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?

All of the above Signup and view all the answers

What is the primary characteristic of true incontinence?

Frequency and urgency without loss of bowel contents Signup and view all the answers

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

All of the above Signup and view all the answers

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

It can contribute to the loss of the ability to live independently Signup and view all the answers

What is the difference between fecal incontinence and anal incontinence?

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

What is urge incontinence?

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

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

Around 7% of the population Signup and view all the answers

What is a risk factor for fecal incontinence?

Hormone therapy Signup and view all the answers

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

Autonomic nervous system Signup and view all the answers

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

To relax the anal canal during defecation Signup and view all the answers

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

To improve the ability to perceive weak rectal distention Signup and view all the answers

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

To gain control over involuntary bodily functions Signup and view all the answers

What is the mechanism of manometric bio-feedback?

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

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

Strengthening the pelvic floor muscles that support the bladder and bowel Signup and view all the answers

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

The patient's motivation and intact cognition Signup and view all the answers

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

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

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

To detect obvious anal pathology Signup and view all the answers

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

It tests anorectal sensation Signup and view all the answers

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

To detect structural abnormalities of the anal sphincters Signup and view all the answers

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

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

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

Patients with repairable, neurologically intact sphincter Signup and view all the answers

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

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

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

To bulking agents, such as psyllium Signup and view all the answers

What is a common cause of fecal incontinence in women?

Obstetric injury Signup and view all the answers

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

Increasing collagen deposition Signup and view all the answers

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

Overlapping Sphincteroplasty Signup and view all the answers

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

To improve symptoms in many patients Signup and view all the answers

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

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

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

For patients who are not amenable to surgical intervention Signup and view all the answers

What is the purpose of antegrade continence enema?

To manage fecal incontinence in patients with a stoma Signup and view all the answers

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

It is a simpler and safer procedure Signup and view all the answers

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

Non-surgical causes 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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Description

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