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Venara A, Rebmann E, Helbert C, Lemasson F, Legendre G, Hamel JF. Improving the quality of information after an obstetrical anal sphincter injury improves the quality of life for women experiencing anal incontinence. Eur J Obstet Gynecol Reprod Biol 2025; 310:113989. [PMID: 40286343 DOI: 10.1016/j.ejogrb.2025.113989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 03/09/2025] [Accepted: 04/18/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND To compare the information remembered by women about the potential risk of obstetrical anal sphincter injury (OASIS) according to the occurrence of anal incontinence and the time elapsed since the OASIS. METHODS This prospective and observational monocentric cohort study included all the 227 women who had OASIS during a 15-years period. Information was collected using the Fecal Incontinence Quality of Life (FIQL) questionnaire, sent to participants by post, and by a phone interview about women's memories of the information given. RESULTS 80 patients had at least one episode of anal incontinence (AI) (35.2 %). Patients remembered having received information about the risk of AI in 28.2 % (n = 64) and about the risk of urinary incontinence (UI) in 34.4 % (n = 78). 82.2 % (n = 188) stated that they would be interested in having information about AI and 84.6 % wanted information about UI. Patients who received the information ≤ 5 years ago were more able to remember information about AI and UI than other patients. Being able to remember information about the risk of AI was significantly associated with a better quality of life. CONCLUSION Patients who had received information ≤ 5 years ago were able to remember more of it. This coincides with the implementation of a specific post-OASIS consultation and therefore advocates for such consultations becoming common practice.
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Affiliation(s)
- Aurélien Venara
- Faculty of Health, Angers, France; Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 Angers, France; IHFIH, UPRES EA 3859, University of Angers, Angers, France; The Enteric Nervous System in Gut and Brain Disorders, Université de Nantes, INSERM, TENS, IMAD, F-44000 Nantes, France.
| | - Emeline Rebmann
- Faculty of Health, Angers, France; Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | | | | | - Guillaume Legendre
- Faculty of Health, Angers, France; Department of Gynecology-Obstetrics, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - Jean-François Hamel
- Faculty of Health, Angers, France; Department of Biostatistics, CHU Angers, 4 rue Larrey, 49933 Angers, France; Ester|Irset Inserm UMR 1085, Angers, France
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Venara A, Levaillant M, Poitevin M, Vitton V, Hamel JF. Anal incontinence in adults under 65 years: A survey based on social networks. Clin Res Hepatol Gastroenterol 2025; 49:102577. [PMID: 40122381 DOI: 10.1016/j.clinre.2025.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 03/17/2025] [Accepted: 03/20/2025] [Indexed: 03/25/2025]
Abstract
INTRODUCTION The frequency of anal incontinence in the general population is likely an underestimation, particularly among adults ≤65 years, for whom personal and professional considerations limit their utilization of medical care. The objective of this study was to assess the prevalence of anal incontinence in the young population and to address the reasons why such individuals do not seek care. METHODS This was a public health survey conducted using personal and professional social networks between April and November 2023. Participants between the ages of 18 and 65 were invited to respond a survey about their experience of anal incontinence (AI). The survey collected data on the Vaizey's score and the Anal Incontinence Quality of Life Index (FIQL). RESULTS Of the 481 individuals who completed the survey, 176 (36.6 %) reported experiencing AI. The majority of respondents exhibited mild incontinence (46 %), while 15.8 % experienced severe or major AI. Among those with AI, only 27.3 % consulted a physician, and in nearly 40 % of cases, no treatment was proposed. The primary reasons for not seeking consultation were embarrassment about the condition (63 %) and perceived stigma surrounding treatment (28 %), including a lack of awareness about available treatments. Multivariate analysis revealed that individuals between the ages of 26 and 45 were more likely to seek medical attention. CONCLUSION The prevalence of incontinence of the anal nature among young adults remains significantly underestimated, despite its impact on their quality of life. Enhanced public health communication regarding the management of incontinence, particularly among young individuals and healthcare providers, is imperative.
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Affiliation(s)
- Aurélien Venara
- Department of Medicine, University Hospital of Angers, Angers, France; Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, Angers 49933, France; The Enteric Nervous System in Gut and Brain Disorders, INSERM, TENS, IMAD, Université de Nantes, Nantes, France; IHFIH, UPRES EA 3859, University of Angers, Angers, France.
| | | | - Maëlig Poitevin
- Department of Medicine, University Hospital of Angers, Angers, France; Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, Angers 49933, France
| | - Véronique Vitton
- Gastroenterology Unit, Assistance Publique- Hôpitaux de Marseille, France
| | - Jean-Francois Hamel
- Department of Medicine, University Hospital of Angers, Angers, France; Ester | Irset INSERM UMR 1085, Angers, France
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Hou J, Zhao Y, Zhuang S, Ma X, Hou Y, Li X, Wang Y. Visit rates and risk factors of healthcare-seeking behavior for urinary incontinence, fecal incontinence, and pelvic organ prolapse among women: A systematic review and meta-analysis. Geriatr Nurs 2025; 63:307-319. [PMID: 40239392 DOI: 10.1016/j.gerinurse.2025.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 02/02/2025] [Accepted: 03/31/2025] [Indexed: 04/18/2025]
Abstract
INTRODUCTION Female pelvic floor dysfunction(FPFD), including urinary incontinence, fecal incontinence, and pelvic organ prolapse, is an expanding global health problem among women, declining their quality of life. Healthcare-seeking behavior of FPFD patients plays a vital role in preventing symptom deterioration and reducing future burdens. Poor healthcare-seeking behavior has resulted in lower visit rates than prevalence. This study aimed to investigate the visit rate and risk factors of healthcare-seeking behavior in patients with FPFD and to provide a basis for developing prevention strategies against risk factors. METHODS An exhaustive systematic literature search was undertaken using the following databases: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL, published from inception to June 2022. Two investigators independently extracted data and assessed the quality of the studies using the Health Care Quality and Research (AHRQ) or Newcastle-Ottawa Scale (NOS). A meta-analysis was performed by using Review Manager 5.3. RESULTS Eighty studies were selected, including 83,996 participants. Data were extracted from 71 studies for urinary incontinence, 5 for pelvic organ prolapse, and 4 for fecal incontinence. Meta-analysis results indicated that the visit rates of urinary incontinence, pelvic organ prolapse, and fecal incontinence were lower, at 29%(95%CI:27% to 32%, I2=99%, P<0.00001), 42%(95%CI:18% to 65%, I2=99%, p=0.0005), and 35%(95%CI:16% to 54%, I2=99%, p=0.0004), respectively. The study shows that there are a variety of factors affecting the healthcare-seeking behavior of FPFD women, including sociodemographic factors(treatment and diagnosis costs are high, lack of time, type of UI, duration of UI, symptom severity, and impact of UI), psychological factors(shame, fear of medical treatment side effects, fear of examination, and fear of surgery), cognitive factors(considering it as the normal status of aging, the perception that symptoms are not treatable, believing that symptoms could recover naturally, lack of knowledge of available treatment, believing they should cope with the problem themselves, do not think it is serious enough), healthcare service factors(the physician said it was not necessary, other health problems taking priority). Age, fear of hospitals/doctors, and fear of diagnosis do not affect healthcare-seeking behavior. CONCLUSION Patients with urinary incontinence, pelvic organ prolapse, and fecal incontinence have a low visit rate. Many risk factors affect the healthcare-seeking behavior of female pelvic floor dysfunction diseases, mainly sociodemographic, psychological, cognitive, and healthcare service factors. However, due to a lack of data, high-quality studies are still required to confirm. In the future, attention should be paid to policy guidance and ethical changes, strengthening the training of medical personnel and comprehensive medical education on the diagnosis, treatment and management of FPFD as well as appropriate nursing pathways. In addition, public information campaigns on the comprehensive prevention of FPFD should be strengthened to raise women's awareness of the comprehensive prevention of FPFD, especially health education.
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Affiliation(s)
- Jiawen Hou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China; Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanan Zhao
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Simin Zhuang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Ximei Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Yijing Hou
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Xiuling Li
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China.
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Carvalho C, Rocha APR, Dos Santos GB, Guimarães JB, Amorim MN, Beleza ACS, Rodrigues-de-Souza DP, da Silva Serrão PRM, de Oliveira Sato T. Pelvic Floor Dysfunction and Associated Factors in Women with Systemic Autoimmune Rheumatic Diseases: A Cross-Sectional Study. Int Urogynecol J 2025; 36:821-828. [PMID: 39903236 DOI: 10.1007/s00192-025-06071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 01/14/2025] [Indexed: 02/06/2025]
Abstract
INTRODUCTION AND HYPOTHESIS Systemic autoimmune rheumatic diseases (SARDs) cause musculoskeletal disorders and are associated with various issues that affect the quality of life. Since the musculoskeletal system is affected, the pelvic floor muscles can also be impacted, leading to possible pelvic floor dysfunctions (PFDs). Thus, the purpose of this study was to investigate the presence of PFDs, such as urinary incontinence (UI), anal incontinence (AI), genital-pelvic pain/penetration disorder (GPPPD), and pelvic organ prolapse (POP) symptoms in women with SARDs compared to a control group composed of women without SARDs; and investigate the association between SARDs and PFDs. METHODS An online cross-sectional survey was carried out. Using a web-based questionnaire, data on demographic and anthropometric features, PFD (UI, nocturia, AI, GPPPD, and POP), and obstetric history were gathered. For quantitative variables, the Mann-Whitney U test was used, and for categorical variables, the chi-squared test was used for comparison between groups. The association between SARDs and PFD was investigated using logistic regression analysis. RESULTS The questionnaire was completed by 326 women (224 with SARDs and 102 healthy controls). Women with SARDs reported significantly more symptoms of PFD, UI, nocturia, AI (flatus and fecal incontinence), POP, and GPPPD than healthy controls. SARDs were associated with PFD, flatus incontinence, fecal incontinence, dyspareunia, and vaginismus. CONCLUSIONS PFD was much more common in women with SARDs than in healthy women. Women with SARDs were 1.8 to 5.2 times more likely than the control group to report PFD symptoms than women without SARDs.
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Affiliation(s)
- Cristiano Carvalho
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil.
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
| | | | | | - Júlia Barbosa Guimarães
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Mariana Nobrega Amorim
- Department of Biosciences, Federal University of São Paulo, Campus Baixada Santista, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
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Seitz V, Calata J, Mei L, Davidson ERW. Missed Opportunities: A Mixed-Methods Assessment of Disparities in Treatment for Fecal Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2025; 31:243-249. [PMID: 39689216 DOI: 10.1097/spv.0000000000001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
IMPORTANCE Previous work identified racial disparities in access to fecal incontinence (FI) treatments. However, less is known about patient perspectives of these barriers. OBJECTIVES This study assessed differences in FI symptom severity and treatment utilization between Black and White patients. STUDY DESIGN This mixed-methods assessment studied adult non-Hispanic Black and White women treated for FI who either did not respond to medical therapy nor received sacral neuromodulation or did not follow up after medical therapy. Structured interviews queried patients about treatments offered and symptom severity. RESULTS Of the 118 patients in the retrospective evaluation, 59 (50%, 24 Black and 35 White) were interviewed. Black patients were more likely than White patients to report occasional, weekly, or daily solid and stool incontinence (75.0% vs 48.6%, P = 0.042; 87.5% vs 51.4%, P = 0.004, respectively) and flatal incontinence (83.3% vs 62.9%, P = 0.088).Of those prescribed fiber supplements and antidiarrheal medications, Black patients were less likely to report symptom improvement (25.0% vs 70.0%, P = 0.013; 57.1% vs 87.5%, P = 0.092, respectively, for each medication type) and ongoing regimen adherence (25.0% vs 63.3%, P = 0.013; 28.6% vs 87.5%, P = 0.035, respectively).Black patients were more likely to report impairment in daily functioning secondary to FI (83.3% vs 57.1%, P = 0.034) and were more likely to seek a follow-up visit with a health care professional that performs sacral neuromodulation (79.2% vs 28.6%, P < 0.001). CONCLUSIONS Black patients were more likely to have severe symptoms and poorer treatment outcomes and desire future follow-up, highlighting the importance of addressing racial differences in patient preferences in FI management strategies.
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Yousefifard M, Imani F, Mahjoubi B, Shamseddin J, Sarveazad S, Vazirizadeh-Mahabadi M, Yarahmadi M, Sarveazad A. The effect of low-level laser therapy on external anal sphincter repair and treatment of fecal incontinence: A double-blind randomized controlled clinical trial. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2024; 13:114-121. [DOI: 10.18528/ijgii240062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/03/2024] [Accepted: 10/03/2024] [Indexed: 04/01/2025] Open
Affiliation(s)
- Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Department of Anesthesiology and Pain Medicine, Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahar Mahjoubi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jebreil Shamseddin
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shahriar Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadhossein Vazirizadeh-Mahabadi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mobina Yarahmadi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Shahsavari D, Rao SSC. Review article: advances in the diagnosis and management of anorectal motility disorders. Aliment Pharmacol Ther 2024; 60:701-714. [PMID: 39051556 DOI: 10.1111/apt.18170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/27/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Anorectal motility disorders such as dyssynergic defecation (DD), faecal incontinence (FI) and anorectal pain affect 40% of the population and are a frequent reason for gastroenterology consultation. They significantly affect the quality of life and lead to psychological distress. Lack of understanding of these problems compounded by a lack of availability and knowledge of diagnostic tools in most medical centres and/or trained physicians has significantly hampered this field. AIMS To discuss the latest advances in pathophysiology, diagnostic tests and therapeutic options for these disorders using an evidence-based approach. METHODS We reviewed the published literature over the past 20 years on DD, FI and anorectal pain and distilled these into a narrative review. RESULTS A detailed history, prospective stool diary and digital rectal exam, together with diagnostic tests such as anorectal manometry, balloon expulsion test, translumbosacral anorectal magnetic stimulation test for assessing neuropathy, defecography and anal ultrasound, can provide detailed mechanistic and structural information. Such knowledge can pave the way for a meaningful and pathophysiologic-based management approach. This could include biofeedback therapy for DD or FI, sensory training for rectal hyposensitivity or sensory adaptation training for rectal hypersensitivity or sphincter bulking agents or neuromodulation therapies. These treatments are effective and safe. CONCLUSIONS Anorectal motility disorders are common, but either less well recognized or poorly managed by most gastroenterologists. Equipped with the practical and up-to-date knowledge provided in this review, physicians could provide improved health care for these patients.
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Affiliation(s)
- Dariush Shahsavari
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, Georgia, USA
| | - Satish S C Rao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, Georgia, USA
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Hiramoto B, Flanagan R, Muftah M, Shah ED, Chan WW. Centrally Distributed Adiposity as a Modifiable Risk Factor for Fecal Incontinence: United States Population-based Analysis. Clin Gastroenterol Hepatol 2024; 22:1908-1916.e1. [PMID: 38657883 PMCID: PMC11344694 DOI: 10.1016/j.cgh.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Fecal incontinence (FI) is highly prevalent with substantial impacts on quality of life and health care utilization. The impact of obesity on FI remains unclear, with differing conclusions using body mass index (BMI) as a risk factor. We aimed to determine the association between obesity and FI, and whether this relationship is dependent on the distribution of adiposity (waist circumference-to-height ratio [WHtR]). METHODS This was a population-based analysis of the National Health and Nutrition Examination Survey, including participants who responded to the bowel health survey in 2005 to 2010. FI was defined by the accidental bowel leakage of solid stool, liquid, or mucus at least once in the past month. Stepwise multivariable logistic regression models were constructed to assess risk factors for FI. RESULTS A total of 7606 participants were included, with an overall FI prevalence of 9.2%. When stratified by quartiles of body measurements, FI was increasingly prevalent from the 1st to the 4th quartile for both WHtR (range, 5.3%-12.5%) and BMI (range, 7.1%-10.5%). WHtR was associated with FI and was a stronger predictor than BMI in all quartiles of body measurement. On multivariable analysis, WHtR remained a significant predictor of FI comparing the 4th with the 1st quartile of body measurements (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.11-2.80; P = .017), whereas BMI was not. A WHtR cutoff of >0.592 optimized the Youden index in prediction of FI in the overall sample. CONCLUSION WHtR was independently associated with increased odds of FI in this nationally representative sample of United States adults, whereas BMI was not consistently correlated. This suggests bowel continence may depend more on how body mass is distributed.
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Affiliation(s)
- Brent Hiramoto
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ryan Flanagan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mayssan Muftah
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Eric D Shah
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Yu Z, Guo M, Bai X, Ruan G, Sun Y, Han W, Yang H. Exploring the association between cardiovascular health and bowel health. Sci Rep 2024; 14:11819. [PMID: 38783080 PMCID: PMC11116406 DOI: 10.1038/s41598-024-62715-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic constipation, diarrhea, and fecal incontinence have high incidence, potential disability, and socioeconomic impact, imposing a heavy burden on the quality of life. We aim to explore the association between cardiovascular health (CVH) and bowel health from National Health and Nutrition Survey 2005-2010. CVH is assessed using Life's Essential 8 (LE8). Chronic constipation, chronic diarrhea, and fecal incontinence are assessed based on Bristol Stool Form Scale classification, bowel movements, and bowel leakage. Better health behaviors (odds ratio [OR]: 0.71, 95% confidence interval [CI] 0.53-0.94, p = 0.02) and worse health factors (OR: 1.45, CI 1.03-2.04, p = 0.04) were associated with less chronic constipation. Less chronic diarrhea is correlated with better CVH (OR: 0.53, 95% CI 0.35-0.79, p = 0.003) and health factors (OR: 0.61, CI 0.46-0.81, p = 0.001). Meanwhile, the proportion of chronic diarrhea significantly decreases when the health behaviors score exceeds 59.42. Lower fecal incontinence was associated with better health behaviors (OR: 0.63, CI 0.44-0.90, p = 0.01) CVH. Better CVH and health behaviors are both linked to lower all-cause mortality in participants with chronic constipation and chronic diarrhea. A higher health behaviors score is also associated with less all-cause mortality in patients with fecal incontinence. Maintaining CVH at the population level contributes to intestinal health, achieving the dual management of both while saving on healthcare costs. However, further prospective research is needed to confirm these associations.
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Affiliation(s)
- Ziqing Yu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Mingyue Guo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Gechong Ruan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yinghao Sun
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hong Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Mack I, Hahn H, Gödel C, Enck P, Bharucha AE. Global Prevalence of Fecal Incontinence in Community-Dwelling Adults: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2024; 22:712-731.e8. [PMID: 37734583 PMCID: PMC10948379 DOI: 10.1016/j.cgh.2023.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND & AIMS Fecal incontinence (FI) can considerably impair quality of life. Through a systematic review and meta-analysis, we sought to determine the global prevalence and geographic distribution of FI and to characterize its relationship with sex and age. METHODS We searched PubMed, Web of Science, and Cochrane Library databases to identify population-based surveys of the prevalence of FI. RESULTS Of the 5175 articles identified, the final analysis included 80 studies; the median response rate was 66% (interquartile range [IQR], 54%-74%). Among 548,316 individuals, the pooled global prevalence of FI was 8.0% (95% confidence interval [CI], 6.8%-9.2%); by Rome criteria, it was 5.4% (95% CI, 3.1%-7.7%). FI prevalence was greater for persons aged 60 years and older (9.3%; 95% CI, 6.6%-12.0%) compared with younger persons (4.9%; 95% CI, 2.9%-6.9%) (odds ratio [OR], 1.75; 95% CI, 1.39-2.20), and it was more prevalent among women (9.1%; 95% CI, 7.6%-10.6%) than men (7.4%; 95% CI, 6.0%-8.8%]) (OR, 1.17; 95% CI, 1.06-1.28). The prevalence was highest in Australia and Oceania, followed by North America, Asia, and Europe, but prevalence could not be estimated in Africa and the Middle East. The risk of bias was low, moderate, and high for 19 (24%), 46 (57%), and 15 (19%) studies, respectively. Exclusion of studies with high risk of bias did not affect the prevalence of FI or heterogeneity. In the meta-regression, the high study heterogeneity (I2 = 99.61%) was partly explained by age. CONCLUSIONS Approximately 1 in 12 adults worldwide have FI. The prevalence is greater among women and older people.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Heiko Hahn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Celina Gödel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Tahmasbi F, Mosaddeghi-Heris R, Soleimanzadeh F, Ghaderpanah R, Sadrian S, Hajebrahimi S, Salehi-Pourmehr H. Effects of Posterior Tibial Nerve Stimulation on Fecal Incontinence: An Umbrella Review. Neuromodulation 2024; 27:229-242. [PMID: 37452797 DOI: 10.1016/j.neurom.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study aimed to summarize relevant data from previous systematic reviews (SRs) and conduct comprehensive research on the clinical effects of posterior tibial nerve stimulation (PTNS), via the transcutaneous posterior tibial nerve stimulation (TPTNS) or percutaneous posterior tibial nerve stimulation (PPTNS) method on fecal incontinence (FI). MATERIALS AND METHODS In adherence to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search was conducted on PubMed, Embase, Scopus, and Web of Science databases. We included English-language, full-text SRs reporting outcomes for FI following either PPTNS or TPTNS. The quality of included studies was assessed using the Joanna Briggs Institute checklist. In addition, reanalyzing the meta-analyses was conducted using Comprehensive Meta-Analysis (CMA) software version 3.0 to achieve effect sizes and the level of statistical significance was set at p ≤ 0.05. RESULTS From a total of 835 citations, 14 SRs met our inclusion criteria. Four of these also conducted a meta-analysis. Most SRs reported an overall improvement in different study parameters, including bowel habits and quality of life. However, there were major inconsistencies across the results. The most studied outcome was FI episodes, followed by incontinence score. The summary outcomes showed no statistically significant changes in comparing PTNS with sham or sacral nerve stimulation (SNS) for FI (p > 0.05). However, the results of subgroup analysis based on the type of intervention in the control group revealed that FI episodes were significantly fewer than in the PTNS arm, whereas PTNS led to fewer episodes of FI than did the sham. In terms of incontinence score, the results showed that PTNS compared with sham did not change the incontinence score; however, SNS improved the score significantly in one eligible study for reanalysis when compared with PTNS (p < 0.001). CONCLUSIONS The findings of the current umbrella review suggest that PTNS can potentially benefit patients with FI. However, this is concluded from studies with a limited population, disregarding the etiology of FI and with limited follow-up duration. Therefore, caution must be taken in contemplating the results.
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Affiliation(s)
- Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Farzin Soleimanzadeh
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rezvan Ghaderpanah
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SeyedHassan Sadrian
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre, A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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Varma R, Feuerhak KJ, Mishra R, Chakraborty S, Oblizajek NR, Bailey KR, Bharucha AE. A randomized double-blind trial of clonidine and colesevelam for women with fecal incontinence. Neurogastroenterol Motil 2024; 36:e14697. [PMID: 37890049 PMCID: PMC10842236 DOI: 10.1111/nmo.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Diarrhea and rectal urgency are risk factors for fecal incontinence (FI). The effectiveness of bowel modifiers for improving FI is unclear. METHODS In this double-blind, parallel-group, randomized trial, women with urge FI were randomly assigned in a 1:1 ratio to a combination of oral clonidine (0.1 mg twice daily) with colesevelam (1875 mg twice daily) or two inert tablets for 4 weeks. The primary outcome was a ≥50% decrease in number of weekly FI episodes. KEY RESULTS Fifty-six participants were randomly assigned to clonidine-colesevelam (n = 24) or placebo (n = 32); 51 (91%) completed 4 weeks of treatment. At baseline, participants had a mean (SD) of 7.5 (8.2) FI episodes weekly. The primary outcome was met for 13 of 24 participants (54%) treated with clonidine-colesevelam versus 17 of 32 (53%) treated with placebo (p = 0.85). The Bristol stool form score decreased significantly, reflecting more formed stools with clonidine-colesevelam treatment (mean [SD], 4.5 [1.5] to 3.2 [1.5]; p = 0.02) but not with placebo (4.2 [1.9] to 4.1 [1.9]; p = 0.47). The proportion of FI episodes for semiformed stools decreased significantly from a mean (SD) of 76% (8%) to 61% (10%) in the clonidine-colesevelam group (p = 0.007) but not the placebo group (61% [8%] to 67% [8%]; p = 0.76). However, these treatment effects did not differ significantly between groups. Overall, clonidine-colesevelam was well tolerated. CONCLUSIONS AND INFERENCES Compared with placebo, clonidine-colesevelam did not significantly improve FI despite being associated with more formed stools and fewer FI episodes for semiformed stools.
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Affiliation(s)
- Revati Varma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelly J Feuerhak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahul Mishra
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nicholas R Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Kuutti MA, Hyvärinen M, Lankila H, Aukee P, Hietavala EM, Laakkonen EK. Association of eating behavior with symptoms of pelvic floor disorders in middle-aged women: An observational study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241305075. [PMID: 39658908 PMCID: PMC11632885 DOI: 10.1177/17455057241305075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 11/08/2024] [Accepted: 11/19/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Estrogen deficiency during menopause, aging, reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. Lifestyle choices, such as eating behavior, may contribute to pelvic floor disorders. OBJECTIVES The objective of the study was to investigate associations of eating behavior with symptoms of pelvic floor disorders, that is, stress urinary incontinence, urgency urinary incontinence, fecal incontinence, and constipation or defecation difficulties among middle-aged women. DESIGN A cross-sectional, observational study was performed using a population sample of 1098 Finnish women aged 47-55 years. METHODS Eating behavior, food consumption frequency, demographical, gynecological, and physical activity variables were assessed using self-report questionnaires. Logistic regression models were used to assess the associations of eating behavior, food frequency, and symptoms of pelvic floor disorders. Models were adjusted with demographical, gynecological, and physical activity variables. RESULTS In adjusted models, middle-aged women with disordered eating style were more likely to experience the symptoms of stress urinary incontinence (odds ratio (OR) 1.5, p = 0.002), and constipation or defecation difficulties (OR 1.4, p = 0.041). Adding body mass index into the models abolished associations. Of the studied food items, more frequent consumption of ready-made, highly processed foods (OR 1.5, p = 0.001), and fast foods (OR 1.5, p = 0.005) were independently associated with symptoms of stress urinary incontinence regardless of eating style, whereas consuming ready-made foods (OR 1.4, p = 0.048) was associated with symptoms of urgency urinary incontinence. Daily consumption of fruits (OR 0.8, p = 0.034) was independently associated with symptoms of stress urinary incontinence. Furthermore, we observed that daily consumption of porridge was associated with symptoms of constipation or defecation difficulties (OR 1.7, p = 0.010) independently of eating style. Alcohol consumption (OR 0.9, p = 0.015) was inversely associated with constipation and defecation difficulties. Women with overall higher quality diet had lower odds for stress urinary incontinence (OR 0.9, p = 0.002). CONCLUSION This study provides proof-of-concept evidence to the hypothesis that eating behavior and consuming certain food items are associated with perceived pelvic floor disorders. As a preventive action, eating behavior of women with the risk of these symptoms should be assessed, and guidance toward healthy eating patterns should be provided.
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Affiliation(s)
- Mari A Kuutti
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Matti Hyvärinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannamari Lankila
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pauliina Aukee
- Department of Obstetrics and Gynecology, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Enni-Maria Hietavala
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eija K Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Wang Y, Li N, Zhou Q, Wang P. Fecal incontinence was associated with depression of any severity: insights from a large cross-sectional study. Int J Colorectal Dis 2023; 38:271. [PMID: 37991579 DOI: 10.1007/s00384-023-04563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Current studies on the association between fecal incontinence (FI) and depression are very limited, and most of them are restricted to women or elderly patients. This study aims to evaluate in detail the association between FI and depression among US adults. METHODS 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. Clinical depression and depression severity were assessed by the validated Patient Health Questionnaide-9 (PHQ-9). Models of multivariate logistic regression were used to calculate adjusted odds ratios (ORs). A subgroup analysis was carried out to ensure that the results were stable. RESULTS After adjusting for covariates such as demographics, risk behaviors and associated comorbidities, the PHQ-9 score and clinical depression were both significantly associated with FI, with ORs and 95%CIs of 1.11 (1.10-1.13) and 3.01 (2.53-3.57). Depression of all severities was also significantly associated with FI. The ORs and 95%CIs of FI with mild depression, moderate depression, and moderately severe to severe depression were 2.29 (1.96-2.68), 3.44 (2.77-4.27) and 4.65 (3.61-6.00), respectively. Subgroup analyses showed no statistically significant interactions (P > 0.05). CONCLUSIONS In conclusion, FI significantly associated with depression of any severity. Like the elderly or female patients with FI, young and middle-aged or men with FI are also at high risk of depression and should also be the focus of depression screening and early intervention.
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Affiliation(s)
- Yan Wang
- Department of Oncology, China Academy of Chinese Medical Sciences Guang' anmen Hospital, 100053, Beijing, China
| | - Na Li
- Department of Anesthesiology, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Qiang Zhou
- Department of Orthopedic Surgery, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Pengfei Wang
- Department of Anorectal surgery, China Academy of Chinese Medical Sciences Xiyuan Hospital, 100091, Beijing, China.
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15
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Moureau MK, Jones LM, Schmuhl NB, Brown HW. Men and women experience different barriers to care seeking for fecal incontinence. Neurourol Urodyn 2023; 42:1769-1776. [PMID: 37614056 PMCID: PMC10810259 DOI: 10.1002/nau.25266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Despite effective treatments for fecal incontinence (FI), FI remains underdiagnosed and undertreated. This study sought to characterize and compare rates of, delays in, experiences with, and barriers to care seeking for FI among men and women. METHODS This study was a secondary analysis of electronic survey data collected from adults with FI. The survey included the use of a validated instrument to assess FI severity and questions that now comprise a validated instrument for assessing barriers to care seeking for FI in women. Descriptive analyses characterized differences between men and women. χ2 testing for categorical variables and t-testing for normally distributed continuous variables compared statistical differences. RESULTS The sample (N = 548) was predominately female (84%), non-Hispanic White (90%), and insured (96%), with a mean Vaizey score (13.4 ± 5.3) consistent with moderate or severe FI. Care seeking rates (p = 0.81) and symptom duration before care seeking (p = 0.23) did not differ between women and men, but women were more likely than men to be told that effective treatments exist; most male and female respondents who sought care were offered treatment. Very few respondents had been asked about FI by a healthcare provider. Whereas normative thinking, limited life impact, and believing that a healthcare provider could not help were more common barriers to care seeking among men, avoidance, fear, and discouragement were more common in women. CONCLUSIONS Men and women with FI seek care at similar rates and after experiencing symptoms for a similar duration of time. Very few patients with FI have been screened for it by a healthcare provider. Barriers to FI care seeking are different for women and men, and men are less likely than women to be informed about effective treatments by a healthcare provider.
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Affiliation(s)
- Madeline K. Moureau
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health
| | - Lisa M. Jones
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health
| | | | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health
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Sun G, Trzpis M, Ding H, Gao X, Broens PMA, Zhang W. Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment. Neurogastroenterol Motil 2023; 35:e14633. [PMID: 37427541 DOI: 10.1111/nmo.14633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aimed to compare the prevalence and symptoms of fecal incontinence (FI) in relation to irritable bowel syndrome (IBS-associated FI), constipation (constipation-associated FI), and isolation (isolated FI). METHODS Data were analyzed from 3145 respondents without organic comorbidities known to influence defecation function from the general Chinese population who filled in the online Groningen Defecation and Fecal Continence questionnaire. FI, IBS, and constipation were evaluated with the Rome IV criteria. KEY RESULTS The prevalence of FI was 10.5% (n = 329) in the non-comorbidity group. After multivariable logistic regression analysis, IBS (odds ratio [OR]: 12.55, 95% confidence interval [CI]: 9.06-17.36) and constipation (OR: 4.38, 95% CI: 3.27-5.85) were the most significant factors contributing to FI. Based on this finding, 106/329 (32.2%) had IBS-associated FI, 119/329 (36.2%) had constipation-associated FI, and 104/329 (31.6%) had isolated FI. Among the 329 FI respondents, there was a high prevalence of IBS and constipation-related symptoms, including abdominal pain (81.5%) and abdominal bloating (77.8%) for IBS and straining during defecation (75.4%), incomplete defecation (72.3%), defecation blockage (63.2%), anal pain during defecation (59.3%), and hard stools (24%) for constipation. The patients with IBS-associated FI asked for specialists' help less frequently than those with isolated FI. Interestingly, among the patients with constipation-associated FI, 56.3% used anti-diarrhea medicine. CONCLUSIONS AND INFERENCES The prevalence of IBS-associated FI, constipation-associated FI, and isolated FI is comparably high. It is important to diagnose and target the cause of FI to provide personalized and cause-targeting care instead of treating only the FI symptoms.
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Affiliation(s)
- Ge Sun
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Haibo Ding
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianhua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Paul M A Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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Wang P, Wang Y, Jia X. Association between fecal incontinence and suicidal ideation in adult Americans: Evidence from NHANES 2005-2010. J Psychosom Res 2023; 170:111377. [PMID: 37229822 DOI: 10.1016/j.jpsychores.2023.111377] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Currently, research on the relationship between fecal incontinence (FI) and suicidal ideation is very limited. This study aims to evaluate whether FI is associated with suicidal ideation among US adults. METHODS In this cross-sectional study, 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. As part of the Patient Health Questionnaire-9, item 9 assessed suicidal ideation. Models of multivariate logistic regression were used to calculate adjusted odds ratios. A subgroup analysis was carried out to ensure that the results were stable. RESULTS It was found that FI was associated with an increased risk of suicidal ideation after controlling for baseline characteristics, risk behaviors, and comorbid conditions such as depression (OR: 1.60, 95%CI: 1.24-2.08, P < 0.001). In subgroup analyses, FI remained significantly associated with suicidal ideation among participants aged 45 years and older, with odds ratios and 95% confidence intervals of 1.62 (1.11-2.38) and 2.49 (1.51-4.13), respectively. For age category <45 years, the association between FI and suicidal ideation weakened (OR: 1.02, 95%CI: 0.60-1.75, P = 0.932). CONCLUSIONS In conclusion, this study showed that FI was significantly associated with suicidal ideation. Patients aged middle-aged and older are at high risk and should be the focus of screening and timely intervention for suicidal ideation.
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Affiliation(s)
- Pengfei Wang
- Department of Anorectal surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Playground, Haidian District, Beijing, China
| | - Yan Wang
- Department of Oncology, Guang' anmen Hospital, China Academy of Chinese Medical Sciences, 5 Beixiange, Xicheng District, Beijing, China
| | - Xiaoqiang Jia
- Department of Anorectal surgery, Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Playground, Haidian District, Beijing, China.
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Dos Santos GB, Sato TDO, Miwa-Cerqueira T, Bifani BE, Rocha APR, Carvalho C. Pelvic floor dysfunctions in women with fibromyalgia: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 282:1-6. [PMID: 36603313 DOI: 10.1016/j.ejogrb.2022.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/17/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD). OBJECTIVE Investigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD. STUDY DESIGN This was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis. RESULTS A total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1-6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3-6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2-5.4; p = 0.01). CONCLUSION The prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM.
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Affiliation(s)
- Gabriel Bernardi Dos Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Tatiana de Oliveira Sato
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Tsugui Miwa-Cerqueira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Bianca Escuer Bifani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Ana Paula Rodrigues Rocha
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
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Carter D, Ram E, Engel T. Combined 3D Endoanal Ultrasound and Transperineal Ultrasound Improves the Detection of Anal Sphincter Defects. Diagnostics (Basel) 2023; 13:diagnostics13040682. [PMID: 36832170 PMCID: PMC9955566 DOI: 10.3390/diagnostics13040682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal muscle injury. However, 3D EAUS accuracy may be hampered by regional acoustic effects, such as intravaginal air. Therefore, our aim was to examine whether a combination of transperineal ultrasound (TPUS) and 3D EAUS would improve the accuracy of detection of anal sphincter injury. METHODS We prospectively performed 3D EAUS followed by TPUS in every patient evaluated for FI in our clinic between January 2020 and January 2021. The diagnosis of anal muscle defects was assessed in each ultrasound technique by two experienced observers that were blinded to each other's assessments. Interobserver agreement for the results of the 3D EAUS and the TPUS exams was examined. A final diagnosis of anal sphincter defect was based on the results of both ultrasound methods. Discordant results were re-analyzed by the two ultrasonographers for a final consensus on the presence or absence of defects. RESULTS A total of 108 patients underwent ultrasonographic assessment due to FI (mean age 69 ± 13). Interobserver agreement for the diagnosis of tear on EAUS and TPUS was high (83%) with Cohen's kappa of 0.62. EAUS confirmed anal muscle defects in 56 patients (52%), while TPUS confirmed them in 62 patients (57%). The final consensus agreed on the diagnosis of 63 (58%) muscular defects and 45 (42%) normal exams. The Cohen's kappa coefficient of agreement between the results of the 3D EAUS and the final consensus was 0.63. CONCLUSIONS The combination of 3D EAUS and TPUS improved the detection of anal muscular defects. The application of both techniques for the assessment of the anal integrity should be considered in every patient going through ultrasonographic assessment for anal muscular injury.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomer, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-35307729
| | - Edward Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department Surgery B, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Tal Engel
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomer, Ramat Gan 5266202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Kuutti MA, Hyvärinen M, Kauppinen M, Sipilä S, Aukee P, Laakkonen EK. Early adulthood and current physical activity and their association with symptoms of pelvic floor disorders in middle-aged women: An observational study with retrospective physical activity assessment. BJOG 2023; 130:664-673. [PMID: 36655435 DOI: 10.1111/1471-0528.17397] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/16/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFDs), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), faecal incontinence (FI), constipation or defecation difficulties (CDDs) and feeling of pelvic organ prolapse (POP) among middle-aged women. DESIGN A cross-sectional, observational study with retrospective PA assessment. SETTING University Research Laboratory. SAMPLE A random population sample of 1098 Finnish women aged 47-55 years. METHODS Early adulthood PA, current PA, and demographic and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of PA variables with symptoms of PFDs. Potential confounding effects of demographic and gynaecological variables were controlled in multiple logistic regression models. MAIN OUTCOME MEASURES Structured questionnaire-assessed retrospective PA assessment at the age of 17-29 years, current PA at middle age, and prevalence of symptoms of CDD, FI, POP, SUI and UUI. RESULTS Current PA was not independently associated with the occurrence of the symptoms of PFDs. Middle-aged women with an early adulthood history of competitive sports were more likely to experience symptoms of UUI (OR 2.16, 95% CI 1.10-4.24, p = 0.025) but not symptoms of SUI, FI, CDD or POP, whereas women with a history of regular PA were more likely to experience symptoms of FI (OR 4.41, 95% CI 1.05-18.49, p = 0.043) but no other symptoms of PFDs. CONCLUSIONS Competitive sports during early adulthood may increase the risk of UUI in middle age. Regular PA during early adulthood may increase the risk of FI.
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Affiliation(s)
- Mari A Kuutti
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Matti Hyvärinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Eija K Laakkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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21
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Lekamalage BBW, Centauri SM, Arachchi A, Grinlinton ME, Hulme-Moir M. Elective overlapping anterior anal sphincter repair - A video vignette. Colorectal Dis 2023. [PMID: 36594267 DOI: 10.1111/codi.16471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023]
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Bharucha AE, Knowles CH, Mack I, Malcolm A, Oblizajek N, Rao S, Scott SM, Shin A, Enck P. Faecal incontinence in adults. Nat Rev Dis Primers 2022; 8:53. [PMID: 35948559 DOI: 10.1038/s41572-022-00381-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.
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Affiliation(s)
- Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Charles H Knowles
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Isabelle Mack
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany
| | - Allison Malcolm
- Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Satish Rao
- Department of Gastroenterology, University of Georgia, Augusta, GA, USA
| | - S Mark Scott
- Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Paul Enck
- University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany.
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23
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Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study. Int Urogynecol J 2022; 34:1025-1033. [PMID: 35913612 DOI: 10.1007/s00192-022-05310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS As a result of the impairment of the musculoskeletal system, the pelvic floor muscles are likely compromised in women with systemic lupus erythematosus (SLE). We hypothesized that women with SLE would report more symptoms of pelvic floor dysfunction (PFD) and there will be an association between SLE and PFD. METHODS An online cross-sectional survey was conducted. Data were collected on demographic and anthropometric characteristics, PFD (urinary incontinence, nocturia, anal incontinence, genital-pelvic pain/penetration disorder and pelvic organ prolapse) and obstetric history using a web-based questionnaire. The groups were compared using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. The association between SLE and PFD was tested using logistic regression analysis. RESULTS A total of 196 women answered the questionnaire (102 with SLE and 94 healthy controls). Women with SLE reported significantly more urinary incontinence, nocturia, anal incontinence, pelvic organ prolapse and genital-pelvic pain/penetration disorder than the healthy controls (p ≤ 0.05). Women with SLE were 2.8- to 3.0-fold more likely to report genital-pelvic pain/penetration disorder than healthy women. CONCLUSIONS The prevalence of PFD was significantly higher in women with SLE compared to healthy women. Thus, PFD seems to be an important problem in women with this disease. An in-depth investigation of these disorders could contribute to the understanding of how SLE impacts pelvic floor function.
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Sawai M, Yuno C, Shogenji M, Nakada H, Takeishi Y, Kawajiri M, Nakamura Y, Yoshizawa T, Yoshida M. Prevalence of symptoms of pelvic floor dysfunction and related factors among Japanese female healthcare workers. Low Urin Tract Symptoms 2022; 14:380-386. [PMID: 35761770 DOI: 10.1111/luts.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women working in the medical field may be at risk for pelvic floor dysfunction due to high physical activity levels leading to increased abdominal pressure; however, the actual situation remains unknown. This study aimed to clarify the prevalence of symptoms of pelvic floor dysfunction and its associated factors among Japanese women working in the medical field. METHODS A cross-sectional study was conducted among female employees at a public hospital in Japan from July to August 2020. Participants answered a web-based questionnaire. Three types of symptoms related to pelvic floor dysfunction were assessed based on one or more subscale scores in the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20). RESULTS Out of 466 female employees in the hospital, 294 responded (response rate 63.1%). The mean age was 42.8 ± 10.3 years old and 221 (73.5%) were nurses. The prevalence of at least one type of symptom was 63.9%. The prevalence of recto-anal symptoms (45.9%) was highest, followed by lower urinary tract (37.1%) and pelvic organ prolapse symptoms (22.8%). The total PFDI-20 score was associated with constipation (β = .254), body mass index (β = .136), and part-time work (β = .167) after adjusting for other variables. CONCLUSION This study showed a high prevalence of symptoms related to pelvic floor dysfunction among women working in the medical field. Lifestyle management to prevent constipation and obesity is a promising strategy to improve symptoms of pelvic floor dysfunction.
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Affiliation(s)
- Moe Sawai
- Department of Nursing, Tohoku University School of Medicine, Health Sciences, Sendai, Japan
| | - Chikako Yuno
- Division of Nursing, Komatsu Municipal Hospital, Komatsu, Japan
| | - Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Harumi Nakada
- Division of Nursing, Komatsu Municipal Hospital, Komatsu, Japan
| | - Yoko Takeishi
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maiko Kawajiri
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuka Nakamura
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toyoko Yoshizawa
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Desprez C, Turmel N, Chesnel C, Sheikh Ismael S, Tamiatto M, Tan E, Haddad R, Le Breton F, Leroi AM, Hentzen C, Amarenco G. Fecal incontinence subtype assessment (FI-SA): A new tool to distinguish among subtypes of fecal incontinence in a neurogenic population. Clin Res Hepatol Gastroenterol 2022; 46:101900. [PMID: 35259498 DOI: 10.1016/j.clinre.2022.101900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Two subtypes of fecal incontinence (FI) are defined in the literature (urge and passive FI). The pertinence of this classification is unknown due to conflicting findings and heterogeneity of definitions. However, no questionnaire is available to clearly classify patients among subtypes. The objective of the present study was to develop and validate a new tool (Fecal incontinence subtype assessment, FI-SA) in order to better classify patients among the different subtypes of FI. METHODS A prospective monocentric study was conducted in consecutive patients with FI according to Rome IV criteria. To validate psychometric properties of the FI-SA questionnaire, a literature review and qualitative interviews were performed and discussed with an expert panel. A feasibility study was realized to assess acceptability and comprehension of items. The reproducibility was investigated in a validation study. RESULTS Comprehension and acceptability were excellent in 90% of patients in the feasibility study (n = 30). Validation study (n = 100) showed a good reproducibility with an intra-class correlation coefficient of 0.91 and 0.89 for questions 1 and 2. Time to fill the questionnaire was 40.0 s. 98.0% patients were classified among subtypes of FI: 34.0% passive FI, 32.0% urge FI and 32.0% mixed FI. CONCLUSION FI-SA is the first questionnaire to classify patients among subtypes of FI with good psychometric characteristics and the first questionnaire introducing the concept of mixed FI. FI-SA could help to determine the pertinence of this classification of FI in the management of these patients.
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Affiliation(s)
- C Desprez
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France.
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Casanova Hospital, 93200 Saint-Denis, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - S Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; ELSAN, Clinique Le Floride, 66420 Le Barcarès, France
| | - M Tamiatto
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - E Tan
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - A-M Leroi
- Rouen University Hospital, Digestive physiology Department, 76000 Rouen, France
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
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Menees S, Chey WD. Fecal Incontinence: Pathogenesis, Diagnosis, and Updated Treatment Strategies. Gastroenterol Clin North Am 2022; 51:71-91. [PMID: 35135666 DOI: 10.1016/j.gtc.2021.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Fecal incontinence (FI) is defined as the involuntary loss or passage of solid or liquid stool in patients. FI is a common and debilitating condition in men and women. The incidence increases with age and also often goes unreported to health care providers. It is crucial that providers ask at-risk patients about possible symptoms. Evaluation and management is tailored to specific symptoms and characteristics of the incontinence. If conservative methods fail to improve symptoms, then other surgical options are considered, such as sacral nerve stimulation and anal sphincter augmentation. This review provides an update on current and future therapies.
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Affiliation(s)
- Stacy Menees
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine Health System, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - William D Chey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine Health System, Ann Arbor, MI, USA
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Al-Badr A, Saleem Z, Kaddour O, Almosaieed B, Dawood A, Al-Tannir M, AlTurki F, Alharbi R, Alsanea N. Prevalence of pelvic floor dysfunction: a Saudi national survey. BMC Womens Health 2022; 22:27. [PMID: 35120501 PMCID: PMC8815131 DOI: 10.1186/s12905-022-01609-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/27/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pelvic Floor Dysfunction (PFD) is a global health problem affecting millions of women worldwide and comprises a broad range of clinical dysfunctions such as urinary incontinence (UI), fecal incontinence (FI), pelvic organ prolapse (POP) vaginal laxity (VL), vaginal wind (VW), and overactive bladder (OAB). This study aims to estimate the prevalence of PFD among Saudi women attending primary health care centers (PHCCs) across 13 regions of Saudi Arabia and their characteristics along with associated factors. METHODS A cross-sectional study was conducted on 2,289 non-pregnant women. The probability population proportional sampling technique was employed followed by a convenient sampling technique to recruit eligible women. Types of PFD were assessed using a self-administered electronic questionnaire. Pelvic Floor Distress Index (PFDI-20) was used to assess the primary study outcomes (FI, VL, POP, VW, and OAB). A multivariate logistic regression model was used to identify independent associated factors for PFD. RESULTS The findings showed that 830 women (36.3%) had any type of UI. Stress UI affected726 (31.7%) women, whilst 525 women (22.9%) had urge UI. VL occurred in 505 women (22.1%), whilst POP occurred in 536 women (23.4%). VW occurred in 733 participants and (32%) 1238 women (54.1%) had OAB. The multivariate analysis suggested that region, location, parity, and assisted birth were significantly associated with UI, VL, FI and PFD (P < 0.001). CONCLUSION PFD is a common condition among Saudi women. UI, VL, VW, OAB, POP and FI increased consistently among urban women with increased age, greater parity, assisted birth, and post-menopausal status.
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Affiliation(s)
- Ahmed Al-Badr
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Zarqa Saleem
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Ouhoud Kaddour
- Prince Naif Healthcare Research Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Bader Almosaieed
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Ashraf Dawood
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Mohamad Al-Tannir
- Applied Clinical Research Administration, Research Center, King Fahad Medical City Saudi Arabia, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia.
| | - Faisal AlTurki
- Urogynecology Department, Women's Specialized Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh, 11525, Saudi Arabia
| | - Reem Alharbi
- College of Medicine, King Abdullah Bin Abdul Aziz Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Nasser Alsanea
- College of Medicine, Al Faisal University, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Abstract
BACKGROUND No long-term pouch studies have included follow-up >30 years or an analysis in patients >80 years old. OBJECTIVE This study aimed to investigate pouch function and pouch failure in patients with a pouch in situ >30 years and in patients >80 years old. DESIGN This is a retrospective review. SETTING This study was conducted at an IBD referral center. PATIENTS Adult patients with ulcerative colitis who underwent an IPAA between 1983 and 1990 were selected. MAIN OUTCOME MEASURES The primary outcomes measured were pouch function and pouch failure rates. METHODS Data collection included diagnosis, age at IPAA, indication for IPAA, medications at IPAA, pathology at the time of IPAA, postoperative morbidity, functional outcomes, quality of life, pouch excision or ileostomy and indication, and date of last follow-up. All living patients were contacted in April 2020 to retrieve functional data and pouch failure rates. RESULTS A total of 566 patients had a pouch constructed between 1983 and 1990; of the 145 at most recent contact, 75 had their pouch in situ ≥30 years and 14 were ≥80 years old. Mean age at diagnosis was 25.8 years (10.6 SD), age at surgery was 34.7 years (11.3 SD), and age at last follow-up was 60.5 years (13.2 SD). At a median of 30 years (IQR, 21-32), 145 patients responded to the functional survey. Significantly increased rates of urgency (always, mostly, sometimes: 71.5% vs 23.5%) and seepage during the day (71.4% vs 22.4%) were observed in patients ≥80 years. In patients ≥80 years with a pouch in situ ≥30 years, urgency and incontinence were sometimes experienced by nearly 50% and pouch failure occurred in one third of patients. The overall rate of pouch failure was 19.4% (n = 110) at a median follow-up of 15 years; risk factors were female sex, 3-stage approach, and pelvic sepsis. LIMITATIONS A retrospective database was used. CONCLUSION Patients with IPAA maintain good pouch function even after 30 years and in patients over the age of 80 years. Pouch function declines with time and failure rates increase over time. See Video Abstract at http://links.lww.com/DCR/B684.Función De La Bolsa Ileal En El Tiempo Y En Pacientes De Edad Avanzada. ANTECEDENTES No se han efectuado estudios en pacientes con bolsa a largo plazo que incluyan un seguimiento por treinta años o más y en pacientes mayores de 80 años. OBJETIVO Investigar la funcionalidad o la falla de la bolsa en pacientes bolsa in situ por mas de treinta años y en pacientes mayors de 80 años. DISEO Revisión retrospective. ESCENARIO Centro de referencia de Enfermedad Inflamatoria Intestinal. PACIENTES Pacientes adultos con diagnóstico de colitis ulcerative sometidos a anastomosis bolsa ileal anal (IPAA) entre 1983 y 1990. PRINCIPALES PARAMETROS DE RESULTADOS Indices de efectividad y disfunción de la bolsa ileal. METODOS Recopilación de la información incluyendo diagnóstico, edad del procedimiento (IPAA), indicaciones para IPAA, medicamentos para IPAA, patología en el transcurso del IPAA, morbilidad postoperatoria, resultados funcionales, calidad de vida, excisión de la bolsa o ileostomía y su indicación y fecha de seguimiento mas reciente. Se contactaron a todos los pacientes vivos en abril de 202 para recuperar la información de los índices de funcionalidad o disfunción de la bolsa. RESULTADOS Se les construyó una bolsa a un total de 566 pacientes entre 1983 y 1990; de los 145 mas recientemente contactados, 75 permanecían con su bolsa in situ ≥ 30 años y 14 eran mayores de 80 años. La edad media en el momento de diagnóstico fue de 25.8 años (con desviación estándar de 10.6, sd), edad al momento de la cirugía fue de 34.7 años (11.3sd), y la edad en el último seguimiento de 60.5 años (13.2,sd). A una media de 30 años (IQR: 21,32), 145 pacientes respondieron al cuestionario de funcionalidad. En pacientes mayores de 80 años se observaron tasas aumentadas de urgencia (siempre, la mayor parte de las veces, algunas veces: 71.5% vs 23.5%) y fuga durante el día (71.4% versus 22.4%). En pacientes mayores de 80 años con una bolsa in situ durante 30 años o más, experimentaron urgencia e incontinencia en cerca del 50% y disfunción de la bolsa en un tercio de los pacientes. La tasa global de fallo de la bolsa fue de 19.4% (n = 110) en un seguimiento a 15 años; los factores de riesgo asociados fueron: sexo femenino, abordaje de tres tiempos y sepsis pélvica. LIMITACIONES Información retrospective. CONCLUSIONES Los pacientes con IPAA continúan con una función adecuada de la bolsa aún después de 30 años de efectuada así como en pacientes mayores de 80 años. La funcionalidad de la bolsa disminuye con el tiempo y las tasa de falla aumentan de igual forma con el tiempo. Consulte Video Resumen en http://links.lww.com/DCR/B684. (Traducción- Dr. Miguel Esquivel-Herrera).
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Knol ME, Snijders HS, van der Heyden JT, Baeten CI. Fecal Incontinence: The Importance of a Structured Pathophysiological Model. J Anus Rectum Colon 2022; 6:58-66. [PMID: 35128138 PMCID: PMC8801252 DOI: 10.23922/jarc.2021-040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Fecal incontinence has an enormous social and economic impact and may significantly impair quality of life. Even though fecal incontinence is a common complaint in (aging) adults, a structured pathophysiological model of the clinical presentations of fecal incontinence is missing in current literature. The most frequent manifestations of fecal incontinence are passive fecal loss, urge incontinence, or mixed fecal incontinence. At our institution, we treat 400 patients per year with defecation disorders, including a significant number of patients with fecal incontinence. On the basis of this experience, we have tried to create a concept that merges current insight in causes and treatment options in a clinically useful algorithm. By applying the system of anamnesis and physical examination described in this article and expanding it with simple additional anorectal examination, in most patients, one can determine the type of fecal incontinence and choose a targeted therapy.
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Walter S, Jones MP, Sjödahl J, Stjernman H, Hjortswang H, Andreasson A. Measuring the impact of gastrointestinal inconvenience and symptoms on perceived health in the general population - validation of the Short Health Scale for gastrointestinal symptoms (SHS-GI). Scand J Gastroenterol 2021; 56:1406-1413. [PMID: 34521305 DOI: 10.1080/00365521.2021.1974087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) symptoms are intimately related to our wellbeing. The Short Health Scale for GI symptoms (SHS-GI) is a simple questionnaire to measure the impact of GI inconvenience and symptoms on quality of life. The aim was to validate the SHS-GI in a general population sample and to compare it with SHS-data across different patient groups. METHOD A subsample of 170 participants from a population-based colonoscopy study completed the Rome II questionnaire, GI diaries, psychological questionnaire (hospital anxiety and depression scale) and SHS-GI at follow-up investigation. Psychometric properties of SHS-GI as an overall score were determined by performing a confirmatory factor analysis (CFA). Spearman correlation between SHS total score and symptoms was calculated in the general population sample. SHS-GI data was compared with SHS data from patients with inflammatory bowel disease (IBD) and fecal incontinence (FI). RESULTS As expected, the general population rated their impact of GI inconvenience on quality of life as better than the patient populations in terms of all aspects of the SHS-GI. The CFA showed a good model fit meeting all fit criteria in the general population. Cronbach's alpha for the total scale was 0.80 in the general population sample and ranged from 0.72 in the FI sample to 0.88 and 0.89 in the IBD samples. CONCLUSIONS SHS-GI demonstrated appropriate psychometric properties in a sample of the normal population. We suggest that SHS-GI is a valid simple questionnaire suitable for measuring the impact of GI symptoms and inconvenience on quality of life in both general and patient populations.
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Affiliation(s)
- Susanna Walter
- Department of Biomedical and Clinical Sciences (BKV), Division of Inflammation and Infection, Linkoping University, Linkoping, Sweden.,Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, Australia
| | - Jenny Sjödahl
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Henrik Stjernman
- Department of Internal Medicine, Ryhov Hospital Jönköping, Jönköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology, Linköping University Hospital, Linkoping, Sweden
| | - Anna Andreasson
- School of Psychological Sciences, Macquarie University, North Ryde, Australia.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Xiang X, Sharma A, Patcharatrakul T, Yan Y, Karunaratne T, Parr R, Ayyala DN, Hall P, Rao SSC. Randomized controlled trial of home biofeedback therapy versus office biofeedback therapy for fecal incontinence. Neurogastroenterol Motil 2021; 33:e14168. [PMID: 34051120 DOI: 10.1111/nmo.14168] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biofeedback therapy is useful for treatment of fecal incontinence (FI), but is not widely available and labor intensive. We investigated if home biofeedback therapy (HBT) is non-inferior to office biofeedback therapy (OBT). METHODS Patients with FI (≥1 episode/week) were randomized to HBT or OBT for 6 weeks. HBT was performed daily using novel device that provided resistance training and electrical stimulation with voice-guided instructions. OBT consisted of six weekly sessions. Both methods involved anal strength, endurance, and coordination training. Primary outcome was change in weekly FI episodes. FI improvement was assessed with stool diaries, validated instruments (FISI, FISS, and ICIQ-B), and anorectal manometry using intention-to-treat analysis. KEY RESULTS Thirty (F/M = 26/4) FI patients (20 in HBT, 10 in OBT) participated. Weekly FI episodes decreased significantly after HBT (Δ ± 95% confidence interval: 4.7 ± 1.8, compared with baseline, p = 0.003) and OBT (3.7 ± 1.6, p = 0.0003) and HBT was non-inferior to OBT (p = 0.2). The FISI and FISS scores improved significantly in HBT group (p < 0.02). Bowel pattern, bowel control, and quality of life (QOL) domains (ICIQ-B) improved significantly in HBT arm (p < 0.023). Resting and maximum squeeze sphincter pressures significantly improved in both HBT and OBT groups and sustained squeeze pressure in HBT, without group differences. CONCLUSIONS & INFERENCES Home biofeedback therapy is non-inferior to OBT for FI treatment. Home biofeedback is safe, effective, improves QOL, and through increased access could facilitate improved management of FI.
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Affiliation(s)
- Xuelian Xiang
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Amol Sharma
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tanisa Patcharatrakul
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yun Yan
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tennekoon Karunaratne
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Rachel Parr
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Deepak Nag Ayyala
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Patricia Hall
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Satish S C Rao
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Understanding the physiology of human defaecation and disorders of continence and evacuation. Nat Rev Gastroenterol Hepatol 2021; 18:751-769. [PMID: 34373626 DOI: 10.1038/s41575-021-00487-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
The act of defaecation, although a ubiquitous human experience, requires the coordinated actions of the anorectum and colon, pelvic floor musculature, and the enteric, peripheral and central nervous systems. Defaecation is best appreciated through the description of four phases, which are, temporally and physiologically, reasonably discrete. However, given the complexity of this process, it is unsurprising that disorders of defaecation are both common and problematic; almost everyone will experience constipation at some time in their life and many will develop faecal incontinence. A detailed understanding of the normal physiology of defaecation and continence is critical to inform management of disorders of defaecation. During the past decade, there have been major advances in the investigative tools used to assess colonic and anorectal function. This Review details the current understanding of defaecation and continence. This includes an overview of the relevant anatomy and physiology, a description of the four phases of defaecation, and factors influencing defaecation (demographics, stool frequency/consistency, psychobehavioural factors, posture, circadian rhythm, dietary intake and medications). A summary of the known pathophysiology of defaecation disorders including constipation, faecal incontinence and irritable bowel syndrome is also included, as well as considerations for further research in this field.
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ACG Clinical Guidelines: Management of Benign Anorectal Disorders. Am J Gastroenterol 2021; 116:1987-2008. [PMID: 34618700 DOI: 10.14309/ajg.0000000000001507] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/09/2021] [Indexed: 12/11/2022]
Abstract
Benign anorectal disorders of structure and function are common in clinical practice. These guidelines summarize the preferred approach to the evaluation and management of defecation disorders, proctalgia syndromes, hemorrhoids, anal fissures, and fecal incontinence in adults and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations Assessment, Development and Evaluation process. When the evidence was not appropriate for Grading of Recommendations Assessment, Development and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.
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Bharucha AE, Gantz MG, Rao SS, Lowry AC, Chua H, Karunaratne T, Wu J, Hamilton FA, Whitehead WE. Comparative effectiveness of biofeedback and injectable bulking agents for treatment of fecal incontinence: Design and methods. Contemp Clin Trials 2021; 107:106464. [PMID: 34139357 PMCID: PMC8429255 DOI: 10.1016/j.cct.2021.106464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/08/2021] [Accepted: 05/30/2021] [Indexed: 12/13/2022]
Abstract
Fecal incontinence (FI), the involuntary passage of stool, is common and can markedly impair the quality of life. Among patients who fail initial options (pads or protective devices, bowel modifying agents, and pelvic floor exercises), the options are pelvic floor biofeedback (BIO), perianal injection with bulking agents (INJ), and sacral nerve electrical stimulation (SNS), which have not been subjected to head-to-head comparisons. This study will compare the safety and efficacy of BIO and INJ for managing FI. The impact of these approaches on quality-of-life and psychological distress, cost effectiveness, and predictors of response to therapy will also be evaluated. Six centers in the United States will enroll approximately 285 patients with moderate to severe FI. Patients who have 4 or more FI episodes over 2 weeks proceed to a 4-week trial of enhanced medical management (EMM) (ie, education, bowel management, and pelvic floor exercises). Thereafter, 194 non-responders as defined by a less than 75% reduction in the frequency of FI will be randomized to BIO or INJ. Three months later, the efficacy, safety, and cost of therapy will be assessed; non-responders will be invited to choose to add the other treatment or SNS for the remainder of the study. Early EMM responders will be re-evaluated 3 months later and non-responders randomized to BIO or INJ. Standardized, and where appropriate validated approaches will be used for study procedures, which will be performed by trained personnel. Prospectively collected data on care costs and resource utilization will be used for cost effectiveness analyses.
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Affiliation(s)
- Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
| | - Marie G. Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC
| | - Satish S. Rao
- Division of Gastroenterology, Augusta University, Augusta, Ga
| | - Ann C. Lowry
- Colon and Rectal Surgery Associates, Minneapolis, Mn
| | - Heidi Chua
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Mn
| | | | - Jennifer Wu
- Division of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - Frank A. Hamilton
- National Institute of Digestive Diseases, Kidney, and Diabetes, Bethesda, MD
| | - William E. Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
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Pincus JB, Moss NP, Chang C, Goldberg RP, Rostaminia G. Pelvic floor architectural defects in female patients with urge fecal incontinence versus passive fecal leakage: a dynamic ultrasound study. Int Urogynecol J 2021; 33:2133-2141. [PMID: 34292342 DOI: 10.1007/s00192-021-04919-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Fecal incontinence (FI) has two primary subtypes: urgency fecal incontinence (UFI) and passive fecal leakage (PFL). The pathophysiology underlying the subtypes is incompletely understood. OBJECTIVES To compare the bowel habits, physical examinations and pelvic floor anatomical defects in patients with UFI-dominant FI versus patients with PFL-dominant FI. STUDY DESIGN This is a retrospective cross-sectional study of female patients who presented with fecal incontinence symptoms to our tertiary urogynecology center. All subjects underwent a comprehensive history, physical examination, 3D-static pelvic floor ultrasound, and 2D-dynamic ultrasound of the posterior compartment. Patients with UFI-dominant FI were compared to patients with PFL-dominant FI. RESULTS One hundred forty-five patients were included in the analysis; 57 categorized as UFI-dominant FI, 69 PFL-dominant FI and 19 categorized as having "both" leakage patterns. In comparing bowel habits, patient with UFI-dominant FI had more frequent bowel movements (15.5 ± SD 13.0/week vs. 10.9 ± SD 7.6 /week, p = 0.022) and were more likely to have loose stools (48.2% vs. 26.1%, p = 0.01). No statistically significant differences were observed in the prevalence of external anal sphincter defect (11.3% vs. 17.2%, p = 0.38) or internal anal sphincter defect (11.3% vs. 19%, p = 0.26) between groups. Finally, patients with UFI-dominant FI had a higher incidence of rectal hypermobility (loss of rectal support on Valsalva) (58% vs. 36.9%, p = 0.025). CONCLUSION Patients with urge-predominant FI have increased frequency of bowel movements, looser stools, and increased rectal folding diagnosed via dynamic ultrasound as compared to patients with passive-dominant FI.
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Affiliation(s)
- Joseph B Pincus
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA. .,Division of Urogynecology, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA.
| | - Nani P Moss
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Cecilia Chang
- NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Roger P Goldberg
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
| | - Ghazaleh Rostaminia
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Thompson DT, Hrabe JE. Staged Approaches to Restorative Proctocolectomy with Ileoanal Pouch-When and Why? J Laparoendosc Adv Surg Tech A 2021; 31:875-880. [PMID: 34182807 DOI: 10.1089/lap.2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Restorative proctocolectomy (RPC) with ileal pouch anal-anastomosis (IPAA) is commonly performed for patients with ulcerative colitis, familial adenomatous polyposis, and selected phenotypes of Crohn's disease (CD). Due to concerns about the effects of surgical complications on pouch functional outcomes, debate remains surrounding when and whether RPC with IPAA should be performed in a staged manner. Particularly debated are the timings of the IPAA, whether it is constructed at time of the proctocolectomy and whether to utilize temporary fecal diversion with a loop ileostomy. RPC with IPAA can be performed in one, two, or three stages, with each stage typically separated by 3-6 months. Proponents of a staged approach argue that poor pouch function, which is often a result of IPAA complications, including leak and infection, can be difficult to overcome and mandate additional, major surgeries, and that staging pouch creation and pairing with a protective ileostomy reduce those complications. However, subjecting patients to multiple surgeries and prolonging their time with an ileostomy present unique risks as well. Surgeons' experience and preference and patient characteristics need to be considered when determining operative planning. Highly selected patients with CD can be considered for RPC with IPAA, although with an acknowledgment of inherently higher pouch failure rates. Understanding the short- and long-term consequences of RPC with IPAA construction can help surgeons determine the appropriate approach.
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Affiliation(s)
- Dakota T Thompson
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer E Hrabe
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Hölscher M, Gräf C, Stickelmann AL, Stickeler E, Najjari L. Perianal ultrasound (PAUS): visualization of sphincter muscles and comparison with digital-rectal examination (DRE) in females. BMC WOMENS HEALTH 2021; 21:247. [PMID: 34144688 PMCID: PMC8214294 DOI: 10.1186/s12905-021-01387-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Background The aim of this study was to determine the reproducibility and tolerance of perianal ultrasound (PAUS) and detect differences in sphincter muscles between various measuring positions and different maneuvers. PAUS was compared to digital-rectal examination (DRE) to see if sphincter contraction is visible and gradable in ultrasound volumes.
Methods Fifty women underwent a medical history, DRU and PAUS by two uro-gynecologists in a prospective trial. PAUS volumes were measured via different parameters in different maneuvers. Examiners’ DRE impressions of sphincter tone were scaled with the DRESS-score. All patients completed a questionnaire. Results Thirty-five patients with complete PAUS and DRE were included in the study. Fifteen patients were excluded due to poor ultrasound volume quality or sphincter defects. Comparison of sphincter muscle thickness at different positions in PAUS showed significant differences between 6 and 12 o’clock positions (12 > 6 o’clock) and diameters (horizontal > vertical). No difference was found between the examiners. In comparison of rest and contraction only the vertical diameter changed. There was a negative but not significant correlation between PAUS measurements and DRESS-scores. Twenty-six patients completed the questionnaire that revealed women preferred PAUS over DRE. Conclusion PAUS is a reproducible and good tool to visualize the anal canal. It is comfortable for patients and easily handled by examiners. Sphincter muscle contraction is iso-volumetric. Vertical diameter changes during contraction leading the anal canal change its shape to oval due to external influence. PAUS is the ideal additional tool to visualize relevant structures that are palpable on DRE.
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Affiliation(s)
- Miriam Hölscher
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Charlotte Gräf
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Anna-Lena Stickelmann
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Laila Najjari
- Department of Gynecology and Obstetrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Non-dynamic graciloplasty is an effective treatment for patients with passive fecal incontinence. Tech Coloproctol 2021; 25:849-855. [PMID: 33978860 DOI: 10.1007/s10151-021-02455-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fecal incontinence is a multifactorial problem and its etiology is complex. Various therapies are available and different success rates have been described. The aim of this study was to assess the effectiveness and safety of non-dynamic graciloplasty in patients with passive fecal incontinence. METHODS We retrospectively studied charts of patients with fecal incontinence treated with graciloplasty at our institution from November 2015 until June 2018. Patients were included according to the following criteria: (1) presence of predominantly passive fecal incontinence and (2) presence of a lax perineal body. Primary outcome was the effectiveness, defined as a significant reduction or absence of the complaints of passive fecal incontinence at 3, 6 and 12 months after surgery. Second, we studied the safety of the procedure evaluating the complications within 30 days after surgery. RESULTS Thirty-one patients met the inclusion criteria. Twenty-six of them, in addition to passive incontinence as the main symptom, had some degree of fecal urgency. The median age at the first visit to the outpatient clinic was 64.0 years (IQR 52-68). Most patients were female (n = 29, 94%). At 3 months after graciloplasty, 71% (22 of 31) of patients were successfully treated for their passive fecal incontinence. At 6 months, the success rate of the graciloplasty increased to 77%. At 12 months among the patients who were still seen in the clinic, the success rate was 58% (18/31). Two patients cancelled follow-up visits after 3 months, because of failure to control symptoms in 1 case. After 6 months, 9 patients were given the choice to do telephone follow-up only. Of these 11 patients without in-person follow-up, 10 were contacted 1 year after surgery and in 7 of them, the graciloplasty was effective in controlling their passive fecal incontinence for an overall success rate of 80% (25/31). Of the 26 patients with mixed passive and urge incontinence, 6 (23%) still complained of urge incontinence at 1 year. Of these patients with persistent urge incontinence, 6 underwent sacral nerve stimulation which was successful in 4. Two serious complications occurred within 30 days. A rectal perforation requiring temporary colostomy and a recto-vaginal fistula which was successfully repaired. CONCLUSION Non-dynamic graciloplasty is an effective treatment for passive fecal incontinence. Differentiation based on subtypes of fecal incontinence might be important for a pattern-specific approach to treatment. More research is necessary to determine the right indications for more invasive treatments of fecal incontinence.
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Abstract
BACKGROUND Rectal prolapse has a diverse symptom profile that affects patients of all ages. OBJECTIVE We sought to identify bothersome symptoms and clinical presentation that motivated patients who have rectal prolapse to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms. DESIGN This study is a retrospective analysis of a prospectively maintained registry. SETTINGS This study was conducted at a tertiary referral academic center. PATIENTS Included were 129 consecutive women with full-thickness rectal prolapse. MAIN OUTCOME MEASURES The main outcomes measured were primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, and the 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age <65 vs age ≥65 years. RESULTS Cleveland Clinic/Wexner Fecal Incontinence score >9 was more common in older patients (87% vs 60%, p = 0.002). Obstructed Defecation Syndrome score >8 was more common in younger patients (57% vs 28%, p < 0.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p = 0.021) and bleeding (12% vs 2%, p = 0.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p = 0.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p = 0.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p = 0.056). On multivariable regression, increasing age, narcotic use, and nonprotracting prolapse at rest were associated with reporting pain as a primary concern. LIMITATIONS This was a single-center study with a small sample size. CONCLUSIONS Rectal prolapse-related bothersome symptoms and health care utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at http://links.lww.com/DCR/B492. PROLAPSO DE RECTO INFLUENCIA DE LA EDAD EN DIFERENCIAS VINCULADAS CON LA PRESENTACIÓN CLÍNICA Y LOS SÍNTOMAS MAS DESAGRADABLES: El prolapso de recto tiene una gran variedad de síntomas que afectan a pacientes con edades diferentes.Identificar los síntomas mas molestos y la presentación clínica que motivaron a los pacientes con un prolapso de recto a consultar por atención médica, caracterizar las diferencias de gravedad de los síntomas con relación a la edad y determinar los factores asociados con los síntomas mas molestos.Análisis retrospectivo de un registro prospectivo.Centro académico de referencia terciaria.Consecutivamente 129 mujeres que presentaban un prolapso rectal completo.Síntomas y molestias primarias, cuestionario de incontinencia fecal de la Cleveland Clinic / Wexner de 5 ítems, cuestionario de síndrome de defecación obstruida de 5 ítems. Los pacientes fueron categorizados en < 65 años versus ≥ 65 años.El puntaje de incontinencia fecal de la Cleveland Clinic / Wexner > 9 fue más común en pacientes mayores (87% vs 60%, p = 0.002). La puntuación del síndrome de defecación obstructiva > 8 fue más común en pacientes más jóvenes (57% vs 28%, p <0,001). Los pacientes mayores fueron más propensos que los pacientes jóvenes a informar síntomas y molestias de dolor (38% vs 19%, p = 0.021) y sangrado (12% vs 2%, p = 0.046). La mayoría de los pacientes informaron secresión de moco (mayores, 72% frente a más jóvenes, 66%, p = 0,54), pero sólo el 18% tuvo molestias, independientemente de la edad. Los pacientes mayores tenían una exteriorización de prolapso más grave que los pacientes jóvenes (en reposo, 33% frente a 11%; durante la actividad, 26% frente a 19%; solo con defecación, 40% frente a 64%, p = 0,006). Los pacientes mayores tenían más probabilidades de buscar atención médica dentro de los 6 meses posteriores al inicio del prolapso (29% frente a 11%, p = 0.056). Tras la regresión multivariable, el aumento de la edad, el uso de narcóticos y el prolapso no prolongado en reposo se asociaron con la notificación de dolor como queja principal.Centro único; tamaño de muestra pequeño.Los síntomas y molestias relacionadas con el prolapso rectal y la solicitud de atención médica difieren según la edad. Aunque el dolor rectal a menudo no se asocia comúnmente con el prolapso, incomoda a muchas pacientes y motiva a las mujeres mayores a someterse a un examen médico. Los cuestionarios funcionales con las respuestas de las pacientes pueden no reflejar las preocupaciones principales de éstos con respecto a los síntomas específicos y podrían requerir cuestionarios complementarios para así obtener prioridades individualizadas con relación a los síntomas identificados. Consulte Video Resumen en http://links.lww.com/DCR/B492. (Traducción-Dr. Xavier Delgadillo).
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Tucker J, Steen M, Briley A. Enhancing the identification of anal incontinence in women of reproductive age. Nurs Stand 2021; 36:71-76. [PMID: 33870661 DOI: 10.7748/ns.2021.e11735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Anal incontinence is an unpredictable and debilitating condition that can significantly reduce quality of life. Symptoms include the involuntary loss of solid and/or liquid stool, flatus incontinence and rectal urgency. Pregnancy and childbirth are two major factors that increase the risk of anal incontinence in women of reproductive age. Women at high risk of anal incontinence include those with a known history of the condition and those who have experienced severe perineal trauma, particularly after injury to the anal sphincters (third-degree and fourth-degree tears). Routine screening for anal incontinence of women in high-risk groups during pregnancy and after childbirth appears to be limited in clinical practice. This article discusses the potential benefits of screening for anal incontinence, outlines the factors that inhibit and enable screening, describes current bowel screening tools and their limitations, and explores how the identification of anal incontinence in women of reproductive age could be improved.
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Affiliation(s)
| | - Mary Steen
- professorial lead for maternal and family health, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Annette Briley
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Mei L, Patel K, Lehal N, Kern MK, Benjamin A, Sanvanson P, Shaker R. Fatigability of the external anal sphincter muscles using a novel strength training resistance exercise device. Am J Physiol Gastrointest Liver Physiol 2021; 320:G609-G616. [PMID: 33596155 PMCID: PMC8238165 DOI: 10.1152/ajpgi.00456.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 01/31/2023]
Abstract
Exercises involving pelvic floor muscles including repetitive voluntary contractions of external anal sphincter (EAS) musculature have been used to improve fecal incontinence. Muscle fatigue is a prerequisite for successful strength training. However, muscle fatigue induced by these exercises has not been systematically studied. We aimed to assess the fatigability of EAS muscles during various exercise methods. Twelve nulliparous (21 ± 2.7 yr) women were studied. We evaluated fatigue during 40 repetitive 3-s contractions and 30-s long squeeze contractions both with and without an intra-anal compressible resistant load. The sequence of exercises was randomized. This load was provided by the continence muscles Resistance Exerciser Device. Anal canal pressures were recorded by high-resolution manometry. Exercise against a resistive load showed significant decrease in anal contractile integral (CI) and maximum squeeze pressure during repetitive short squeeze contractions compared with exercise without a load. Linear regression analysis showed a significant negative correlation between anal CI and successive contraction against load, suggesting "fatigue." Similar findings were observed for maximum squeeze pressure (slope with load = -4.2, P = 0.0003, vs. without load = -0.9, P = 0.3). Long squeeze contraction against a load was also more susceptible to fatigue than without a load (P < 0.0001). In conclusion, repetitive contractions against a compressible load induce fatigue and thus have the potential to strengthen the anal sphincter contractile function than contractions without a load. Fatigue rate in long squeeze contraction exercises with a load is significantly faster than that without a load, also indicating greater effectiveness in inducing muscle fatigue.NEW & NOTEWORTHY Fecal incontinence is a distressing disorder with a mainstay of treatment being pelvic floor muscle exercises. However, none of these exercises has proven occurrence of fatigability, which is an important prerequisite for successful muscle strengthening in rehabilitative exercises. In this study, we proved that we can fatigue the external anal sphincter muscles more efficiently by providing a resistive load during anal repetitive short squeeze contractions and long squeeze contraction exercise.
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Affiliation(s)
- Ling Mei
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Krupa Patel
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Navjit Lehal
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mark K Kern
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam Benjamin
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Patrick Sanvanson
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nilsson IEK, Åkervall S, Molin M, Milsom I, Gyhagen M. Symptoms of fecal incontinence two decades after no, one, or two obstetrical anal sphincter injuries. Am J Obstet Gynecol 2021; 224:276.e1-276.e23. [PMID: 32835724 DOI: 10.1016/j.ajog.2020.08.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The long-term effects of 1 or 2 consecutive obstetrical anal sphincter injuries on bowel continence are still inadequately investigated, and published results remain contradictory. OBJECTIVE This study aimed to present detailed descriptive measures of the current bowel incontinence 20 years after the first birth in women who had 2 vaginal deliveries with and without sphincter injuries. STUDY DESIGN Birth register data were used prospectively and linked to information from a questionnaire survey about current symptoms. Women with 2 singleton vaginal births, from 1992 to 1998, and no further births were retrieved and surveyed by the Swedish Medical Birth Register and Statistics Sweden in 2015. A simple random sample of 11,000 women was drawn from a source cohort of 64,687 women. The cumulative effect was studied in all women with a repeat sphincter injury from 1987 to 2000. Postal and web-based questionnaires were used. The study population consisted of 6760 women with no sphincter injury, 357 with 1 sphincter injury, and 324 women with 2 sphincter injuries. Women with 2 deliveries without sphincter injuries aged 40 to 60 years as reference, were compared with those of women that sustained 1 or 2 consecutive sphincter injuries. Here, third- and fourth-degree perineal tears were presented as 1 group. Fecal incontinence was defined as current involuntary leakage of solid or liquid stool, with and without concomitant leakage of gas. The Fisher exact test and the Mann-Whitney U test were used to compare the results of the 2 groups. The trend was analyzed using the Mantel-Haenszel statistics. Logistic regression models obtained the estimated age-related probability of fecal incontinence components. RESULTS The risk of sphincter injury at first delivery was 3.9%, and the risk of a repeat sphincter injury was 10.0% (odds ratio, 2.70; 95% confidence interval, 1.80-4.07). The overall prevalence of fecal incontinence in women without sphincter injuries was 11.7%, which doubled to 23.8% (odds ratio, 2.27; 95% confidence interval, 1.75-2.94) in those with 1 sphincter injury and more than tripled to 36.1% (odds ratio, 3.97; 95% confidence interval, 3.11-5.07) after 2 sphincter injuries (trend P<.0001). The proportion of women with severe fecal incontinence increased 3-fold and 5-fold from 1.8% after no obstetrical anal sphincter injury to 5.4% (95% confidence interval, 3.3-8.2) and 9.0% (95% confidence interval, 6.1-12.6) after 1 or 2 obstetrical anal sphincter injuries, respectively (trend P<.0001). In women without sphincter injuries, the estimated probability of fecal incontinence increased from 7.0% at the age of 40 years to 19.8% at the age of 60 years. In contrast, in women with 1 or 2 sphincter injuries, the estimated probability of fecal incontinence increased from 26.1% and 33.3%, respectively, at the age of 40 years to 36.8% and 48.8% at the age of 60 years. The prevalence of fecal incontinence increased after 52 years of age in women with 1 or 2 sphincter injuries. The dominant types of leakage in women with fecal incontinence were the combination of liquid stool and gas, and the triple combination consisting of solid and liquid stools and gas. The triple combination increased from 18.9% in those without sphincter injury to 28.2% in women with 2 injuries (trend P=.0204). CONCLUSION The risk of sustaining a repeat sphincter injury at the second delivery was almost tripled compared with the risk at the first delivery. Furthermore, 1 or 2 sphincter injuries brought severe long-term consequences for bowel continence. Accidental leakage of stool and gas increased with each sphincter injury, and the effect was proportionally cumulative. After the age of 52 years, the prevalence of fecal incontinence seemed to accelerate.
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Affiliation(s)
- Ida E K Nilsson
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Southern Älvsborg Hospital, Borås, Sweden
| | - Sigvard Åkervall
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Ian Milsom
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Gyhagen
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Southern Älvsborg Hospital, Borås, Sweden.
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Abstract
Fecal incontinence can be a challenging and stigmatizing disease with a high prevalence in the elderly population. Despite effective treatment options, most patients do not receive care. Clues in the history and physical examination can assist the provider in establishing the diagnosis. Direct inquiry about the presence of incontinence is key. Bowel disturbances are common triggers for symptoms and represent some of the easiest treatment targets. We review the epidemiology and impact of the disease, delineate a diagnostic and treatment approach for primary care physicians to identify patients with suspected fecal incontinence and describe appropriate treatment options.
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Affiliation(s)
- Trisha Pasricha
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Wang 5, Boston, MA 02114, USA; Department of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, CRP 9, Boston, MA 02114, USA.
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Arslan RS, Mutlu L, Engin O. Management of Colorectal Surgery Complications. COLON POLYPS AND COLORECTAL CANCER 2021:355-377. [DOI: 10.1007/978-3-030-57273-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Okeahialam NA, Thakar R, Sultan AH. Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI). Int Urogynecol J 2020; 32:1719-1726. [PMID: 33263781 PMCID: PMC8295136 DOI: 10.1007/s00192-020-04607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022]
Abstract
Introduction and hypothesis Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum. Conclusions Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.
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Affiliation(s)
- Nicola Adanna Okeahialam
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK
| | - Ranee Thakar
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK.,St George's, University of London, London, UK
| | - Abdul H Sultan
- Croydon Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Thornton Heath, UK. .,St George's, University of London, London, UK.
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Plair A, Bennington J, Williams JK, Parker-Autry C, Matthews CA, Badlani G. Regenerative medicine for anal incontinence: a review of regenerative therapies beyond cells. Int Urogynecol J 2020; 32:2337-2347. [PMID: 33247762 DOI: 10.1007/s00192-020-04620-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Current treatment modalities for anal sphincter injuries are ineffective for many patients, prompting research into restorative and regenerative therapies. Although cellular therapy with stem cells and progenitor cells show promise in animal models with short-term improvement, there are additional regenerative approaches that can augment or replace cellular therapies for anal sphincter injuries. The purpose of this article is to review the current knowledge of cellular therapies for anal sphincter injuries and discusses the use of other regenerative therapies including cytokine therapy with CXCL12. METHODS A literature search was performed to search for articles on cellular therapy and cytokine therapy for anal sphincter injuries and anal incontinence. RESULTS The article search identified 337 articles from which 33 articles were included. An additional 12 referenced articles were included as well as 23 articles providing background information. Cellular therapy has shown positive results for treating anal sphincter injuries and anal incontinence in vitro and in one clinical trial. However, cellular therapy has disadvantages such as the source and processing of stem cells and progenitor cells. CXCL12 does not have such issues while showing promising in vitro results for treating anal sphincter injuries. Additionally, electrical stimulation and extracorporeal shock wave therapy are potential regenerative medicine adjuncts for anal sphincter injuries. A vision for future research and clinical applications of regenerative medicine for anal sphincter deficiencies is provided. CONCLUSION There are viable regenerative medicine therapies for anal sphincter injuries beyond cellular therapy. CXCL12 shows promise as a focus of therapeutic research in this field.
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Affiliation(s)
- Andre Plair
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA.
| | - Julie Bennington
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
| | | | | | | | - Gopal Badlani
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA
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Fecal Continence for Solid and Liquid Stool: The Function of the Anal-External Sphincter Continence Reflex and the Puborectal Continence Reflex. Dis Colon Rectum 2020; 63:1419-1426. [PMID: 32969885 DOI: 10.1097/dcr.0000000000001615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The anal-external sphincter continence reflex and the puborectal continence reflex control fecal continence by involuntary contractions of the external anal sphincter and puborectal muscle. To date it is unknown what the effect of liquid stool is on these reflexes. OBJECTIVE The purpose of this study was to analyze the consequence of liquid stool on the presence and function of these fecal continence reflexes. DESIGN This was a prospective, observational study. SETTING The study was conducted at the Anorectal Physiology Laboratory, University Medical Center Groningen. PATIENTS Forty-two healthy subjects were included. MAIN OUTCOME MEASURES Pressure changes at the level of the external anal sphincter and the puborectal muscle during the anorectal pressure test used to measure voluntary contractions, the balloon retention test used to measure involuntary contractions mimicking solid stool, and the rectal infusion test used to investigate the effect of only water mimicking liquid stool were measured. RESULTS During the test mimicking solid stool, the pressure at the level of the external anal sphincter increased from the start to the end (132 ± 54 vs 198 ± 69 mm Hg; p < 0.001). The pressure at the level of the puborectal muscle increased simultaneously (30 ± 9 vs 176 ± 52 mm Hg; p < 0.001). After injecting water into the rectum, mimicking liquid stool, we observed immediate activation of the anal-external sphincter continence reflex (87 ± 32 vs 145 ± 36 mm Hg; p < 0.001); this was after a median 30 seconds, whereas no activation of the puborectal continence reflex appeared (26 ± 9 vs 26 ± 7 mm Hg; p = 0.655). LIMITATIONS We only performed anorectal function tests mimicking 2 types of stool consistencies, namely water and solid. CONCLUSIONS The anal-external sphincter continence reflex controls fecal continence of both solid and liquid stool. Contrarily, the puborectal continence reflex contributes to solid stool continence only. See Video Abstract at http://links.lww.com/DCR/B286. CONTINENCIA FECAL PARA HECES SÓLIDAS Y LÍQUIDAS: LA FUNCIÓN DEL REFLEJO DE CONTINENCIA DEL ESFÍNTER ANAL EXTERNO Y EL REFLEJO DE CONTINENCIA PUBORRECTAL: El reflejo de continencia del esfínter anal externo y el reflejo de continencia puborrectal controlan la continencia fecal mediante contracciones involuntarias del esfínter anal externo y el músculo puborrectal, respectivamente. Hasta la fecha, se desconoce cuál es el efecto de las heces líquidas en estos reflejos.Analizar las consecuencias de las heces líquidas en la presencia y función de estos reflejos de continencia fecal.Estudio prospectivo observacional.Laboratorio de F fisiología anorrectal, University Medical Center Groningen.Cuarenta y dos sujetos sanos.Los cambios de presión a nivel del esfínter anal externo y el músculo puborrectal durante la prueba de presión anorrectal utilizada para medir las contracciones voluntarias, la prueba de retención con balón utilizada para medir las contracciones involuntarias que imitan las heces sólidas, y la prueba de infusión rectal utilizada para investigar El el efecto de solo agua imitando las heces líquidas.Durante la prueba que imita las heces sólidas, la presión a nivel del esfínter anal externo aumentó desde el principio hasta el final (132 ± 54 mm Hg versus 198 ± 69 mm Hg, p <0.001). La presión a nivel del músculo puborrectal aumentó simultáneamente (30 ± 9 mm Hg versus 176 ± 52 mm Hg, p <0,001).Después de inyectar agua en el recto, imitando las heces líquidas, observamos la activación inmediata del AESCR (87 ± 32 mm Hg versus 145 ± 36 mm Hg, p <0.001), esto fue después de una mediana de 30 segundos, mientras que no hubo activación de la continencia puborrectal apareció reflejo (26 ± 9 mm Hg versus 26 ± 7 mm Hg, p = 0,655).Solo realizamos pruebas de función anorrectal que imitan dos tipos de consistencia de heces, a saber, discriminando entre a agua y sólidos.El reflejo de continencia del esfínter anal-externo controla la continencia fecal de las heces sólidas y líquidas. Por el contrario, el reflejo de continencia puborrectal contribuye solo a la continencia de heces sólidas. Consulte Video Resumen en http://links.lww.com/DCR/B286. (Traducción-Dr Adrian Ortega).
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Zyczynski HM, Richter HE, Sung VW, Arya LA, Lukacz ES, Visco AG, Rahn DD, Carper B, Mazloomdoost D, Gantz MG. Performance, acceptability, and validation of a phone application bowel diary. Neurourol Urodyn 2020; 39:2480-2489. [PMID: 32960998 DOI: 10.1002/nau.24520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
AIMS To assess performance, acceptability, external validity, and reliability of a phone application electronic bowel diary (PFDN Bowel eDiary). METHODS Women reporting refractory accidental bowel leakage (ABL) were enrolled in a randomized, crossover trial evaluating paper versus eDiary documentation of bowel movements (BM) and fecal incontinence episodes (FIE). Events were characterized by the presence or absence of urgency and Bristol stool scale consistency. The eDiary entries were date/time stamped and prompted by twice-daily phone notifications. Women were randomized to complete up to three consecutive 14-day diaries in two sequences. Diary events were compared between formats using the Pearson correlation. System usability scale (SUS) assessed eDiary usability. The eDiary test-retest reliability was assessed with intraclass correlations (ICCs). RESULTS Paired diary data were available from 60/69 (87%) women 63.8 ± 9.8 years old with mean 13.2 BM per week and 6.5 FIE per week (nearly half with urgency). Among those providing diaries, adherence did not differ by paper or eDiary (93.3% vs. 95.0%). Notifications prompted 29.6% of eDiary entries, improving adherence from 70% to 95%. Paper and eDiaries were moderate to-strongly correlated for BMs per week (r = .61), urgency BMs per week (r = .76), FIE per week (r = .66), urgency FIE per week (r = .72). Test-retest reliability was good (ICC = .81 BMs per week, .79 urgency BMs per week, .74 FIE per week, and .62 urgency FIE per week). The mean SUS score was high, 82.3 ± 17.5 (range, 0-100) with 91.4% rating it easy to use, and 75.9% preferring the eDiary over paper. CONCLUSION The PFDN Bowel eDiary correlated well with paper diary was considered easy to use, preferred to paper diaries, had high rates of confirmed real-time diary completion that obviated staff data entry.
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Affiliation(s)
- Halina M Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh/Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women's and Infants Hospital, Providence, Rhode Island, USA
| | - Lily A Arya
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily S Lukacz
- Department of Reproductive Medicine, UC San Diego Health Care System, San Diego, California, USA
| | - Anthony G Visco
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, Texas, USA
| | - Benjamin Carper
- Biostatistics and Epidemiology Division, RTI International, Durham, NC, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Marie G Gantz
- Biostatistics and Epidemiology Division, RTI International, Durham, NC, USA
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Abstract
Abstract
Introduction Defecation disorders, whether anal incontinence or chronic intestinal constipation, are frequent pelvic floor alterations in the general population and are more common in those with risk factors,i.e., in the elderly, women with an obstetric background, and those with comorbidities, history of pelvic radiotherapy, diabetics, the bedridden, or those with history of orifice surgery, among others.
Objective To analyze the incidence of defecation disorders in geriatric patients treated at the Medical Specialties Outpatient Service (MSOS) of Hospital Santa Marcelina.
Methods Prospective, randomized study that interviewed the same patients in two moments: 1) subjective anamnesis through spontaneous history and 2) objective anamnesis with specific questionnaires to assess anal incontinence and chronic constipation.
Results Between March 2016 and June 2017, 149 patients were analyzed, of whom 114 (76.5%) were female, with a similar mean age between genders; 51.67% had symptoms of anal incontinence and/or chronic constipation. Only 35.5% of patients with complaints of fecal leakage or flatus spontaneously reported them, while 87.1% of constipated patients did so. In the present study, no significant correlation was observed between the mode of delivery (p = 0.106), pregnancy (p = 0.099), and the number of deliveries (p = 0.126) with anal incontinence. In turn, there was no higher incidence of chronic intestinal constipation in females (p = 0.099) and most patients with this complaint had Bristol type 1 or 2 stools.
Conclusion The incidence of defecation disorders in the geriatric population is high and, most notably, anal incontinence is not spontaneously reported by most patients.
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50
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Abstract
PURPOSE OF REVIEW To review the epidemiology, pathogenesis, clinical features, and management of primary constipation and fecal incontinence in the elderly. RECENT FINDINGS Among elderly people, 6.5%, 1.7%, and 1.1% have functional constipation, constipation-predominant IBS, and opioid-induced constipation. In elderly people, the number of colonic enteric neurons and smooth muscle functions is preserved; decreased cholinergic function with unopposed nitrergic relaxation may explain colonic motor dysfunction. Less physical activity or dietary fiber intake and postmenopausal hormonal therapy are risk factors for fecal incontinence in elderly people. Two thirds of patients with fecal incontinence respond to biofeedback therapy. Used in combination, loperamide and biofeedback therapy are more effective than placebo, education, and biofeedback therapy. Vaginal or anal insert devices are another option. In the elderly, constipation and fecal incontinence are common and often distressing symptoms that can often be managed by addressing bowel disturbances. Selected diagnostic tests, prescription medications, and, infrequently, surgical options should be considered when necessary.
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Affiliation(s)
- Brototo Deb
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA
| | - David O Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA.
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