function due to the unphysiological nature of its measurement. Technical advances, particularly in digital data storage, have made the recording of anal pressure in a normal environment for prolonged periods of time possible. This offers an improved understanding both of anal activity and the interaction of rectal and anal function in normal and pathological states. In normal subjects anal function during a number of normal physiological events such as micturition, passage of flatus and sleep have been investigated. The sampling reflex has been further defined. Abnormalities of the sampling reflex, rectal activity and slow wave activity in the anal sphincter have been demonstrated in a number of pathological conditions of the anorectum and in the states of incontinence or constipation. Effective ambulatory anal manometry remains in its infancy. With continuing advances it offers exciting possibilities in defining normal or abnormal activity of the anorectum and in the investigation of patients with disorders of defecation and continence.
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PMID:The role and technique of ambulatory anal manometry. 158 67

Twenty-seven patients with rectal prolapse and faecal incontinence were treated by abdominal rectopexy. They were studied clinically and by anal manometry both pre- and postoperatively. Postoperatively eleven patients gained full continence, eight had incontinence for flatus, six were incontinent for liquid stools and only two had daily soiling--none was totally incontinent. Those patients who gained continence had significantly higher maximal basal pressure (MBP) (p less than 0.05) postoperatively as compared to those who remained incontinent. There was an inverse correlation between MBP and grade of postoperative incontinence (p less than 0.02). The postoperative increase of MBP correlated (p less than 0.05) with improving incontinence score. Such changes did not occur with the maximal voluntary contraction pressure (MVCP). Our results suggest that functional recovery of the internal anal sphincter is better in postoperatively continent patients.
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PMID:Improvement of continence after abdominal rectopexy for rectal prolapse. 158 27

Anal sphincter reconstruction for anal incontinence was performed in 55 women between 1973 and 1987 at The Jewish Hospital of St. Louis. The mean age was 34 years (range, 22-75 years). Incontinence was due to obstetric injury in 48 patients and to fistulotomy in 7 patients. Patients suffered from complete incontinence (41), incontinence of liquid stool and flatus (11), or incontinence of flatus only (3). All patients underwent an anterior overlapping sphincter muscle reconstruction, and one patient also had a posterior repair. Complete continence was restored in 28 patients, and partial continence was achieved in 24 patients. Only three patients remained totally incontinent. Clinical assessment did not accurately reflect functional outcome after 1 year of follow-up. No factor predicting outcome was found retrospectively. Clinical assessment of a patient's outcome may be inaccurate unless specific questions are asked. The use of a perineal drain reduced infection but did not affect outcome. Previous repair or associated rectovaginal fistula does not affect outcome. Sphincter injury owing to fistula disease may result in poor outcome after repair.
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PMID:Anal sphincter reconstruction: anterior overlapping muscle repair. 191 35

Both postanal repair and anterior sphincteroplasty with levatorplasty have been advocated in the treatment of idiopathic fecal incontinence. To assess the functional results of these procedures, physiologic and radiologic measurements were carried out prospectively in 33 patients with idiopathic incontinence undergoing operative treatment, and 12 age- and sex-matched controls. Sixteen patients had anterior sphincteroplasty and levatorplasty and 17 had postanal repair. A satisfactory postoperative outcome was defined as perfect continence or incontinence of flatus only. Ten patients in the anterior sphincteroplasty group had satisfactory results (64 percent) and 10 in the postanal repair group (59 percent). Preoperatively, both groups had decreased resting and squeeze pressures, impaired and mucosal electrosensitivity, and marked pelvic descent vs. controls. Postoperatively, significant improvement in sphincter pressures and mucosal electrosensitivity was seen in both groups. No significant change in anorectal angle was demonstrated in the postanal repair group, whereas it was made significantly more obtuse in the anterior sphincteroplasty group. It is likely that the improved continence resulting from either of these two procedures is secondary to better anal sphincter muscle function and improved and sensation. It would appear that the anorectal angle is not crucial in maintaining continence.
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PMID:Comparison of anterior sphincteroplasty and postanal repair in the treatment of idiopathic fecal incontinence. 200 47

Anal endosonography was performed in 62 consecutive patients with incontinence of flatus or faeces following obstetric trauma, and in 18 parous controls. Of the incontinent group, 90% had defects in the external sphincter, 65% in the internal sphincter and 44% disruption of the perineal body, compared with none of the controls. This triad of lesions is pathognomonic of obstetric trauma. Anal endosonography revealed a higher prevalence of sphincter damage than expected from anorectal physiology tests, and therefore has a role in screening patients following complicated or difficult deliveries.
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PMID:Unsuspected sphincter damage following childbirth revealed by anal endosonography. 202 96


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