Fecal Incontinence

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the usual underlying cause of urge incontinence in patients?

Abnormal rectal compliance and decreased rectal sensation

Altered stool consistency and abnormal rectal compliance

Weakness of the internal anal sphincter

Weakness of the external anal sphincter and decreased rectal capacity (correct)

What is typically evaluated during the physical examination of a patient with fecal incontinence?

Rectal capacity and hypersensitivity

Urinary incontinence and neurological symptoms

Inspection of the perianal area and a digital rectal examination (correct)

Lower back and perineal pain

What is a characteristic feature of passive faecal incontinence?

Weakness of the external anal sphincter

Weakness of the internal anal sphincter (correct)

Altered stool consistency and urgency

Decreased rectal sensitivity and abnormal compliance

What is the purpose of taking a thorough history in a patient with fecal incontinence?

To determine whether true incontinence is present and its severity Signup and view all the answers

What is a risk factor for developing fecal incontinence?

All of the above Signup and view all the answers

What is a characteristic of true incontinence in patients?

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

What is the estimated percentage of the population affected by fecal incontinence over the age of 70?

7% Signup and view all the answers

Which of the following is NOT a type of fecal incontinence?

Stress incontinence Signup and view all the answers

What is the primary function of the internal anal sphincter?

Involuntary control of defecation Signup and view all the answers

Which nerve is responsible for transmitting sensory information from the rectum and anus?

Pudendal nerve Signup and view all the answers

What is the term for the normal reflex that prevents defecation when the rectum is full?

Recto-anal inhibitory reflex Signup and view all the answers

Which of the following is a risk factor for fecal incontinence?

Diabetes mellitus Signup and view all the answers

What is the term for the involuntary loss of solid or liquid feces?

Fecal incontinence Signup and view all the answers

Which part of the brain is involved in the control of defecation?

Cerebral cortex Signup and view all the answers

What is the primary purpose of performing a digital rectal examination in the assessment of fecal incontinence?

To detect obvious anal pathology Signup and view all the answers

Which of the following is NOT an indication for surgery in patients with fecal incontinence?

Poor surgical candidates Signup and view all the answers

What is the primary role of anorectal manometry in the evaluation of fecal incontinence?

To evaluate functional sphincter weakness Signup and view all the answers

Which of the following is a potential complication of obstetric injury that can contribute to fecal incontinence?

Pudendal nerve stretch Signup and view all the answers

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

To improve rectal sensation Signup and view all the answers

Which of the following is NOT a mechanism of action of stool bulking agents in the management of fecal incontinence?

Improve anal sphincter tone Signup and view all the answers

What is the primary indication for defecography in the evaluation of fecal incontinence?

Detecting enteroceles and rectoceles Signup and view all the answers

Which of the following is NOT a potential cause of idiopathic fecal incontinence?

Pudendal nerve damage Signup and view all the answers

What is the primary mechanism of biofeedback training in improving fecal incontinence?

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

What is the role of manometric bio-feedback in biofeedback training?

Recording anal canal pressures Signup and view all the answers

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

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

What is the correct way to perform Kegel exercises?

Contract the muscles that normally stop the flow of urine and hold for 3 seconds, then relax for 3 seconds Signup and view all the answers

What is a factor that contributes to the success of biofeedback training in patients with fecal incontinence?

Patient motivation and intact cognition Signup and view all the answers

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

To improve the coordination of sphincter contractions with rectal sensation Signup and view all the answers

What is the primary mechanism by which injection therapy helps in fecal incontinence?

Bulking effect of the injected materials with subsequent collagen deposition Signup and view all the answers

What is the gold standard procedure for surgical management of fecal incontinence?

Overlapping Sphincteroplasty Signup and view all the answers

What is the name of the procedure that involves a permanent neurostimulator implantation?

Therapeutic phase Signup and view all the answers

What is the name of the technique that involves the use of an antegrade continence enema?

Antegrade Continent Enema Signup and view all the answers

What is the year in which injection therapy was first described for use in fecal incontinence?

1993 Signup and view all the answers

What is the name of the device that is used to enhance continence in patients with fecal incontinence?

Artificial Anal Sphincter Signup and view all the answers

What is the name of the procedure that involves the reconstruction of the anal sphincter with muscle transposition?

Sphincter reconstruction-muscle transposition Signup and view all the answers

What is the proportion of patients who have a non-surgical cause of fecal incontinence?

Majority Signup and view all the answers

Study Notes

Importance of Fecal Incontinence

Fecal incontinence has significant social and economic impacts.
It can impair quality of life and 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 more common in females.
It is often underestimated and underreported due to patient factors.
The prevalence of fecal incontinence is around 7% in people over 70 years old.

Risk Factors

Older age.
Diarrhea.
Fecal urgency.
Urinary incontinence.
Diabetes mellitus.
Hormone therapy.

Anatomy and Physiology

The external anal sphincter is a striated muscle under voluntary control.
The internal anal sphincter is a smooth muscle under autonomic control.
The cerebral cortex, particularly the superior frontal and anterior cingulate gyri, play a role in the regulation of bowel movements.
The enteric nervous system, including the inferior mesenteric ganglion and the hypogastric nerves, is involved in the regulation of bowel movements.

Anorectal Sampling

The rectoanal inhibitory reflex (RAIR) is an important reflex in the regulation of bowel movements.
The RAIR is mediated by the internal anal sphincter and the rectal wall.

Aetiology and Pathogenesis

Fecal incontinence can be caused by dysfunction of the anal sphincters, abnormal rectal compliance, and decreased rectal sensation.
Incontinence is often multifactorial.
Urge incontinence patients have weakness of the external anal sphincter and decreased rectal capacity.
Passive fecal incontinence patients often have weakness of the internal anal sphincter.

Evaluation

History: determining whether fecal incontinence is truly present and its severity.
Physical examination: inspection of the perianal area, digital rectal examination, and testing of perianal sensation.
Investigations: laboratory studies, endoscopy, anorectal manometry, endorectal ultrasound, and defecography.

Aetiology

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

Principles of Management

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

Treatment (Conservative)

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

Dietary Modification and Medication

Dietary fiber.
Stool bulking agents (e.g. psyllium).
Avoid dairy products (especially in lactose intolerance).
Loperamide.
Codeine phosphate.
Cholestyramine.
Enema program (bowel washout).

Biofeedback

Mind-body technique that involves using visual or auditory feedback to gain control over involuntary bodily functions.
Improving the strength of the sphincter (motor skills training).
Increasing the ability to perceive weak rectal distention (discrimination training).
Combining the previous two mechanisms (training in the coordination of sphincter contractions with rectal sensation).
Success more likely if patient is motivated, has intact cognition, and some rectal sensation.

Pelvic Floor Exercises

Strengthen the pelvic floor muscles that support the bladder and bowel.
Contract the muscles that normally stop the flow of urine.
Hold the contraction for three seconds, then relax for three seconds.
Repeat this pattern 10 times, gradually increasing the duration of the contraction.

Surgical Options

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

Injection Therapy

First described for use in fecal incontinence in 1993.
Bulking effect of the injected materials with subsequent collagen deposition helping to enhance continence.
This technique is safe and simple.

Conclusion

Majority of patients have a non-surgical cause.
Conservative management can improve symptoms in many patients.
Patient selection for surgery is critical.
Overlapping Sphincteroplasty is the gold standard procedure.
For patients not amenable to surgery, alternative options include injection therapy, sacral nerve stimulation, artificial anal sphincter, and antegrade continent enemas.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the definition, terminology, and classification of fecal incontinence, its social and economic impact, and its effects on quality of life.