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

OBJECTIVE: The aim of this study was to examine the results of surgery for complex anal fistulas treated by a variety of techniques, in terms of fistula healing, recurrent anal sepsis and effect of surgery on anal continence. PATIENTS AND METHODS: This study included 63 patients with complex fistulas treated between November 1995 and September 1999. A variety of techniques were employed, including short-term loose seton drain (12), long-term loose seton drain (11), cutting seton (17), and rectal advancement flap (19). Outcome was assessed at clinic review and continence was further assessed by detailed questionnaire sent to the patients sometime after surgery. RESULTS: Healing occurred in 9 (75%) patients treated with a short-term, loose drainage seton; 16 (94%) patients treated with a cutting seton and 17 (89%) patients in the rectal advancement flap group. Incontinence reported at clinic review seemed to be more frequent in the advancement flap group. However, a detailed continence questionnaire revealed that 50% of patients reported episodes of incontinence to flatus or liquid after all techniques, which had not been detected at routine clinical review. Incontinence to solids was only reported by two of the patients who had been treated with a cutting seton. CONCLUSIONS: Complex fistulas may be successfully treated by a variety of techniques. Disturbed anal continence following surgery is common and worse than clinic assessment would suggest.
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PMID:The outcome of surgery for complex anal fistula. 1278 May 95

The algorithm of the treatment of the stool-incontinence starts with the differentiation between soiling and incontinence for flatus, liquid or formed faeces. In case of soiling, first all the causes that can be surgically solved should be treated. If this is not successful, the scheme of the incontinence-treatment should be followed. The first step is a dietary consultation, which includes prescription of appropriate drugs against diarrhoea, constipation and proctitis. The anal-physiological examinations will inform about the elasticity of the ampulla recti, which can be reduced in inflammatory processes, it will as well inform about the innervations of the ano-rectum and allow an objective sphincter pressure. If dietary therapy and drugs intake fail, the anal sphincter should be more closely examined. An endosonography or a perineal sonography and in case of a rectocele with incontinence a defecography need to be performed. In case of intact or defective sphincter a biofeedback training is started. If this is not successful, a sphincter-repair is performed in case of defective sphincter. To maintain the result the biofeedback training is continued. In case of failure as well as in case of intact sphincter that cannot be treated with the help of the biofeedback training, sacral nerve stimulation is indicated. If this does not work, the next step will be a dynamic graciloplasty or an artificial bowel sphincter. Both these methods are also indicated when the sphincter is missing. If this fails an anus praeter would definitively improve the quality of life of the patients. With bedridden or heavy demented patients, the anus praeter is often the first choice of procedure. The costs of the expensive pacemaker of the sacral nerve stimulation or the dynamic graciloplasty as well as the artificial bowel sphincter scare the insurances. Talking about cost and benefit these appliances are interesting as already in two years the costs a permanent anus praeter is causing are higher than the price of these medical appliances. In this overview article, different surgical procedures are described considering their indications, results and operative principles. The step-by-step use of the proposed algorithm leads to an optimal treatment of the stool-incontinence.
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PMID:[Surgical therapy of fecal incontinence]. 1280

Anal incontinence and constipation are not only physically and psychologically disabling symptoms but also a significant social and public health problem. The epidemiology of anal incontinence and constipation from community-bases remains largely unknown, especially in Asian women. This study is a continuation of a previous survey taken on the epidemiology of urinary incontinence and overactive bladder in Taiwanese women by using a second questionnaire (correlation coefficient for symptoms, r=0.87; P<0.05). We evaluated the prevalence and potential risk factors associated with anal incontinence and constipation in the general population. Of the 1,584 (2.92%) women sampled, 1,253 (79.1%) were successfully interviewed at home. The prevalence of fecal incontinence and flatus incontinence was 35 (2.8%) and 107 (8.6%), respectively. There were 306 (24.5%) participants who reported constipation. However, according to the current medical criteria for constipation, the prevalence of constipation was only 2.7%. The prevalence of anal incontinence did not increase after the age of 65 years (9.7%, including 3.5% of elderly women with fecal incontinence and 6.2% of elderly women with flatus incontinence). The prevalence of constipation significantly increased in the women aged 65 years and over (self-reported prevalence: 32.4%, fitted in medical criteria for constipation: 8.3%). Our results demonstrated that constipation shares some of the same risk factors, namely, symptoms of uterovaginal prolapse, prior gynecologic surgery, and overactive bladder that predispose women to the occurrence of anal incontinence. The questionnaire needs a higher discriminatory capacity, and a longitudinal study should be conducted to clarify this conflict further.
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PMID:Prevalence and correlations of anal incontinence and constipation in Taiwanese women. 1459 11

Fifty-two women with a rectovaginal fistula were managed over a period of 15 years. All the fistulae were caused by obstetric injury commonly resulting from breakdown of the repair of complete perineal tears or from unrecognised injury during forceps or precipitate delivery. In five patients the fistula healed spontaneously within 12 weeks of the injury. Thirty-nine patients underwent transvaginal purse-string repair by standard technique and eight patients had perineoproctotomy and sphincteroplasty for large fistulae associated with anal incontinence. Surgical repair was successful in all the 47 patients including two patients who had previous failed repair elsewhere. The routine postoperative follow-up period of the patients ranged between 6 months and 8 years. There were no residual symptoms of anal sphincter weakness in the patients treated with transvaginal purse-string repair. Two of the patients who underwent perineoproctotomy and sphincteroplasty complained of varying degrees of postoperative incontinence of flatus that resolved by 8 weeks postoperation. In our experience the transvaginal purse-string method of repair for small, low rectovaginal fistulae proved highly satisfactory with 100% cure rate. Perineoproctotomy and sphincteroplasty for larger fistulae associated with anal incompetence was equally successful with minimal postoperative morbidity.
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PMID:Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years' experience in a teaching hospital. 1461 59

One hundred and seventeen patients with anal fissure underwent fissure excision in combination with lateral subcutaneous sphincterotomy. The mean follow-up after treatment was 4.3 years. All the patients were questioned by the phone. Thirty-six ones who had some symptoms were examined at outpatient department. The examination included physical examination, anorectal manometry, endorectal ultrasonography, irrigoscopy, defecography. Recurrences of anal fissure were revealed in 12 (10.2%) patients. The cause of recurrence was incomplete sphincterotomy. Different grade of anal incontinence was revealed in 23 patients: 2 of them had soiling, 12 -- incontinence of the flatus, 8 -- incontinence of liquid faeces, 1 -- incontinence of solid faeces. In 4 patients the cause of anal incontinence was excessive sphincter section during sphincterotomy, in 16 -- perineal descent syndrome, in 3 -- advanced age. It is concluded that it is necessary to modify surgical technique and to examine patients more carefully before surgery including anorectal manometry.
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PMID:[Long-term results of excision of anal fissure in combination with lateral subcutaneous sphincterotomy]. 1609 93

The aim of this prospective study is to describe the combined technique and results of stapled haemorrhoidopexy and lateral internal sphincterotomy for patients suffering from prolapsing 3rd-degree haemorrhoids and chronic fissure-in-ano. During the period from 1999 to 2004, 26 patients underwent combined surgical treatment for anal fissure and prolapsing symptomatic haemorrhoids. Preoperative and postoperative clinical evaluation and the patient's degree of satisfaction were recorded. Early complications included faecal urgency (3 patients) and pain (2 patients). Complete continence was restored within 10 weeks in all patients except 1 who had persisting incontinence to flatus. All fissures healed completely within 4 weeks. No haemorrhoidal or fissure recurrence has been observed during follow-up. The combination of stapled haemorrhoidopexy and lateral internal sphincterotomy is a safe and effective procedure for the treatment of prolapsing 3rd-degree haemorrhoids and chronic anal fissures.
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PMID:Stapled haemorrhoidopexy for haemorrhoids in combination with lateral internal sphincterotomy for fissure-in-ano. 1637 15

Although ileal pouch-anal anastomosis (IPAA) is the procedure of choice for polyposis and ulcerative colitis with medically refractory disease or dysplasia, controversy exists concerning whether mucosal preservation with double-stapled (DS) IPAA is superior to mucosectomy and handsewn (HS) IPAA anastomosis for postoperative function. Prospective studies have shown no statistically significant differences. The use of meta-analysis can strengthen statistical power by combining the data from related studies. A meta-analysis was performed to determine whether there was a significant difference in functional and manometric outcome between HS-IPAA and DS-IPAA. Prospective, randomized studies were identified using a literature search. Functional outcome variables included number of normal continence, minor incontinence, nocturnal evacuation, the ability to discriminate flatus from stool, and antidiarrheal medication. Manometric outcomes included postoperative resting and squeeze anal pressures. Four prospective, randomized trials were identified. Of the 184 total patients, the HS-IPAA group included 86 patients (48 men and 38 women) and the DS-IPAA group included 98 patients (49 men and 49 women). There were no significant differences in functional outcome between HS-IPAA and DS-IPAA. In addition, there was no significant difference in sphincter resting and squeeze pressures between the two patient groups. This meta-analysis demonstrates that DS-IPAA offers no advantage in functional or manometric outcome when compared with HS-IPAA.
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PMID:Can a meta-analysis answer the question: is mucosectomy and handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis? 1705 34

Cryptoglandular fistula-in-ano is a common affliction that usually responds well to conventional surgical procedures such as fistulectomy, fistulotomy, and seton placement. These procedures, however, can be associated with varying degrees of fecal incontinence. Endorectal mucosal advancement flap has been advocated as an alternative procedure that avoids this problem. This study was undertaken to determine the risks and benefits associated with endorectal mucosal advancement flap in the treatment of complex fistula-in-ano. One hundred sixty-four patients underwent 167 endorectal mucosal advancement flap procedures for complex cryptoglandular fistula-in-ano between January 1982 and December 1990. There were 126 men and 38 women whose mean age was 42.1 years (range 20 to 79 years). The majority of the patients (70%) had complex fistulas (transsphincteric, suprasphincteric, or extrasphincteric). Fifteen patients (9%) had an intersphincteric fistula. All patients were available for short-term follow-up (6 weeks). Postoperative morbidity was minimal and included urinary retention in 13 patients (7.8%) and bleeding in one patient. Healing time averaged 6 weeks. Long-term follow-up, ranging from 19 to 135 months, was carried out in 61 patients. There were two recurrences (3.28%). Nine patients (15%) complained of varying degrees of fecal incontinence. Six patients complained of incontinence to flatus and three patients complained of incontinence to liquid stool. No patient was incontinent of solid stool. Sixty patients (98%) rated their functional result as excellent or good. Endorectal mucosal advancement flap is a safe and effective technique for the treatment of complex cryptoglandular fistula-in-ano. It can be performed with minimal morbidity, no mortality, an acceptable recurrence rate, and little alteration in anorectal continence.
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PMID:Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-in-ano. 1706 35

A total of 208 women were assessed 2 years' post-delivery to record the prevalence of subjective urinary and faecal incontinence, incontinence of flatus, dyspareunia, subjective depression and sexual satisfaction. This was correlated with mode of delivery. A sample population was selected from the Cardiff Birth Survey Database, in accordance with strict inclusion and exclusion criteria. Each woman was invited to complete and return a postal questionnaire addressing symptoms of pelvic floor dysfunction. There was a significant decrease in sexual satisfaction scores in women who underwent vaginal delivery in comparison with those who underwent elective caesarean section at 2 years follow-up. There was also a significant increase in the prevalence of urinary incontinence, incontinence of flatus, dyspareunia and subjective depression in women who underwent vaginal delivery.
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PMID:Female genital tract morbidity and sexual function following vaginal delivery or lower segment caesarean section. 1707 32

The aims of the present study were to assess the number of women performing pelvic floor muscle training (PFMT) during pregnancy and to compare the background variables in those exercising and in those who did not. Four hundred and sixty-seven pregnant women (response rate 84%), mean age 31.5 years (range 20-49), answered a questionnaire on general physical activity level during pregnancy including PFMT. The questionnaire was sent out in week 32 of gestation and answered within week 36. Twenty-four percent reported problems with urinary incontinence and 9% flatus/fecal incontinence. The percentages of pregnant women performing PFMT at least once a week before pregnancy and during trimesters 1, 2, and 3 were 7, 12.9, 17.6, and 17.4%, respectively. More women with lower prepregnancy BMI and with present and past pelvic girdle pain were performing regular PFMT. No significant differences were found in any other background variables. It is concluded that relatively few women perform regular PFMT during pregnancy. In conclusion, only 17% of pregnant Norwegian women reported performing PFMT during pregnancy.
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PMID:Do pregnant women exercise their pelvic floor muscles? 1712 Jan 74


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