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

The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.
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PMID:[Deep rectovaginal fistula and incontinence after labor trauma]. 846 18

Thirty-eight women with rupture of the anal sphincter occurring during childbirth were followed for 3-12 months. Nineteen had complete rupture of the external anal sphincter, 14 had a lesion involving more than half of the sphincter muscle and five had a superficial rupture. Fourteen patients presented with continence disturbances: nine to solid or liquid faeces and five to flatus. Incontinence was present in nine women 3 months after childbirth. Anal manometry and electromyography were performed in patients 3-5 days after delivery and repeated at 3, 6 and 12 months. Manometry and electromyography were also performed in 16 control subjects who were nulliparous or had given birth more than 2 years previously and 24 primiparous controls, who were investigated at 3-5 days and at 3 months. There were significant differences between both incontinent and continent patients compared with nulliparous and primiparous controls. Primiparous control subjects had decreased anal squeeze pressure as well as decreased electromyographic activity on the first days after delivery compared with nulliparous controls. After 3 months no differences were found. Continence disturbances are frequent after sphincter rupture; these patients should be monitored after delivery and those with persisting incontinence offered sphincter repair.
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PMID:Sphincter rupture in childbirth. 847 62

Six patients underwent objective measurement of anorectal sensory function following abdominoperineal excision of the rectum and total anorectal reconstruction. No patient perceived neorectal distension as a desire to defaecate or as a feeling of flatus. Anal mucosal sensation was preserved in two patients in whom some anal mucosa was retained. These sensory deficiencies may result in faecal retention and incontinence in patients undergoing reconstructive surgery. The loss of rectal sensation suggests that the prime sensors of rectal filling may lie within the rectum itself.
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PMID:Total anorectal reconstruction results in complete anorectal sensory loss. 865 65

This article presents the concepts that give meaning to the pressures observed in the various parts of the body occurring normally and abnormally in various conditions. Normal pressure relationships, holding urine, voiding, incontinence, and flatulence and defecation are discussed.
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PMID:Physiology of the lower urinary tract. 865 19

Obstetric injury is the principal cause of faecal incontinence in women. We describe use of a 120 degrees sector ultrasound probe to assess integrity of the anal sphincters in primigravid women. Eighty-eight women were successfully studied 6 weeks following vaginal delivery. Anal vector manometry and pudendal nerve studies were abnormal in 54 (61%), of whom 41 (71%) were symptomatic (urgency of defaecation, incontinence to flatus or faeces). The sonographic pattern of the anal sphincters described with a 360 degrees probe was reproduced. Forty-eight abnormal scans were reported by two radiologists with a kappa statistic of 0.65. Sphincter defects were found in 11 asymptomatic women. We conclude that anal endosonography has an important role screening for and diagnosis of postpartum anal sphincter defects. Use of a 120 degrees sector ultrasound probe may prove a cost-effective means of increasing the availability of this technique.
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PMID:Endosonographic assessment of postpartum anal sphincter injury using a 120 degree sector scanner. 876 92

Overlapping sphincter reconstruction for fecal incontinence due to perineal tears, trauma or iatrogenic injuries is the therapy of choice. If this technique fails repeatedly or more than half of the sphincter is destroyed, a gracilis muscle plasty is indicated. Incontinence caused by an ectropion must be treated by a skin flap procedure (Ferguson or VY-plasty). These techniques are described in detail. Results of 54 overlapping procedures carried out in 47 patients (30 females, 17 males, age 15-84, median 47 years) during the last 3.5 years are presented. The most frequent cause of incontinence was fistulectomy followed by perineal tears. Thirty-day success rate with excellent or good results (difficulty in controlling flatus) was 82%, decreasing to 70% at the end of follow-up. Complications were rare (7/54) and did not influence outcome except for wound healing by second intention, which resulted in a high failure rate. Superior results were achieved when the reason for incontinence was a perineal tear (81%, compared with fistulectomy (64%). In conclusion, overlapping sphincter reconstruction results in a high success rate, especially when fecal incontinence was caused by a perineal tear.
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PMID:[Reinterventions in secondary incontinence]. 877 78

Thirty-three adolescents (aged 12 to 20 years; median, 15) with a corrected low (n = 17) or high (n = 16) anorectal anomaly were assessed using anorectal physiological examination, semistructured interviews [Child Assessment Schedule [CAS]), and questionnaires (Child Behavior Checklist [CBCL], Youth Self-Report [YSR]). Seven patients, all of whom had low malformations, were totally continent. Twenty-three (70%) had persistent dysfunction with staining (n = 12) or intermittent/constant soiling (n = 11). Twenty-four (73%) had flatus incontinence. Fecal incontinence correlated negatively with anal canal resting pressure (r = - .58, P = <.001) and squeeze pressure (r = -.54, P < .01). Three adolescents had a permanent colostomy. Nineteen patients (58%) met the criteria for a psychiatric diagnosis, and impairment of psychosocial function was found in 24 (73%). The degree of psychosocial impairment correlated significantly with fecal incontinence (F = -.37, P < .05) and flatus incontinence (r = -.49, P < .01). Continence of flatus correlated significantly with mental health symptom scores (YSR: r = .52, P < .01; CAS:r = .53, P < .01). The findings indicated that, in addition to soiling, staining as well as fear of flatus are associated with psychiatric and psychosocial dysfunction among patients with anorectal malformations. Optimal treatment of patients with low and high anorectal anomalies requires somatic and psychological care and follow-up into adulthood.
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PMID:Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies. 886 71

Between 1965 and 1994 eight selected patients with faecal incontinence for solid stool (Grade 4) were operated on by the original procedure described by Pickrell (1952), combined with biofeedback training postoperatively. No postoperative complication occurred. All patients were improved by this procedure. Five had normal continence and there were 3 incontinence for flatus. Anal manometry showed an increase in postoperative squeeze pressure (p < 0.05). Long term results (48.5 months) remained the same in five cases. One patient became incontinent following an anal dilatation at 108 months, and two required excision of mucosal ectropion at 7 and 78 months with restoration of continence. One patient died of unrelated disease at 31 months.
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PMID:Gracilis muscle transposition in the treatment of faecal incontinence. 891 35

In 48 patients who had undergone anterior resection for rectal cancer with straight colorectal reconstruction, clinical and manometric results were correlated with the level of anastomosis. Patients were divided into four groups by anastomotic level: < or = 3, 4-6, 7-9, and > or = 10 cm. Functional outcome with regard to frequency of bowel movements, minor leakage, fecal incontinence. ability to defer stool and to differentiate consistency showed increasing impairment the lower the anastomotic level. Frequency, leakage owing to the inability to defer stool, incontinence for solid stool, inability to discriminate flatus from stool, and incomplete emptying were significantly different (P < 0.05) between the patients with an anastomotic level between 3-6 cm and between 7-9 cm. Manometric data revealed no trend or significant differences among the groups with regard to anal resting pressure and maximal and median squeeze pressure. Rectoanal inhibitory reflex was abolished in 60% of the patients. Clear changes, with a trend toward reduced function with lower anastomotic levels, were seen in the volume that produced a feeling of urgency, maximal tolerable volume, and neorectal compliance (between anastomotic levels 7-9 and > or = 10 cm the differences were significant; P < 0.05). Analysis by length of residual rectum (< 1.5, 1.5-4.0, 4.1-6.5, > 6.5 cm) demonstrated similar findings, suggesting that impaired function after rectal resection is due to reduced function of the neorectum. Thus, as much residual rectum as possible should be preserve without risking cure. If the level of the anastomosis is expected to be below 6 cm, or if the residual rectum is less than 4 cm, the construction of a colon pouch to increase neorectal capacity should be considered.
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PMID:Continence after colorectal reconstruction following resection: impact of level of anastomosis. 918 76

1. Many benefits claimed for episiotomy are not sufficiently proven. In recent literature, some of them are questioned and some have been disproven. 2. Episiotomy, especially median episiotomy, has a higher risk of third-degree lacerations. Mediolateral episiotomy is more often followed by postpartum pain and impaired wound-healing. 3. Typical, albeit rare complications of episiotomy and third-degree lacerations are incontinence for stool and flatus, and-very seldom-fistula formation. 4. Complications of episiotomy as well as the failure to perform an episiotomy have had forensic consequences. 5. For good healing of an episiotomy or a perineal laceration suturing with an adequate technique and the use of non-reactive suture material is mandatory.
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PMID:[Episiotomy and its complications]. 941 May 30


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