Fecal Incontinence Terminology and Classification
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Questions and Answers

What is the primary cause of urge incontinence in patients?

  • Abnormal rectal compliance
  • Weakness of the external anal sphincter (correct)
  • Decreased rectal sensation
  • Weakness of the internal anal sphincter

    • What is the primary role of the internal anal sphincter in fecal incontinence?

  • Maintenance of rectal sensation
  • Regulation of stool consistency
  • Relaxation to allow contents into the upper anal canal
  • Prevention of passive fecal incontinence (correct)

    • What is the significance of a patient's obstetric history in the evaluation of fecal incontinence?

  • It is irrelevant to the diagnosis
  • It is used to determine the severity of incontinence
  • It is used to rule out other gastrointestinal disorders
  • It helps to identify the underlying cause of incontinence (correct)

    • What is the primary component of a physical examination in the evaluation of fecal incontinence?

    <p>All of the above</p> Signup and view all the answers

    What is the primary characteristic of true incontinence?

    <p>Frequency and urgency without loss of bowel contents</p> Signup and view all the answers

    What is a common underlying factor in patients with multifactorial fecal incontinence?

    <p>All of the above</p> Signup and view all the answers

    What is the significant impact of fecal incontinence on an individual's life?

    <p>It can contribute to the loss of the ability to live independently</p> Signup and view all the answers

    What is the difference between fecal incontinence and anal incontinence?

    <p>Fecal incontinence is the loss of solid or liquid feces, while anal incontinence is the loss of flatus</p> Signup and view all the answers

    What is urge incontinence?

    <p>The desire to defecate, but incontinence occurs despite efforts to retain stool</p> Signup and view all the answers

    What is the prevalence of fecal incontinence in the population over 70 years of age?

    <p>Around 7% of the population</p> Signup and view all the answers

    What is a risk factor for fecal incontinence?

    <p>Hormone therapy</p> Signup and view all the answers

    Which part of the nervous system controls the internal sphincter muscle?

    <p>Autonomic nervous system</p> Signup and view all the answers

    What is the purpose of the rectoanal inhibitory reflex (RAIR)?

    <p>To relax the anal canal during defecation</p> Signup and view all the answers

    What is the purpose of sensory discrimination training in biofeedback therapy?

    <p>To improve the ability to perceive weak rectal distention</p> Signup and view all the answers

    What is the primary goal of biofeedback therapy for bowel control?

    <p>To gain control over involuntary bodily functions</p> Signup and view all the answers

    What is the mechanism of manometric bio-feedback?

    <p>Recording anal canal pressures and coupling them to visual/auditory signals</p> Signup and view all the answers

    What is the primary benefit of pelvic floor exercises, such as Kegel exercises?

    <p>Strengthening the pelvic floor muscles that support the bladder and bowel</p> Signup and view all the answers

    What is a key factor in the success of biofeedback therapy for bowel control?

    <p>The patient's motivation and intact cognition</p> Signup and view all the answers

    What is the purpose of EMG bio-feedback in biofeedback therapy?

    <p>To record EMG activity from the striated muscles and provide feedback to the patient</p> Signup and view all the answers

    What is the purpose of performing digital rectal examination in patients with fecal incontinence?

    <p>To detect obvious anal pathology</p> Signup and view all the answers

    What is the significance of anocutaneous reflex (anal wink sign) in patients with fecal incontinence?

    <p>It tests anorectal sensation</p> Signup and view all the answers

    What is the role of endorectal ultrasound/magnetic resonance imaging in the investigation of fecal incontinence?

    <p>To detect structural abnormalities of the anal sphincters</p> Signup and view all the answers

    What is the primary goal of patient selection in the management of fecal incontinence?

    <p>To identify patients with minimal symptoms or poor surgical candidates</p> Signup and view all the answers

    What is the primary indication for surgery in the management of fecal incontinence?

    <p>Patients with repairable, neurologically intact sphincter</p> Signup and view all the answers

    What is the primary goal of biofeedback training in the management of fecal incontinence?

    <p>To improve rectal sensation, which is an important predictor of response to biofeedback training</p> Signup and view all the answers

    What is the role of dietary modification in the management of fecal incontinence?

    <p>To bulking agents, such as psyllium</p> Signup and view all the answers

    What is a common cause of fecal incontinence in women?

    <p>Obstetric injury</p> Signup and view all the answers

    What is the primary mechanism of action of injection therapy in treating fecal incontinence?

    <p>Increasing collagen deposition</p> Signup and view all the answers

    What is the gold standard surgical procedure for treating fecal incontinence?

    <p>Overlapping Sphincteroplasty</p> Signup and view all the answers

    What is the primary goal of conservative management in treating fecal incontinence?

    <p>To improve symptoms in many patients</p> Signup and view all the answers

    What is the purpose of the screening phase in sacral nerve stimulation?

    <p>To evaluate the patient's response to peripheral nerve stimulation</p> Signup and view all the answers

    What is the primary indication for using an artificial anal sphincter in treating fecal incontinence?

    <p>For patients who are not amenable to surgical intervention</p> Signup and view all the answers

    What is the purpose of antegrade continence enema?

    <p>To manage fecal incontinence in patients with a stoma</p> Signup and view all the answers

    What is the primary benefit of injection therapy compared to other surgical options?

    <p>It is a simpler and safer procedure</p> Signup and view all the answers

    What is the most common cause of fecal incontinence in adults?

    <p>Non-surgical causes</p> Signup and view all the answers

    Study Notes

    Importance of Fecal Incontinence

    • Fecal incontinence has significant social and economic impacts
    • It impairs quality of life and can contribute to the loss of ability to live independently

    Terminology and Classification

    • Fecal incontinence: involuntary loss of solid or liquid feces
    • Anal incontinence: involuntary loss of solid or liquid feces or flatus
    • Urge incontinence: desire to defecate, but incontinence occurs despite efforts to retain stool
    • Passive incontinence: lack of awareness of the need to defecate before the incontinent episode

    Epidemiology

    • Fecal incontinence is commoner in females
    • Underestimated and underreported due to patient factors
    • More than 7% of the population over 70 years old is affected

    Risk Factors

    • Older age
    • Diarrhea
    • Faecal urgency
    • Urinary incontinence
    • Diabetes mellitus
    • Hormone therapy

    Anatomy and Physiology

    • External sphincter: striated muscle (voluntary control)
    • Internal sphincter: smooth muscle (involuntary control)
    • Cerebral cortex: superior frontal and anterior cingulate gyri
    • Enteric nervous system: regulates gut function
    • Inferior mesenteric ganglion: sympathetic and parasympathetic innervation
    • Pudendal nerve: S2-S4 spinal segments, innervates external anal sphincter

    Anorectal Sampling and RectoAnal Inhibitory Reflex (RAIR)

    • Every 8-10 minutes, internal sphincter relaxes, and rectal contents enter the upper anal canal
    • RAIR: reflexive contraction of the internal sphincter in response to rectal distension

    Aetiology and Pathogenesis

    • Dysfunction of the anal sphincters
    • Abnormal rectal compliance
    • Decreased rectal sensation
    • Incontinence is usually multifactorial
    • Urge incontinence: weakness of the external anal sphincter, decreased rectal capacity, and rectal hypersensitivity
    • Passive faecal incontinence: weakness of the internal anal sphincter

    Evaluation

    • History: determining the presence and severity of fecal incontinence
    • Physical examination: inspection, digital rectal examination, and anocutaneous reflex testing
    • Investigations: laboratory studies, endoscopy, anorectal manometry, endorectal ultrasound/magnetic resonance imaging, and defecography

    Aetiology

    • Mechanical: obstetric injury, fistula disease, trauma, iatrogenic, systemic disease
    • Neurogenic: pudendal nerve stretch, strain, medical illness
    • Idiopathic: no clear etiology

    Principles of Management

    • Patient selection is critical
    • Medically manage those with minimal symptoms or poor surgical candidates
    • Rehabilitation: physiotherapy, dietary modification, and medications
    • Surgery reserved for those with repairable, neurologically intact sphincter

    Treatment (Conservative)

    • Dietary modification and medications
    • Biofeedback
    • Pelvic floor muscle training and electrostimulation
    • Anal plug

    Surgical Options

    • Injection therapy
    • Sphincteroplasty
    • Sacral nerve stimulation
    • Sphincter reconstruction-muscle transposition
    • Artificial sphincters
    • Magnetic anal sphincter
    • Tibial nerve stimulation
    • Stoma

    Conclusion

    • Majority of patients have a non-surgical cause
    • Conservative management can improve symptoms in many patients
    • Patient selection for surgery is critical

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    Copy of Feacal Incontince 2023 .pptx

    Description

    This quiz covers the terminology and classification of fecal incontinence, including anal incontinence, urge incontinence, and their impact on quality of life.

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