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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: 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: 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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Hubeaux K, Gueganton L, Nowak E, Arnouat B, Belleguic C, Danner-Boucher I, Mankikian J, Payet A, Urban T, Buyse M, Ramel S. Prevalence and severity of functional urinary and anorectal disorders and their impact on quality of life in cystic fibrosis. J Cyst Fibros 2023:S1569-1993(23)01659-4. [PMID: 37907384 DOI: 10.1016/j.jcf.2023.10.011] [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: 06/29/2023] [Revised: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND In cystic fibrosis (CF), coughing is associated with a risk of pelvic floor dysfunction. However, data on the prevalence of symptoms (stress urinary incontinence, bladder overactivity, dysuria, and faecal incontinence) are lacking in males and females with CF. The impact of incontinence on adherence to respiratory care has not been studied. METHODS We conducted a multicentre study in adults with CF followed in the North-West French CF network. Urinary disorders and their severity were assessed using the Urinary Symptom Profile (USP) self-report questionnaire; the impact of urinary disorders on general quality of life was measured using the SF-Qualiveen questionnaire; faecal incontinence was assessed using the Wexner self-report questionnaire; and the CFQ-R14+ questionnaire was used to assess quality of life. A self-administered questionnaire developed for the study assessed the impact of symptoms on respiratory care. RESULTS Of the 178 people with CF included, 34 % reported stress urinary incontinence, with a large female predominance (63.5 % of females vs. 7.5 % of males), 65 % bladder overactivity (including 16 % urge incontinence) and 50 % faecal incontinence, also with a female predominance. Neither urinary nor faecal incontinence were related to the severity of the respiratory impairment (FEV1). Quality of life was particularly affected in women. Stress urinary Incontinence symptoms affected respiratory care in both sexes. CONCLUSION The prevalence of functional urinary and faecal disorders was high in adults with CF and impacted on quality of life and respiratory care. Therefore, multidisciplinary teams must have knowledge of symptoms, the diagnostic tools and management strategies to provide specific treatment.
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Affiliation(s)
- Katelyne Hubeaux
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Laetitia Gueganton
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Emmanuel Nowak
- Direction de la Recherche Clinique et de l'Innovation (DRCI), CHU de Brest, Brest, France & Centre d'Investigation Clinique, INSERM CIC 1412, CHU de Brest, Brest, France
| | - Baptiste Arnouat
- Dept of Respiratory Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Chantal Belleguic
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, Rennes F-35033, France
| | - Isabelle Danner-Boucher
- Service de Pneumologie, L'Institut Du Thorax, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Julie Mankikian
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHU, hôpital Bretonneau, Tours, France
| | - Annabelle Payet
- Service de Pneumologie, CHU La Réunion Site Sud Réunion, Saint Pierre, Réunion, France
| | - Thierry Urban
- Département de Pneumologie, CHU d'Angers, Angers, France
| | - Marion Buyse
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France
| | - Sophie Ramel
- CRCM (Centre de Ressources et de Compétences de la Mucoviscidose), Fondation Ildys, Roscoff, France.
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3
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Bourre B, Desprez C, Gourcerol G, Tavolacci MP, Duflot T, Leroi AM. Multiple sclerosis and bowel symptoms: Frequency and barriers to their management. Mult Scler Relat Disord 2023; 78:104919. [PMID: 37579644 DOI: 10.1016/j.msard.2023.104919] [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: 04/14/2023] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The frequency of bowel symptoms (BSs) is still a matter for debate in multiple sclerosis (MS) patients. However, BSs have been shown to cause significant distress. Our study aimed to (i) investigate the frequency of BSs, particularly those that are not managed, (ii) identify potential predictors for help-seeking care for patients with BSs, and (iii) evaluate the ability of the Neurogenic Bowel Dysfunction (NBD) score to screen for BSs. METHOD Three hundred sixty-nine MS patients completed a cross-sectional demographic and clinical survey of MS and BSs and their management. RESULTS BSs were reported by 47.7% of MS patients. Eighty-eight percent of MS patients had a very minor-minor Neurogenic Bowel Disorder (NBD) score and 12% had a moderate-severe NBD score. Forty-one percent of patients did not report their BS to a healthcare provider, mainly because they preferred not to talk about the problem. BS duration was the only significant predictor of help-seeking for BS management. Female sex, visual impairment, a digestive history, and longer MS duration were good predictors of BSs. Patients with BSs (86%) were correctly identified with an NBD score >2. CONCLUSION BSs are under-detected in MS populations. This is partially related to non-declaration by patients. Targeting BSs using the NBD score is a good way to increase reporting.
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Affiliation(s)
- Bertrand Bourre
- Department of Neurology, CHU Rouen, CIC-CRB 1404, Rouen F-76000, France
| | - Charlotte Desprez
- Department of Digestive Physiology, CHU Rouen, CIC-CRB 1404, Rouen University Normandie, INSERM, ADEN UMR 1073, F-76000, Rouen, France
| | - Guillaume Gourcerol
- Department of Digestive Physiology, CHU Rouen, CIC-CRB 1404, Rouen University Normandie, INSERM, ADEN UMR 1073, F-76000, Rouen, France
| | - Marie-Pierre Tavolacci
- Department of Epidemiology, CHU Rouen, CIC-CRB 1404, Rouen University Normandie, INSERM, ADEN UMR 1073, F-76000, Rouen, France
| | - Thomas Duflot
- Department of Pharmacology, Endothelium, Valvulopathy, and Heart Failure, CHU Rouen, CIC-CRB 1404, University Rouen Normandie, INSERM, EnVI UMR1096, F-76000, Rouen, France
| | - Anne-Marie Leroi
- Department of Digestive Physiology, CHU Rouen, CIC-CRB 1404, Rouen University Normandie, INSERM, ADEN UMR 1073, F-76000, Rouen, France.
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Shivakumar V, Jayarajah U, Samarasekera DN. Characteristics and post-operative outcomes of surgery for fistula-in-ano managed at a tertiary care hospital in Sri Lanka: a retrospective study. J Int Med Res 2023; 51:3000605231194516. [PMID: 37706483 PMCID: PMC10503298 DOI: 10.1177/03000605231194516] [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: 05/13/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES Management of fistula-in-ano is associated with recurrence and, occasionally, with anal incontinence. We investigated the clinical characteristics and outcomes of fistula-in-ano. METHODS We included patients with fistula-in-ano managed at a tertiary care center (2016-2021). We collected clinical characteristics and 1-year outcomes using questionnaires. The chi-square test was used in statistical analysis. RESULTS In total, 284 patients (231 men, 81.3%; median age 39.5 [range: 7-73] years) were included. Most patients had simple fistulae (n = 191, 67.3%). Transphincteric (n = 110, 38.7%) fistulae were the most common type, followed by intersphinteric fistulae (n = 103, 36.6%). Fistulotomy (n = 157, 55.3%) was the most common procedure. Follow-up details were traceable in 157 (55.3%) patients. At 1 year, the overall healing rate was 88.5% (n = 136). There was no association between type of surgical procedure and incontinence. The mean Vaizey score, used to assess anal incontinence, was 0.84 (range: 0-14). Incontinence was observed in 32 patients (20.9%), and flatus incontinence was the most common type (n = 17, 53.1%). Complex fistulae were associated with higher recurrence rates than simple fistulae (32.6% vs. 2.8%). CONCLUSION The healing rate in surgical treatment of fistula-in-ano was 88.5%, with acceptable complication rates. There was no association between surgical procedure type and incontinence.
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Affiliation(s)
| | - Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
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Levaillant M, Venara A, Damon H, Siproudhis L, Brochard C, Hamel JF. Young women and elderly men at risk of severe faecal incontinence: results of a French nationwide database analysis : Faecal incontinence in France. Int J Colorectal Dis 2023; 38:131. [PMID: 37191698 DOI: 10.1007/s00384-023-04431-8] [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] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The incidence of severe faecal incontinence (FI) in young people is likely underestimated. The objective of this study is to assess the incidence of FI by using the French national insurance information system (SNDS). METHODS The SNDS was used, including 2 health insurance claims databases. The study included 49,097,454 French people who were ≥ 20 years old in 2019. The main outcome measure was the occurrence of FI. RESULTS In 2019, 123,630 patients out of the entire French population (n = 49 097 454) (0.25%) were treated for FI. The numbers of male and female patients were similar. The data showed a dramatic increase in the incidence of FI between the ages of 20 and 59 in female patients, compared to 60 and 79 in male patients. The risk of FI increased with age (OR of 3.6 to 11.3 depending on age). Women had a higher risk of severe FI compared to men between the ages of 20 and 39 (OR = 1.3; 95%CI:1.3-1.4) and the ages of 40 and 59 (OR = 1.1; 95%CI:1.08-1.13). This risk decreased after the age of 80 (OR = 0.96; 95%CI:0.93-0.99). The rate of diagnosis of FI also increased where there were greater numbers of proctologists practising in the region of residence in question (OR of 1.07 to 1.35 depending on the number of proctologists). CONCLUSION Young women who have given birth and elderly men are at risk of FI and must be targeted by public health information campaigns. The development of coloproctology networks should be encouraged.
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Affiliation(s)
- M Levaillant
- Faculty of Health, Department of Medicine, Angers, France
| | - A Venara
- Faculty of Health, Department of Medicine, Angers, France.
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 09, France.
- IHFIH, UPRES EA 3859, University of Angers, Angers, France.
| | - H Damon
- Hospices Civils de Lyon, 69437, Lyon, France
- Clinique Protestante, 69300, Caluire et Cuire, France
| | - L Siproudhis
- Unité d'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France
- Service des Maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, Rennes, France
| | - C Brochard
- Unité d'explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France
- Service des Maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, Rennes, France
| | - J F Hamel
- Faculty of Health, Department of Medicine, Angers, France
- Department of Biostatistics, La Maison de la Recherche, University Hospital of Angers, Angers Cedex 9, France
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Marcellier G, Dupont A, Bourgeois-Moine A, Le Tohic A, De Carne-Carnavalet C, Poujade O, Girard G, Benbara A, Mandelbrot L, Abramowitz L. Risk Factors for Anal Continence Impairment Following a Second Delivery after a First Traumatic Delivery: A Prospective Cohort Study. J Clin Med 2023; 12:jcm12041531. [PMID: 36836068 PMCID: PMC9967240 DOI: 10.3390/jcm12041531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Postpartum anal incontinence is common. After a first delivery (D1) with perineal trauma, follow-up is advised to reduce the risk of anal incontinence. Endoanal sonography (EAS) may be considered to evaluate the sphincter and in case of sphincter lesions to discuss cesarean section for the second delivery (D2). Our objective was to study the risk factors for anal continence impairment following D2. Women with a history of traumatic D1 were followed before and 6 months after D2. Continence was measured using the Vaizey score. An increase ≥2 points after D2 defined a significant deterioration. A total of 312 women were followed and 67 (21%) had worse anal continence after D2. The main risk factors for this deterioration were the presence of urinary incontinence and the combined use of instruments and episiotomy during D2 (OR 5.12, 95% CI 1.22-21.5). After D1, 192 women (61.5%) had a sphincter rupture revealed by EAS, whereas it was diagnosed clinically in only 48 (15.7%). However, neither clinically undiagnosed ruptures nor severe ruptures were associated with an increased risk of continence deterioration after D2, and cesarean section did not protect against it. One woman out of five in this population had anal continence impairment after D2. The main risk factor was instrumental delivery. Caesarean section was not protective. Although EAS enabled the diagnosis of clinically-missed sphincter ruptures, these were not associated with continence impairment. Anal incontinence should be systematically screened in patients presenting urinary incontinence after D2 as they are frequently associated.
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Affiliation(s)
- Gabriel Marcellier
- Proctology and Gastroenterology Department, APHP-Bichat Hospital, 75018 Paris, France
- Correspondence: ; Tel.: +33-6-68-97-79-05
| | - Axelle Dupont
- Biostatistics and Medical IT Department, APHP-Bichat Hospital, 75018 Paris, France
| | | | - Arnaud Le Tohic
- Department of Obstetrics and Gynecology, Versailles Hospital, 78157 Le Chesnay, France
| | | | - Olivier Poujade
- Department of Obstetrics and Gynecology, APHP-Beaujon Hospital, 92110 Clichy, France
| | - Guillaume Girard
- Department of Obstetrics and Gynecology, APHP-Armand Trousseau Hospital, 75012 Paris, France
| | - Amélie Benbara
- Department of Obstetrics and Gynecology, APHP-Jean Verdier Hospital, 93140 Bondy, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, APHP-Louis Mourier Hospital, 92700 Colombes, France
| | - Laurent Abramowitz
- Proctology and Gastroenterology Department, APHP-Bichat Hospital, 75018 Paris, France
- Proctology and Gastroenterology Department, Blomet Clinic (Ramsay GDS Group), 75015 Paris, France
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7
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Sautereau M, Bouchard D, Brochard C, Pigot F, Siproudhis L, Fayette JM, Train C, Laurain A, Favreau C, Abramowitz L. Prospective and multicentre study of radiofrequency treatment in anal fistula. Colorectal Dis 2023; 25:289-297. [PMID: 36128714 DOI: 10.1111/codi.16344] [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] [Received: 04/11/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The most effective treatment for anal fistula is fistulotomy, but it involves a risk of anal incontinence. To reduce this morbidity, sphincter-sparing treatments have been developed, but their success in real life is often less than 50%. The aim is to determine the clinical healing rate 6 months after radiofrequency treatment. METHODS We planned to evaluate 50 patients from three French proctology centres. Treatment efficacy was evaluated at 6 and 12 months by means of clinical and magnetic resonance imaging examination. We evaluated morbidity and healing prognostic factors. RESULTS Fifty patients with a mean age of 51 years (22-82) were included. Eleven patients had a low trans-sphincteric fistula (LTS), 21 patients had a high trans-sphincteric fistula (HTS), eight had a complex fistula and nine had Crohn's disease fistula. After 6 months, 17 patients (34.7%) had a clinically healed fistula, including five (45.5%) with LTS fistula, seven (33.3%) with HTS fistula, one (12.5%) with complex fistula, four (44.4%) with Crohn's disease, with no significant difference between these fistula types (p: 0.142). At 12 months, the healing rate was identical. MRI in 15 out of 17 clinically healed patients showed a deep remission of 73.3% at 12 months. Energy power was associated with the success of the treatment. There was an 8.2% incidence of post-surgical complications with 4.1% being abscesses (one required surgical management). Postoperative pain was minor. No new cases or deterioration of continence have been shown. CONCLUSION Radiofrequency is effective in 34.7% of the cases as an anal fistula treatment in this first prospective study, with low morbidity and no effect on continence. Clinical healing was deep (MRI) in three-quarters at 1 year. The increase in energy power during the procedure seems to be a key point to be analysed to optimise results.
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Affiliation(s)
- Marie Sautereau
- Department of Gastroenterology and Proctology, APHP, CHU Bichat, Paris, France
| | | | - Charlène Brochard
- Digestive Physiology Unit, Rennes Pontchaillou University Hospital, University of Rennes 1, Rennes, France
| | - François Pigot
- Department of Proctology, Bagatelle Hospital, Talence, France
| | - Laurent Siproudhis
- Digestive Physiology Unit, Rennes Pontchaillou University Hospital, University of Rennes 1, Rennes, France
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Mathieu L, Legendre G, Rebmann E, Hamel JF, Venara A. Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis. Int J Gynaecol Obstet 2022; 159:284-289. [PMID: 35044683 DOI: 10.1002/ijgo.14101] [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: 11/14/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE to assess the relationship between anal incontinence (AI) 8 years after childbirth and the occurrence of Obstetrical Anal Sphincter Injury (OASI) and/or performance of an episiotomy during childbirth. METHODS This is a nationwide database analysis performed on two national medico-administrative databases, including all the women aged ≥18 years who delivered infants in France in 2012. The main outcome measure was AI in the 8-years after delivery. RESULTS Of the 163,443 perineal tears reported, 0.47% were grade-3 and 0.08% were grade-4; 8,938 women experienced AI (1.33%) and 261 women experienced severe AI (0.04%). Episiotomies performed in the absence of risk factors for OASI were significantly associated with an increased risk of AI (Odds Ratio (OR)=1.59; 95% Confidence Interval (CI):1.49-1.69;p<0.001). Grade 3 and 4 OASI also significantly increased the risk of AI and severe AI. Mediolateral episiotomy was preventative of OASI when performed in subjects at risk (OR=0.26; 95% CI:0.23-0.30; p<0.001) but contributed to OASI in the absence of risk (OR=2.18; 95% CI:1.98-2.40; p<0.001). CONCLUSIONS OASI is a risk factor for AI. Episiotomies could reduce the occurrence of OASI, but they could also have a increase the risk of long-term AI in the absence of risk factors for OASI.
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Affiliation(s)
- Levaillant Mathieu
- Faculty of Health, Angers, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.,Department of Biostatistics, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Guillaume Legendre
- Faculty of Health, Angers, France.,Department of Gynaecology-obstetrics, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Emeline Rebmann
- Faculty of Health, Angers, France.,Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Jean-François Hamel
- Faculty of Health, Angers, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.,Ester
- Irset Inserm UMR 1085
| | - 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
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9
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Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Tajima Y, Endo T, Cheong YC. Prevalence and Risk Factors of Anal and Fecal Incontinence in Japanese Medical Personnel. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:386-394. [PMID: 34746503 PMCID: PMC8553347 DOI: 10.23922/jarc.2021-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to elucidate the actual state of anal incontinence (AI), fecal incontinence (FI), and the associated factors in Japanese medical personnel. Methods A questionnaire was completed by Japanese medical personnel after listening to lectures on AI. AI was defined as involuntary loss of feces or flatus. Results A total of 463 persons (mean age, 35.6 years; range, 20-91; male/female/no answer, 132/324/7) participated in the questionnaire. AI occurred in 34.4% of 450 participants (flatus/liquid stool/solid stool: 30.4%/3.6%/0.4%). AI was significantly more prevalent in females (male/female: 15.5%/42.7%, p < 0.001). AI and FI occurred significantly more prevalent in participants aged ≧40 years (p < 0.024). AI was significantly associated with childbirth, frequency of childbirth (more than three times), vaginal delivery, urinary incontinence, the style of urination/defecation, and a history of gynecologic surgery and systemic diseases (p < 0.05). Female gender and age as well as urinary incontinence and inability to defecate separately in female and previous colorectal disease and/or surgery in male were risk factors of AI by multivariate analysis (p < 0.05). FI was correlated with urinary incontinence. Conclusions AI and FI occurred in 34.4% and 4.0% of Japanese medical personnel, respectively. Gas incontinence was common in every age group. AI was associated with female gender, higher age group, urinary incontinence, the style of urination and defecation in female, and previous colorectal disease and/or surgery in male. FI was associated with urinary incontinence.
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Affiliation(s)
- Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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Garros A, Bourrely M, Sagaon-Teyssier L, Sow A, Lydie N, Duchesne L, Higuero T, Damon H, Velter A, Abramowitz L. Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. J Sex Med 2021; 18:1880-1890. [PMID: 37057489 DOI: 10.1016/j.jsxm.2021.07.014] [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: 01/22/2021] [Revised: 05/28/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of receptive anal intercourse (RAI) is increasing. A few studies, with heterogeneous designs, have investigated the associated risk of fecal incontinence (FI). AIM The primary objective of this study was to determine FI prevalence in a population of men who have sex with men (MSM) engaging in RAI. The secondary objective was to identify risk factors for severe FI. METHODS OUTCOMES An online survey of 24,308 MSM was performed in 2019. Demographic and socioeconomic data were collected, together with information about RAI sexual practices, and FI defined by: "During the last month, have you experienced any involuntary leakage of stools?" RESULTS CLINICAL IMPLICATIONS In total, 1,734 (8%) of the 21,762 participants reported FI. Mean age was 35.3 years. The prevalence of FI was correlated with RAI frequency: 12.7% (if RAI ≥ 1 /wk) versus 5.7% (if no RAI). In multivariate analysis, the factors associated with FI were age (OR: 1.01), low socioeconomic status (OR 1.32 to 1.40), HIV-seropositivity (OR: 1.78), high RAI frequency (OR: 1.64), chemsex (OR: 1.67) and fist-fucking (OR: 1.61). STRENGTHS AND LIMITATIONS Main strengths of our study are population size and assessment of detailed modalities of sexual practices. Main limitations are the use of a convenience non-random sample and the assessment of FI only during the past month. CONCLUSION This study of a large MSM population, highlights risk factors for FI among RAI practices: RAI ≥ 1 /wk, chemsex, fist-fucking, low socioeconomic status. Garros A, Bourrely M, Sagaon-Teyssier L, et al. Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. J Sex Med 2021;18:1880-1890.
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Affiliation(s)
- Aurélien Garros
- CH ST Joseph ST LUC - Gastroenterologie, Lyon, Auvergne-Rhône-Alpes, France.
| | - Michel Bourrely
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Abdourahmane Sow
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Nathalie Lydie
- Public Health France (SPF), Paris, France, Paris, France
| | - Lucie Duchesne
- Public Health France (SPF), Paris, France, Paris, France
| | - Thierry Higuero
- Hepato-Gastroenterology Department, Beausoleil, Beausoleil, France
| | - Henri Damon
- Gastroenterology department, Infirmerie Prostante, Caluire, Caluire, France
| | - Annie Velter
- Public Health France (SPF), Paris, France, Paris, France
| | - Laurent Abramowitz
- Hepato-Gastroenterology and Proctology Department, Bichat University Hospital, Paris, France
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Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2021; 27:337-343. [PMID: 34080581 DOI: 10.1097/spv.0000000000001069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors. METHODS This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores. RESULTS Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.5], P = 0.56). Global Health scores correlated with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire scores (all P's < 0.0001). In multivariable models, menopause was associated with better physical QOL, and constipation, coronary artery disease, pelvic pain, and increased body mass index with worse physical QOL. Age was associated with better mental QOL, and constipation, fecal incontinence, pelvic pain, and coronary artery disease with worse mental QOL. CONCLUSIONS Women choosing POP surgery versus pessary had similar physical and mental generic QOL.
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Meurette G, Siproudhis L, Leroi AM, Damon H, Urs Josef Keller D, Faucheron JL. Sacral neuromodulation with the InterStim™ system for faecal incontinence: results from a prospective French multicentre observational study. Colorectal Dis 2021; 23:1463-1473. [PMID: 33387373 DOI: 10.1111/codi.15507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
AIM The aim of this work was to evaluate the effectiveness, patient satisfaction and quality of life (QoL) and the safety of sacral neuromodulation (SNM) with the InterStimTM system for the treatment of faecal incontinence (FI) and establish whether results published predominantly by expert sites are generalisable. METHOD This is a prospective, multicentre, observational study that invited all French sites treating FI with the InterStim™ system to enrol subjects indicated for an SNM therapy evaluation. Data were collected at three follow-up visits within 1 and 15 months. Therapeutic effectiveness was evaluated by the reduction in leakages per week and improvements over time in the ability to defer defaecation and QoL (as measured with the Faecal Incontinence Quality of Life score). Safety was assessed through reported adverse events. RESULTS A total of 221 subjects with a mean age of 62.1 years were tested (184 women) and 178 received a permanent implant. For all implanted subjects with diary data at baseline and follow-up, a reduction in leakage of more than 50% was observed in 80%, 76% and 83% at 1-3, 4-8 and 9-15 months, respectively. The mean number of leakage episodes and urgency improved significantly compared with the baseline (p < 0.0001). Subjects showed improvements in QoL and time to defer defaecation and were generally satisfied with their therapy. The main device-related adverse event was the requirement to undertake reprogramming (in 52% of subjects with actions following an event). The rates of infection (in 6% of subjects) and surgical revision (in 10% of subjects) were in agreement with literature reports. CONCLUSION This study confirms the clinical effectiveness, safety and positive effect of SNM on QoL as well as high patient satisfaction for the treatment of FI in real-life.
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Affiliation(s)
| | | | | | - Henri Damon
- Hôpital Edouard Herriot, CHU de Lyon, Lyon, France
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13
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Scott SM, Simrén M, Farmer AD, Dinning PG, Carrington EV, Benninga MA, Burgell RE, Dimidi E, Fikree A, Ford AC, Fox M, Hoad CL, Knowles CH, Krogh K, Nugent K, Remes-Troche JM, Whelan K, Corsetti M. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 1: Epidemiology, diagnosis, clinical associations, pathophysiology and investigation. Neurogastroenterol Motil 2021; 33:e14050. [PMID: 33263938 DOI: 10.1111/nmo.14050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic constipation is a prevalent disorder that affects patients' quality of life and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology & Motility journal supplement devoted to the investigation and management of constipation was published (2009; 21 (Suppl.2)). This included seven articles, disseminating all themes covered during a preceding 2-day meeting held in London, entitled "Current perspectives in chronic constipation: a scientific and clinical symposium." In October 2018, the 3rd London Masterclass, entitled "Contemporary management of constipation" was held, again over 2 days. All faculty members were invited to author two new review articles, which represent a collective synthesis of talks presented and discussions held during this meeting. PURPOSE This article represents the first of these reviews, addressing epidemiology, diagnosis, clinical associations, pathophysiology, and investigation. Clearly, not all aspects of the condition can be covered in adequate detail; hence, there is a focus on particular "hot topics" and themes that are of contemporary interest. The second review addresses management of chronic constipation, covering behavioral, conservative, medical, and surgical therapies.
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Affiliation(s)
- S Mark Scott
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam D Farmer
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Institute of Applied Clinical Science, University of Keele, Keele, UK
| | - Philip G Dinning
- College of Medicine and Public Health, Flinders Medical Centre, Flinders University & Discipline of Gastroenterology, Adelaide, SA, Australia
| | - Emma V Carrington
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca E Burgell
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - Eirini Dimidi
- Department of Nutritional Sciences, King's College London, London, UK
| | - Asma Fikree
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK.,Gastroenterology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James's, Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
| | - Caroline L Hoad
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham University, Nottingham, UK
| | - Charles H Knowles
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Nugent
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Jose Maria Remes-Troche
- Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, Mexico
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham University, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Mengistu Z, Gillor M, Dietz HP. Is pelvic floor muscle contractility an important factor in anal incontinence? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:995-998. [PMID: 32959435 DOI: 10.1002/uog.23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Pelvic floor muscle contractility (PFMC) may contribute to anal continence. The aim of this study was to assess the association between clinical and sonographic measures of PFMC and anal incontinence (AI) symptoms, after controlling for anal sphincter and levator ani muscle (LAM) trauma. METHODS This was a retrospective study of 1383 women assessed at a tertiary center between 2013 and 2016. All patients underwent an interview, including the St Mark's incontinence score (SMIS) in those who reported AI symptoms, a clinical examination, including assessment of PFMC using the modified Oxford scale (MOS), and four-dimensional translabial ultrasound (TLUS). Sonographic measures of PFMC, i.e. cranioventral shift of the bladder neck (BN) and reduction of anteroposterior (AP) diameter of the levator hiatus, were measured offline using ultrasound volumes obtained at rest and on maximum pelvic floor contraction. The reviewer was blinded to all clinical data. RESULTS Of the 1383 patients assessed during the study period, seven were excluded due to missing imaging data, leaving 1376 for analysis. Mean age of the participating women was 55 years and mean body mass index was 29 kg/m2 . AI was reported by 221 (16.1%) women, with a mean SMIS of 11.8. Mean MOS grade was 2.3. On TLUS, mean BN cranioventral shift was 5.9 mm and mean AP diameter reduction was 8.1 mm. LAM avulsion and significant external anal sphincter (EAS) defect were diagnosed in 24.8% and 8.7% patients, respectively. On univariate analysis, sonographic measures of PFMC were not associated with AI. Lower MOS grade was associated with symptoms of AI; however, statistical significance was lost on multivariate analysis. CONCLUSION Clinical and sonographic measures of PFMC were not significantly associated with AI symptoms after controlling for EAS and LAM trauma. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Z Mengistu
- Department of Gynecology and Obstetrics, University of Gondar, Gondar, Ethiopia
| | - M Gillor
- University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel
| | - H P Dietz
- University of Sydney, Sydney, NSW, Australia
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15
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Mege D, Omouri A, Maignan A, Sielezneff I. Long-term results of dynamic graciloplasty for severe fecal incontinence. Tech Coloproctol 2021; 25:531-537. [PMID: 33590438 DOI: 10.1007/s10151-021-02421-y] [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] [Received: 10/11/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fecal incontinence is a common complaint. In the presence of extensive sphincter deterioration, after anorectal trauma, or failure of non-invasive surgical procedures, a sphincter reconstruction with dynamic graciloplasty can be proposed. The aim of our study was to evaluate the long-term results of dynamic graciloplasty. METHODS A retrospective study was conducted on all the patients who underwent dynamic graciloplasty between 1997 and 2019 in one French tertiary referral center for severe fecal incontinence after previous unsuccessful treatments. Only patients with available long-term results (≥ 1 year) were included. RESULTS Among 40 patients who underwent dynamic graciloplasty, 31 patients [77% women, median age = 57 years (range 17-74 years)] were included with a mean long-term follow-up of 11 ± 6 years. The mean duration of fecal incontinence was 8 ± 7.9 years and the mean Wexner score was 16 ± 3. Fecal incontinence was adult-acquired in 88% of patients. 74% of patients underwent previously unsuccessful surgical procedures. A diverting colostomy was present in 7 patients (23%). Postoperative overall, surgical and major morbidity occurred in 20 (64%), 17 (55%) and 7 (23%) patients, respectively. At the end of follow-up, 18 patients still used their stimulation device (58%), and 4 patients required a permanent colostomy (12.5%). Long-term efficacy of dynamic graciloplasty was reported by 17 patients (55%). CONCLUSION The efficacy of dynamic graciloplasty is conserved in 55% of patients after a mean follow-up of 11 years. This procedure needs to be kept in the surgical armamentarium for persistent and severe fecal incontinence after previous surgical interventions or in the presence of large perineal defects, before the ultimate step of permanent stoma.
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Affiliation(s)
- D Mege
- Department of Digestive Surgery, Timone University Hospital, Aix Marseille Univ, APHM, Marseille, France.
| | - A Omouri
- Department of Digestive Surgery, Timone University Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - A Maignan
- Department of Digestive Surgery, Timone University Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Aix Marseille Univ, APHM, Marseille, France
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Maeda K, Yamana T, Takao Y, Mimura T, Katsuno H, Seki M, Tsunoda A, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version. J Anus Rectum Colon 2021; 5:52-66. [PMID: 33537501 PMCID: PMC7843140 DOI: 10.23922/jarc.2020-057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
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The severity of symptoms is insufficient to predict major alterations to quality of life of patients with fecal incontinence or chronic constipation. Int J Colorectal Dis 2020; 35:2041-2048. [PMID: 32627072 DOI: 10.1007/s00384-020-03685-w] [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] [Accepted: 06/30/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Evaluate the impact of fecal incontinence (FI) and chronic constipation (CC) on the quality of life (QoL) in a large population and determine if a threshold of symptom scores was associated with alterations to QoL. METHODS A total of 422 outpatients with FI (n = 186), CC (n = 186), and mixed FI-CC (n = 50) referred for anorectal manometry were included prospectively. All patients completed a set of questionnaires to evaluate the severity of FI and CC (respectively Jorge and Wexner and KESS scores) and their impact on QoL (Gastrointestinal Quality of Life Index (GIQLI)). RESULTS The study population included 81.8% women. The QoL was altered to the same degree for both FI and CC, with significant more marked impairments in patients with mixed FI-CC (median GIQLI: 91 (71-108) vs. 91 (73-108) vs. 81 (57-97) respectively, p = 0.05). The symptom severity significantly but weekly correlated with the GIQLI score (r2 = - 0.454 for FI and r2 = - 0.483 for CC, p < 0.001). Thus, the large dispersion of the data flawed the identification of a threshold for symptom severity that could predict major impairment to QoL. CONCLUSION The QoL was equally altered for FI and CC. Although the symptom score severity was slightly but significantly associated with alterations to QoL, it was not possible to determine a threshold for symptom scores that predict an alteration to QoL. Therefore, the evaluation of QoL in parallel to the assessment of the symptom score is required to endorse the entire spectrum of the severity of CC or FI.
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Abstract
BACKGROUND Faecal incontinence (FI) affects 1-19% of the general population and carries significant physical and psychological morbidity. Treatment strategies vary greatly with respect to morbidity and efficacy and relatively little is known regarding the role of mechanical devices such as anal and vaginal inserts. This is an up-to-date systematic review of the use of these devices in the management of patients with FI. METHODS A systematic electronic search was performed of the Medline, Pubmed and Embase databases using the key words and/or MeSH 'anal plug', 'anal insert', 'vaginal insert' and 'faecal incontinence'. Only articles that reported clinical outcomes for these devices for FI in the English language were included. Review articles were excluded to avoid duplication of data. RESULTS Thirteen articles fulfilled the eligibility criteria. Two articles reported outcomes for the Eclipse vaginal insert and 11 articles reported on three types of anal inserts; the Coloplast 'Tulip' design (6), the Procon/ProTect device (2) and the Renew insert (3). When tolerated, both anal and vaginal inserts significantly improved continence, bowel function and quality of life where reported. Adverse effects included discomfort, leakage and slippage. Long-term compliance and benefit are yet to be determined. CONCLUSIONS Vaginal and anal inserts may be a useful treatment for FI. Better quality of evidence is needed to define its effectiveness.
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Andy UU, Jelovsek JE, Carper B, Meyer I, Dyer KY, Rogers RG, Mazloomdoost D, Korbly NB, Sassani JC, Gantz MG. Impact of treatment for fecal incontinence on constipation symptoms. Am J Obstet Gynecol 2020; 222:590.e1-590.e8. [PMID: 31765640 DOI: 10.1016/j.ajog.2019.11.1256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/17/2019] [Accepted: 11/17/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Defecatory symptoms, such as a sense of incomplete emptying and straining with bowel movements, are paradoxically present in women with fecal incontinence. Treatments for fecal incontinence, such as loperamide and biofeedback, can worsen or improve defecatory symptoms, respectively. The primary aim of this study was to compare changes in constipation symptoms in women undergoing treatment for fecal incontinence with education only, loperamide, anal muscle exercises with biofeedback or both loperamide and biofeedback. Our secondary aim was to compare changes in constipation symptoms among responders and nonresponders to fecal incontinence treatment. STUDY DESIGN This was a planned secondary analysis of a randomized controlled trial comparing 2 first-line therapies for fecal incontinence in a 2 × 2 factorial design. Women with at least monthly fecal incontinence and normal stool consistency were randomized to 4 groups: (1) oral placebo plus education only, (2) oral loperamide plus education only, (3) placebo plus anorectal manometry-assisted biofeedback, and (4) loperamide plus biofeedback. Defecatory symptoms were measured using the Patient Assessment of Constipation Symptoms questionnaire at baseline, 12 weeks, and 24 weeks. The Patient Assessment of Constipation Symptoms consists of 12 items that contribute to a global score and 3 subscales: stool characteristics/symptoms (hardness of stool, size of stool, straining, inability to pass stool), rectal symptoms (burning, pain, bleeding, incomplete bowel movement), and abdominal symptoms (discomfort, pain, bloating, cramps). Scores for each subscale as well as the global score range from 0 (no symptoms) to 4 (maximum score), with negative change scores representing improvement in defecatory symptoms. Responders to fecal incontinence treatment were defined as women with a minimally important clinical improvement of ≥5 points on the St Mark's (Vaizey) scale between baseline and 24 weeks. Intent-to-treat analysis was performed using a longitudinal mixed model, controlling for baseline scores, to estimate changes in Patient Assessment of Constipation Symptoms scores from baseline through 24 weeks. RESULTS At 24 weeks, there were small changes in Patient Assessment of Constipation Symptoms global scores in all 4 groups: oral placebo plus education (-0.3; 95% confidence interval, -0.5 to -0.1), loperamide plus education (-0.1, 95% confidence interval, -0.3 to0.0), oral placebo plus biofeedback (-0.3, 95% confidence interval, -0.4 to -0.2), and loperamide plus biofeedback (-0.3, 95% confidence interval, -0.4 to -0.2). No differences were observed in change in Patient Assessment of Constipation Symptoms scores between women randomized to placebo plus education and those randomized to loperamide plus education (P = .17) or placebo plus biofeedback (P = .82). Change in Patient Assessment of Constipation Symptoms scores in women randomized to combination loperamide plus biofeedback therapy was not different from that of women randomized to treatment with loperamide or biofeedback alone. Responders had greater improvement in Patient Assessment of Constipation Symptoms scores than nonresponders (-0.4; 95% confidence interval, -0.5 to -0.3 vs -0.2; 95% confidence interval, -0.3 to -0.0, P < .01, mean difference, 0.2, 95% confidence interval, 0.1-0.4). CONCLUSION Change in constipation symptoms following treatment of fecal incontinence in women are small and are not significantly different between groups. Loperamide treatment for fecal incontinence does not worsen constipation symptoms among women with normal consistency stool. Women with clinically significant improvement in fecal incontinence symptoms report greater improvement in constipation symptoms.
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Affiliation(s)
- Uduak U Andy
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA.
| | - J Eric Jelovsek
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | | | - Isuzu Meyer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Keisha Y Dyer
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, CA
| | - Rebecca G Rogers
- Department of Women's Health, Dell Medical School, University of Texas at Austin. Austin, TX; University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Nicole B Korbly
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI
| | - Jessica C Sassani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
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Gommesen D, Nohr EA, Qvist N, Rasch V. Obstetric perineal ruptures-risk of anal incontinence among primiparous women 12 months postpartum: a prospective cohort study. Am J Obstet Gynecol 2020; 222:165.e1-165.e11. [PMID: 31449804 DOI: 10.1016/j.ajog.2019.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/09/2019] [Accepted: 08/17/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anal incontinence leads to impairment of the quality of life and lower self-esteem with implications for social, physical, and sexual health; anal incontinence after vaginal delivery is a major concern for many women. Only about half of the cases of postpartum anal incontinence can be related to anal sphincter injuries, and the remaining cases must thus be related to other factors. OBJECTIVE The aim of this study was to examine the association between maternal and obstetric characteristics, including the degree of perineal rupture and anal incontinence 12 months postpartum. Furthermore, the aim was to investigate the association between anal sphincter muscle defects, perineal length, and perineal strength and the risk of anal incontinence. MATERIALS AND METHODS We conducted a prospective cohort study at 4 Danish hospitals: Odense University Hospital, Aarhus University Hospital, Esbjerg Hospital, and Kolding Hospital. Baseline data were obtained 2 weeks postpartum in relation to an evaluation of perineal wound healing. Symptoms of anal incontinence were evaluated 12 months postpartum by a Web-based questionnaire (St. Mark's incontinence score questionnaire). In addition, defects in the anal sphincter muscles were examined using endoanal ultrasound, perineal length was measured, and perineal strength was examined using anal manometry. The main outcome measurement was anal incontinence defined as a St. Mark's score of >4. We performed multivariate analyses to investigate the risk factors for anal incontinence and to investigate the risk of anal incontinence according to endoanal ultrasound scanning and anal manometry findings. RESULTS A total of 603 primiparous women (203 with no/labia/first-degree ruptures, 200 with second-degree ruptures, and 200 with third-/fourth-degree ruptures) were included between July 2015 and January 2018. At 12 months postpartum, 575 women (95%) answered the questionnaire; 193 with no/labia/first-degree ruptures, 193 with second-degree ruptures, and 189 with third-/fourth-degree ruptures. A total of 499 women underwent an endoanal ultrasound scanning and 482 women underwent anal manometry. Anal incontinence with a St. Mark's score of >4 was reported by 7% and 9% of women with no/labia/first-degree ruptures or second-degree ruptures, respectively, and by 14%, 15%, 35%, and 33% of women with ruptures of degree 3a, 3b, 3c, and 4, respectively. Compared to women with no or minor tears, women with anal sphincter ruptures had a higher risk of anal incontinence (adjusted relative risk, 2.46; 95% confidence interval, 1.28-4.71). Ruptures of degree 3c and 4 were associated with a substantial increase in risk of anal incontinence (adjusted relative risk, 4.74; 95% confidence interval, 1.98-11.3; and adjusted relative risk, 2.23; 95% confidence interval, 1.59-11.3, respectively), especially if a defect in the external or internal anal sphincter muscle was present (adjusted relative risk, 4.74; 95% confidence interval, 1.54-14.5; and adjusted relative risk, 6.58; 95% confidence interval, 3.35-12.9, respectively). The risk of anal incontinence increased by 8% per 1-unit increase in body mass index (adjusted relative risk, 1.08; 95% confidence interval, 1.03-1.14). CONCLUSION Obesity with body mass index of >29.9 and a high-degree rupture (3c or 4), especially with a persistent defect in the internal or external anal sphincter muscle, increased the risk of anal incontinence.
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Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term? Tech Coloproctol 2019; 24:49-55. [DOI: 10.1007/s10151-019-02128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/22/2019] [Indexed: 01/24/2023]
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22
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Huang Y, Koh CE. Sacral nerve stimulation for bowel dysfunction following low anterior resection: a systematic review and meta-analysis. Colorectal Dis 2019; 21:1240-1248. [PMID: 31081580 DOI: 10.1111/codi.14690] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 02/08/2023]
Abstract
AIM Low anterior resection syndrome (LARS) can affect up to 70% of all patients with rectal cancer. In the last two decades, sacral nerve stimulation (SNS) has emerged as an effective treatment for faecal incontinence. There is some encouraging literature on the use of SNS in patients with LARS. The purpose of this review is to provide an up to date review on the utility of SNS on LARS. METHOD A literature search was conducted using the MEDLINE, Embase and PubMed databases (January 1981-March 2019). Studies identified were appraised with standard selection criteria. Data points were extracted, and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Ten studies met the inclusion criteria and were included in this study. All studies used the Cleveland Clinic Incontinence Score (CCIS), whereas the low anterior resection syndrome score (LARS score) was used in three studies. Overall median improvement in the scoring system was 67.0% (range 35.5%-88.2%) after SNS implantation. There was a significant reduction in CCIS after SNS implantation (mean difference 11.23, 95% confidence interval 9.38-13.07, Z = 11.90, P < 0.00001). The LARS score was also significantly reduced after using SNS in patients with LARS (mean difference 17.87, 95% confidence interval 10.15-25.59, Z = 4.54, P < 0.00001). CONCLUSION Use of SNS may provide symptomatic benefits for patients with LARS refractory to medical therapy. However, the current level of evidence remains limited. A large multicentre study of SNS for LARS using the validated LARS score is warranted. In addition, the cost-effectiveness of SNS for patients with LARS needs further exploration.
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Affiliation(s)
- Y Huang
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - C E Koh
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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23
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Brochard C, Chambaz M, Ropert A, l'Héritier AM, Wallenhorst T, Bouguen G, Siproudhis L. Quality of life in 1870 patients with constipation and/or fecal incontinence: Constipation should not be underestimated. Clin Res Hepatol Gastroenterol 2019; 43:682-687. [PMID: 30880096 DOI: 10.1016/j.clinre.2019.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Quality of life is increasingly seen as important, but remains difficult to assess in patients with functional anorectal complaints. OBJECTIVE We aimed to quantify quality of life and to analyse the symptomatic descriptors associated with a poor outcome in patients with faecal incontinence (FI) and/or constipation. METHODS The characteristics of the patients, data from self-administered questionnaires and from physical examinations were evaluated prospectively for all cases of functional anorectal disease over a period of thirteen years. Functional anorectal disease included faecal incontinence (FI) and/or constipation. Patients with scores in the lowest quartile of the Gastrointestinal Quality of Life Index (GIQLI) were considered to have suffered severe alterations to their quality of life, and were compared with the other patients. RESULTS In total, 1870 patients with functional anorectal disease were included (470 with a severely altered quality of life (GIQLI < 70)). Constipation predominated (1212/1870; 65.1%) and severe FI was frequent (761/1870; 40.9%). Severely altered quality of life was significantly associated with constipation (P = 0.0001), urinary urgency and incontinence (P = 0.0001), depression (P = 0.001), diabetes (P = 0.0224), severe FI (P = 0.0001), neurological disease (P = 0.0138) and liquid stools (P = 0.0002) in multivariate analysis. CONCLUSION Several treatable factors are associated to an impaired quality of life in patients with functional anorectal disorders. Intervention studies are mandatory (stool consistency and frequency).
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Affiliation(s)
- Charlène Brochard
- Service des maladies de l'appareil digestif, CHU de Pontchaillou, Université de Rennes 1, Rennes, France; Services d'explorations fonctionnelles digestives, CHU de Pontchaillou, Université de Rennes 1, Rennes, France; Inserm U1241, Université de Rennes 1, Rennes, France; CIC 1414, INPHY, Université de Rennes 1, Rennes, France.
| | - Marion Chambaz
- Service des maladies de l'appareil digestif, CHU de Pontchaillou, Université de Rennes 1, Rennes, France
| | - Alain Ropert
- Services d'explorations fonctionnelles digestives, CHU de Pontchaillou, Université de Rennes 1, Rennes, France; CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | | | - Timothée Wallenhorst
- Service des maladies de l'appareil digestif, CHU de Pontchaillou, Université de Rennes 1, Rennes, France
| | - Guillaume Bouguen
- Service des maladies de l'appareil digestif, CHU de Pontchaillou, Université de Rennes 1, Rennes, France; Inserm U1241, Université de Rennes 1, Rennes, France; CIC 1414, INPHY, Université de Rennes 1, Rennes, France
| | - Laurent Siproudhis
- Service des maladies de l'appareil digestif, CHU de Pontchaillou, Université de Rennes 1, Rennes, France; Inserm U1241, Université de Rennes 1, Rennes, France; CIC 1414, INPHY, Université de Rennes 1, Rennes, France
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Adelborg K, Veres K, Sundbøll J, Gregersen H, Sørensen HT. Risk of cancer in patients with fecal incontinence. Cancer Med 2019; 8:6449-6457. [PMID: 31468727 PMCID: PMC6797632 DOI: 10.1002/cam4.2509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fecal incontinence may be an early symptom of cancer, but its association with cancer remains unclear. We examined the risk of selected cancers, including colorectal cancer, other gastrointestinal cancers, hormone-related cancers, and lymphoma, in patients with fecal incontinence. METHODS Using Danish population-based registries, all patients with hospital-based diagnoses of fecal incontinence during 1995-2013 were identified. We calculated cumulative incidences of cancers. As a measure of relative risks, we computed standardized incidence ratios (SIRs), that is, the observed number of cancers relative to the expected number based on national incidence rates by sex, age, and calendar year. RESULTS Among 16 556 patients with fecal incontinence, the cumulative incidence of colorectal cancers, other gastrointestinal cancers, hormone-related cancers, and lymphoma each was less than 0.4% after 1 year. It increased to under 3% after 10 years. The SIR for any cancer during 19 years of follow-up was 1.12 [95% confidence interval (CI), 1.06-1.19]. The SIRs during the first year were 2.31 (95% CI, 1.65-3.13) for colorectal cancer, 1.56 (95% CI, 0.89-2.54) for other gastrointestinal cancers, 1.00 (95% CI, 0.72-1.35) for hormone-related cancers, and 2.02 (95% CI, 1.01-3.61) for lymphoma. Beyond 1 year, the SIR reached unity for other gastrointestinal cancers, hormone-related cancers, and lymphoma, while a reduced risk was observed for colorectal cancer (SIR = 0.77, 95% CI, 0.59-0.98). CONCLUSIONS Fecal incontinence was a marker of cancer, especially gastrointestinal cancers and lymphoma within 1 year, which presumably is driven partly by reverse causation. However, the absolute risks were low. Heightened diagnostic efforts may explain in part the increased short-term risk of colorectal cancers.
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Affiliation(s)
- Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jens Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Hans Gregersen
- GIOME, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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25
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Brochard C, Mege D, Bridoux V, Meurette G, Damon H, Lambrescak E, Faucheron JL, Trilling B, Lehur PA, Wyart V, Sielezneff I, Mion F, Etienney I, Leroi AM, Siproudhis L. Is Sacral Nerve Modulation a Good Option for Fecal Incontinence in Men? Neuromodulation 2019; 22:745-750. [PMID: 31318471 DOI: 10.1111/ner.13017] [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: 02/15/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective was to assess the efficacy and the safety of sacral nerve modulation (SNM) in men with fecal incontinence (FI) compared with those of SNM in women. METHOD Prospectively collected data from patients from seven tertiary colorectal units who underwent an implant procedure between January 2010 and December 2015 were reviewed retrospectively. Outcomes and surgical revision and definitive explantation rates were compared between men and women. RESULTS A total of 469 patients (60 men [12.8%]; mean age = 61.4 ± 12.0 years) were included in the study, 352 (78.1%) (31 men [8.8%]) of whom received a permanent implant. The ratio of implanted/tested men was significantly lower than the ratio of implanted/tested women (p = 0.0004). After a mean follow-up of 3.4 ± 1.9 years, the cumulative successful treatment rates tended to be less favorable in men than in women (p = 0.0514): 88.6% (75.6-95.1), 75.9% (60.9-86.4), 63.9% (48.0-77.3), and 43.9% (26.7-62.7) at one, two, three, and five years, respectively, in men; 92.0% (89.1-94.2), 84.2% (80.3-87.4), 76.8% (72.3-80.7), and 63.6% (57.5-69.3) at one, two, three, and five years, respectively, in women. The revision rate for infection and the definitive explantation rate for infection were higher in men than in women (p = 0.0001 and p = 0.0024, respectively). CONCLUSION Both short- and long-term success rates of SNM for FI were lower in men than in women. The revision and definitive explantation for long-term infection rates were significantly higher in men.
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Affiliation(s)
- Charlène Brochard
- Department of Digestive Physiology and Department of Gastroenterology, University Hospital of Rennes Pontchaillou, CIC1414, INPHY, INSERM U1241, University of Rennes 1, Rennes, France
| | - Diane Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - Valérie Bridoux
- Normandie Univ, UNIROUEN, Inserm U1073, Rouen University Hospital, Department of Digestive Surgery, Rouen, France
| | - Guillaume Meurette
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Henri Damon
- Université de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hospital E Herriot, Lyon, France
| | - Elsa Lambrescak
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Jean-Luc Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France.,University Grenoble Alps UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Bertrand Trilling
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France.,University Grenoble Alps UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Paul-Antoine Lehur
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France.,Department of General Surgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Vincent Wyart
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Igor Sielezneff
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - François Mion
- Université de Lyon, Hospices Civils de Lyon, Digestive Physiology, Hospital E Herriot, Lyon, France
| | - Isabelle Etienney
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Anne-Marie Leroi
- Normandie Univ, UNIROUEN, Inserm U1073, Rouen University Hospital, Department of Digestive Surgery, Rouen, France
| | - Laurent Siproudhis
- Department of Digestive Physiology and Department of Gastroenterology, University Hospital of Rennes Pontchaillou, CIC1414, INPHY, INSERM U1241, University of Rennes 1, Rennes, France
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26
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Carter D, Bardan E, Maradey-Romero C. Clinical and physiological risk factors for fecal incontinence in chronically constipated women. Tech Coloproctol 2019; 23:429-434. [PMID: 31016549 DOI: 10.1007/s10151-019-01985-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fecal incontinence (FI) and chronic constipation (CC) are disabling symptoms that cause a significant public health problem. The pathophysiology of combined constipation and FI is not fully understood. Our aim was to delineate the clinical, physiological and anatomical factors that may contribute to the association of FI and CC. METHODS A retrospective study was performed in a pelvic floor unit in a tertiary medical center. Consecutive female patients diagnosed with CC were included, and further divided into two groups according to the co-occurrence of FI. Demographic characteristics, anorectal physiology (obtained by manometry) and pelvic anatomical pathology (as assessed by dynamic pelvic ultrasound) were recorded and subsequently compared. RESULTS A total of 267 women were included in the study. Of those, 62 patients (23%) had an associated FI (CCFI). The CCFI group had higher body mass index (BMI) levels and a trend toward younger average age as compared to the group without FI (CCNFI). The number of vaginal and instrumental deliveries was similar in both groups. Anal resting and squeeze pressures were significantly lower in the CCFI group (64 ± 21 vs 48 ± 18, p = 0.004 and 141 ± 136.2 vs. 97.5 ± 38.6, p = 0.02, respectively). Rectal sensation abnormalities were common, but did not differ between both groups. Dyssynergic defecation and rectocele were more common in the CCNFI group (68% vs. 51%, p = 0.04 and 39% vs. 24%, p = 0/045, respectively. CONCLUSIONS Lower anal pressures and higher BMI were found among women with coexisting FI and CC. Pelvic floor anatomical and functional abnormalities are common in women diagnosed with CC and FI, but dyssynergia and diagnosis of significant rectocele, which cause obstructed defecation, were more common in the CCNFI group.
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Affiliation(s)
- D Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - E Bardan
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Maradey-Romero
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
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Ferdinande K, Dorreman Y, Roelens K, Ceelen W, De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Colorectal Dis 2018; 20:1109-1116. [PMID: 29972721 DOI: 10.1111/codi.14324] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim was to determine the prevalence and risk factors of anal symptoms prepartum and postpartum. METHOD A prospective observational cohort study was carried out in Ghent University Hospital, Belgium. Ninety-four pregnant women between their 19th and 25th week of pregnancy were included. An anal symptom questionnaire was filled in at four different times: in the second and third trimester, immediately postpartum and 3 months postpartum. Descriptive data were obtained from patient files. A proctological diagnosis was presumed on the basis of combined symptoms (i.e. rectal bleeding, anal pain and swelling). Constipation was defined by the Rome III criteria. Risk factors were identified using multivariate analysis. RESULTS Sixty-eight per cent of the patients developed anal symptoms. The most prevalent symptom was anal pain. Constipation was reported by 60.7% during the study period. Seven women (7.9%) suffered from faecal incontinence. The most prevalent diagnoses were haemorrhoidal thrombosis (immediately postpartum), haemorrhoidal prolapse (in the third trimester and immediately postpartum) and anal fissure (not episode related). The two independent risk factors for anal complaints were constipation, with a 6.3 odds ratio (95% CI 2.08-19.37), and a history of anal problems, with a 3.9 odds ratio (95% CI 1.2-13). The Bristol Stool Chart was shown to be a reliable indicator in pregnancy and postpartum as significant correlations were observed in all study periods. CONCLUSION Two-thirds of pregnant women have anal symptoms during pregnancy and postpartum, especially haemorrhoidal complications and anal fissure. The most important risk factor is constipation. The prevention of constipation in pregnant women is therefore highly recommended.
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Affiliation(s)
- K Ferdinande
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
| | - Y Dorreman
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - K Roelens
- Department of Gynaecology and Obstetrics, Ghent University Hospital, Ghent University, Gent, Belgium
| | - W Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent University, Gent, Belgium
| | - D De Looze
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent University, Gent, Belgium
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28
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Musa MK, Vinsnes AG, Blekken LE, Harris RG, Goodman C, Boyers D, Norton C. Interventions for treating or managing faecal incontinence in older people living in care homes. Hippokratia 2018. [DOI: 10.1002/14651858.cd013200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Massirfufulay K Musa
- King’s College London; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Anne G Vinsnes
- Norwegian University of Science and Technology; Department of Public Health and Nursing; Mauritz Hansens gt 2 Trondheim Norway N-7491
| | - Lene Elisabeth Blekken
- Norwegian University of Science and Technology; Department of Public Health and Nursing; Mauritz Hansens gt 2 Trondheim Norway N-7491
| | - Ruth G Harris
- King’s College London; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Claire Goodman
- University of Hertfordshire; Centre for Research in Primary and Community Care; Hertfordshire UK AL10 9AB
| | - Dwayne Boyers
- University of Aberdeen; Health Economics Research Unit; Polwarth Building Foresterhill Aberdeen UK AB25 2ZD
| | - Christine Norton
- King’s College London; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
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29
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Grano C, Fernandes M, Bucci S, Aminoff D, Lucidi F, Violani C. Self-efficacy beliefs, faecal incontinence and health-related quality of life in patients born with anorectal malformations. Colorectal Dis 2018; 20:711-718. [PMID: 29751372 DOI: 10.1111/codi.14259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/30/2017] [Indexed: 12/13/2022]
Abstract
AIM Anorectal malformations (ARMs) are rare congenital colorectal anomalies with long lasting consequences, among which faecal incontinence is one of the most relevant since it may strongly affect patients' health-related quality of life (HRQoL). Although a growing body of literature supports the importance of self-efficacy in chronic disease health outcomes, only few studies have focused on self-efficacy in ARMs and in faecal incontinence. The purpose of the present study is to examine the mediational role of self-efficacy in the path between faecal incontinence and HRQoL in patients born with ARMs. METHOD Ninety-eight adult patients from the Italian Association for Anorectal Malformations (AIMAR) responded to measures of faecal incontinence, self-efficacy for managing ARM consequences, and physical and mental HRQoL (SF-36). Data were analysed by means of structural equation models. RESULTS The tested model provides support for the guiding hypothesis. Fit indices indicate that the model fits the data well (χ2 = 33.48, df = 23, P = 0.07; comparative fit index [CFI] = 0.97; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.05). Faecal incontinence has negative effects on both physical and mental HRQoL, as well on self-efficacy. In turn, self-efficacy has a positive and direct effect on mental HRQoL. CONCLUSION Faecal incontinence is the most relevant and negative factor influencing HRQoL; in addition, self-efficacy contributes in reducing emotional distress and in improving mental health outcomes. Longitudinal and controlled studies may be helpful to evaluate the effectiveness of self-efficacy interventions in improving mental HRQoL in patients with faecal incontinence.
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Affiliation(s)
- C Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - M Fernandes
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - S Bucci
- Italian Parents and Patients Organization for Anorectal Malformation (AIMAR), Rome, Italy
| | - D Aminoff
- Italian Parents and Patients Organization for Anorectal Malformation (AIMAR), Rome, Italy
| | - F Lucidi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - C Violani
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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30
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Development of Perianal Sepsis Index (PASI) for assessing quality of life in chronic perianal sepsis. Eur Surg 2018. [DOI: 10.1007/s10353-018-0543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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31
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Leroi AM, Melchior C, Charpentier C, Bridoux V, Savoye-Collet C, Houivet E, Ducrotté P, Gourcerol G. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil 2018; 30:e13291. [PMID: 29345097 DOI: 10.1111/nmo.13291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The functional lumen imaging probe (EndoFLIP® ) is a new technology that measures the distensibility of the anal canal represented by the anal distensibility index. The aims of this study were (i) to compare the anal distensibility index to anal pressure in a cohort of patients with fecal incontinence (FI) and (ii) to compare the diagnostic value of the EndoFLIP® to that of high-resolution anorectal manometry (HRAM) in the same cohort of patients. METHODS Eighty-three consecutive patients with FI who underwent EndoFLIP® and HRAM assessments were enrolled. The diagnostic value of the EndoFLIP® was compared to that of HRAM and agreement between EndoFLIP® and HRAM data was assessed. KEY RESULTS More than 70% of the patients diagnosed with anal deficiency at rest and/or during voluntary contractions by HRAM had the same diagnosis using the EndoFLIP® . Two patients with higher distensibility indexes at rest had normal anal resting pressures. Sixteen patients with a normal EndoFLIP® index (ie, normal distensibility index at rest and during voluntary contractions) had an abnormal HRAM result. Seven of these 16 patients (44%) had no sphincter lesion or neuropathic disorder that could explain an abnormal anal sphincter function. CONCLUSIONS & INFERENCES We demonstrated that the anal distensibility index and HRAM results are largely in agreement. We did, however, identify several discrepancies between the two techniques, indicating that they may be complementary.
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Affiliation(s)
- A M Leroi
- INSERM U1073, Service de Physiologie Digestive, INSERM CIC 1404, Rouen, F-76000, France
| | - C Melchior
- INSERM U1073, Service d'Hépato-Gastroentérologie, CHU Rouen, Rouen, France
| | | | - V Bridoux
- INSERM U1073, Service de Chirurgie Digestive, CHU Rouen, Rouen, France
| | | | - E Houivet
- Unité de Biostatistiques, Rouen, INSERM CIC 1404, Rouen, F-76000, France
| | - P Ducrotté
- INSERM U1073, Service d'Hépato-Gastroentérologie, CHU Rouen, Rouen, France
| | - G Gourcerol
- INSERM U1073, Service de Physiologie Digestive, INSERM CIC 1404, Rouen, F-76000, France
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Operative vaginal delivery in case of persistent occiput posterior position after manual rotation failure: a 6-month follow-up on pelvic floor function. Arch Gynecol Obstet 2018; 298:111-120. [PMID: 29785548 DOI: 10.1007/s00404-018-4794-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/16/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the short- and long-term perineal consequences (at 6 months postpartum) and short-term neonatal consequences of instrumental rotation (IR) to those induced by assisted delivery (AD) in the occiput posterior (OP) position, in case of manual rotation failure. METHODS A prospective observational cohort study; tertiary referral hospital including all women presenting with persistent OP position who delivered vaginally after manual rotation failure with attempted IR or AD in OP position from September 2015 to October 2016. Maternal and neonatal outcomes of all attempted IR deliveries were compared with OP operative vaginal deliveries. Main outcomes measured were pelvic floor function at 6 months postpartum including Wexner score for anal incontinence and ICIQ-FLUTS for urinary symptoms. Perineal morbidity comprised severe perineal tears, corresponding to third and fourth degree lacerations. Fetal morbidity parameters comprised low neonatal Apgar scores, acidaemia, major and minor fetal injuries and neonatal intensive care unit admissions. RESULTS Among 5265 women, 495 presented with persistent OP positions (9.4%) and 111 delivered after manual rotation failure followed by AD delivery: 58 in the IR group and 53 in the AD in OP group. The incidence of anal sphincter injuries was significantly reduced after IR attempt (1.7% vs. 24.5%; p < 0.001) without increasing neonatal morbidity. At 6 months postpartum, AD in OP position was associated with higher rate of anal incontinence (30% vs. 5.5%, p = 0.001) and with more urinary symptoms, dyspareunia and perineal pain. CONCLUSIONS OP operative deliveries are associated with significant perineal morbidity and pelvic floor dysfunction at 6 months postpartum.
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Le Fouler A, Hamy A, Barbieux J, Souday V, Bigot P, Le Naoures P, Jaouen R, Brochard C, Venara A. Long-term functional outcomes of perineal gangrene: worse than expected?-an observational retrospective study. Int J Colorectal Dis 2018; 33:589-592. [PMID: 29500487 DOI: 10.1007/s00384-018-2999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. The aim of this study was to report long-term anal and urinary sphincter dysfunctions, sexual sequelae, and patients' quality of life after treatment of perineal gangrene. METHODS This retrospective observational study was conducted in one university hospital over 16 years. Seventy-three patients experienced PG; 22 were subject to long-term follow-up. Three questionnaires were sent to patients to assess pelvic dysfunction and quality of life: the GIQLI, the Cleveland Incontinence Score, and the USP score for urinary dysfunction. Sexual sequelae were considered if orchiectomy or penile resection for male patients and vulvar resection for female patients were performed. RESULTS Of the 72 patients included, seven died before discharge (9.7%) and at least 14 died during follow-up (19.4%), despite a mean age of 62 years (± 13). Among the surviving patients, seven experienced an alteration of their quality of life (44%) (GIQLI < 96). Six patients still had a colostomy, and among the remaining patients, 11 experienced minimal to mild incontinence (68.7%), while one experienced constipation (6.2%). One patient suffered from urinary incontinence (4.5%), and six suffered from dysuria (27.3%). Three male patients (14%) underwent an orchiectomy, and one female patient (100%) underwent a vulvar resection. CONCLUSION PG leads to a high rate of anal and urinary dysfunctions. Urinary dysfunctions are taken into account and treated; however, anal incontinence is not investigated even though it could lead to decreased quality of life.
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Affiliation(s)
- A Le Fouler
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France.,LUNAM, University of Angers, Angers, France
| | - A Hamy
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France.,LUNAM, University of Angers, Angers, France.,UMR INSERM HIFI, Angers, France
| | - J Barbieux
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France.,LUNAM, University of Angers, Angers, France
| | - V Souday
- Intensive Care Unit and Department of Hyperbaric Medicine, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - P Bigot
- LUNAM, University of Angers, Angers, France.,Department of Urology, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - P Le Naoures
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - R Jaouen
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France.,LUNAM, University of Angers, Angers, France
| | - C Brochard
- UMR INSERM U1235, TENS, Nantes, France.,Department of Gastroenterology, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Aurélien Venara
- Department of Digestive and Endocrinal Surgery, CHU Angers, 4 rue Larrey, 49933, Angers, France. .,LUNAM, University of Angers, Angers, France. .,UMR INSERM HIFI, Angers, France. .,UMR INSERM U1235, TENS, Nantes, France.
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Carrington EV, Scott SM, Bharucha A, Mion F, Remes-Troche JM, Malcolm A, Heinrich H, Fox M, Rao SS. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15:309-323. [PMID: 29636555 PMCID: PMC6028941 DOI: 10.1038/nrgastro.2018.27] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Faecal incontinence and evacuation disorders are common, impair quality of life and incur substantial economic costs worldwide. As symptoms alone are poor predictors of underlying pathophysiology and aetiology, diagnostic tests of anorectal function could facilitate patient management in those cases that are refractory to conservative therapies. In the past decade, several major technological advances have improved our understanding of anorectal structure, coordination and sensorimotor function. This Consensus Statement provides the reader with an appraisal of the current indications, study performance characteristics, clinical utility, strengths and limitations of the most widely available tests of anorectal structure (ultrasonography and MRI) and function (anorectal manometry, neurophysiological investigations, rectal distension techniques and tests of evacuation, including defecography). Additionally, this article provides our consensus on the clinical relevance of these tests.
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Affiliation(s)
- Emma V. Carrington
- National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - S. Mark Scott
- National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Adil Bharucha
- Department of Gastroenterology and Hepatology, Mayo College of Medicine, Rochester, MN, USA
| | - François Mion
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University and Inserm 1032 LabTAU, Lyon, France
| | - Jose M. Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, México
| | - Allison Malcolm
- Division of Gastroenterology, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Henriette Heinrich
- National Bowel Research Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Mark Fox
- Abdominal Center: Gastroenterology, St. Claraspital, Basel, Switzerland
- Clinic for Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Satish S. Rao
- Division of Gastroenterology and Hepatology, Augusta University, Augusta, Georgia
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Benezech A, Desmazes-Dufeu N, Baumstarck K, Bouvier M, Coltey B, Reynaud-Gaubert M, Vitton V. Prevalence of Fecal Incontinence in Adults with Cystic Fibrosis. Dig Dis Sci 2018; 63:982-988. [PMID: 29086331 DOI: 10.1007/s10620-017-4825-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) are deemed at risk of developing urinary incontinence (UI) due to repeated coughing and other factors causing increased pressure on the pelvic floor. Fecal incontinence (FI) is probably derived from the same mechanism, but only very few data are available on its frequency. AIMS The aim of this study was to determine the prevalence of FI in an adult population with CF. METHODS This retrospective study was conducted from January 2012 to June 2014. Patients were recruited from Marseille referral center for adult CF. They were asked to fill in a self-completed anonymous questionnaire for symptom assessment of UI and FI. Clinical data and a detailed history of CF were also recorded. RESULTS A total of 155 out of 190 patients (92 females) of mean age 30.5 ± 11 years completed the survey. Seventy-three patients (47%) were lung transplanted. Forty patients (25.8%) reported FI with a mean St Mark's score of 4.9 ± 2. Thirty-five patients (22.6%) reported UI. Eighteen patients (11.6%) reported both FI and UI. FI was significantly more frequent in older patients (34.27 vs. 29.54 years, p = 0.03) and in patients with associated UI (p = 0.001). No relationship was found between respiratory, bacterial, nutritional status, transplantation, pancreatic status, practice of physiotherapy, delivery history, and FI. CONCLUSIONS The high prevalence of FI in CF and its negative impacts need to integrate this symptom in the overall treatment of this pathology. The systematic early detection of FI may allow its rapid management and limit their consequences.
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Affiliation(s)
- Alban Benezech
- Plateforme d'Interface Clinique, Aix Marseille Université, CNRS, CRN2M-UMR7286, 13344, Marseille Cedex 20, France. .,APHM, Hôpital NORD, Service de Gastroentérologie, CHU Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
| | - Nadine Desmazes-Dufeu
- APHM, Hôpital NORD, Service de Pneumologie, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, 13915, Marseille Cedex 20, France
| | - Karine Baumstarck
- Unité d'aide méthodologique à la Recherche Clinique, Laboratoire de Santé Publique, Aix-Marseille Université, Marseille Cedex 20, France
| | - Michel Bouvier
- Plateforme d'Interface Clinique, Aix Marseille Université, CNRS, CRN2M-UMR7286, 13344, Marseille Cedex 20, France.,APHM, Hôpital NORD, Service de Gastroentérologie, CHU Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Bérengère Coltey
- APHM, Hôpital NORD, Service de Pneumologie, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, 13915, Marseille Cedex 20, France
| | - Martine Reynaud-Gaubert
- APHM, Hôpital NORD, Service de Pneumologie, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, 13915, Marseille Cedex 20, France.,URMITE - CNRS - IRD UMR 6236, Faculté de Médecine de Marseille, Aix Marseille Université, Marseille Cedex 20, France
| | - Véronique Vitton
- Plateforme d'Interface Clinique, Aix Marseille Université, CNRS, CRN2M-UMR7286, 13344, Marseille Cedex 20, France.,APHM, Hôpital NORD, Service de Gastroentérologie, CHU Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France
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Jayarajah U, Wickramasinghe DP, Samarasekera DN. Anal incontinence and quality of life following operative treatment of simple cryptoglandular fistula-in-ano: a prospective study. BMC Res Notes 2017; 10:572. [PMID: 29115980 PMCID: PMC5688815 DOI: 10.1186/s13104-017-2895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/31/2017] [Indexed: 11/20/2022] Open
Abstract
Background Anal incontinence is a known complication following operative treatment of fistula-in-ano which can significantly impact the quality of life. This study was aimed to objectively assess the impact of operative treatment of simple fistula-in-ano on quality of life related to anal incontinence. Therefore, a prospective study was conducted in 34 patients who underwent surgery for fistula-in-ano over a period of 24 months. Quality of life and incontinence were assessed using fecal incontinence quality of life (FIQL) scale and Cleveland clinic incontinence score (CCIS) preoperatively and after a minimum of 12 months follow up (mean-27 months, range 12–40 months). The difference in FIQL and CCIS was analysed using Wilcoxon Rank test and Mann–Whitney U test. Results The median age of the participants was 42.5 years (range 22–63, males = 30). The majority had a trans-sphincteric tract (n = 22, 65%). Superficial tracts and inter-sphincteric tracts were found in 8 (24%) and 4 patients (12%). The overall preoperative and postoperative rates of incontinence were 18 and 38% respectively, but the severity was low. The mean overall FIQL was 16.0 (SD ± 0.4) preoperatively and 16.1 (SD ± 0.4) postoperatively. Considerable difference was seen in the scale measuring “depression/self-perception” (p = 0.012). Only 1 patient (3%) had reduction in scale “lifestyle” which measures the impact of incontinence on day-to-day activities. Conclusions Analysis of a cohort of simple cryptoglandular fistula-in-ano with low pre-operative incontinence showed no worsening in the FIQL following successful treatment despite minor worsening of incontinence. Since greater improvement was noted in scale measuring depression/self-perception, psychological interventions may be helpful before surgery to improve quality of life.
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Affiliation(s)
- Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, Kynsey Road, P. O. Box 271, Colombo 8, Sri Lanka
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Tournu G, Abramowitz L, Couffignal C, Juguet F, Sénéjoux A, Berger S, Wiart AL, Bernard M, Provost F, Pillant-Le Moult H, Bouchard D, Aubert JP. Prevalence of anal symptoms in general practice: a prospective study. BMC FAMILY PRACTICE 2017; 18:78. [PMID: 28774265 PMCID: PMC5543599 DOI: 10.1186/s12875-017-0649-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/24/2017] [Indexed: 12/03/2022]
Abstract
Background Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. Methods In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner’s diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. Results From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14–18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1–5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases. Conclusions Patients’ concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.
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Affiliation(s)
- Géraldine Tournu
- General practice department, University Paris Diderot, F-75018, Paris, France.
| | - Laurent Abramowitz
- AP-HP and GREP; Gastroenterology and proctology unit, Bichat University hospital, Paris, France
| | - Camille Couffignal
- INSERM, IAME, UMR 1137, F-75018, Paris, France.,University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France.,AP-HP, Bichat hospital, Biostatistics unit, F-75018, Paris, France
| | | | - Agnès Sénéjoux
- Proctology unit, Private hospital, Saint Grégoire, France
| | | | | | | | | | | | | | - Jean-Pierre Aubert
- Sorbonne Paris Cité, General practice department, University Paris Diderot, F-75018 Paris, France ; REMES, F-75018, Paris, France
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Mion F, Garros A, Brochard C, Vitton V, Ropert A, Bouvier M, Damon H, Siproudhis L, Roman S. 3D High-definition anorectal manometry: Values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD). Neurogastroenterol Motil 2017; 29. [PMID: 28251732 DOI: 10.1111/nmo.13049] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND 3D-high definition anorectal manometry (3DARM) may aid the diagnosis of functional anorectal disorders, but data comparing asymptomatic and symptomatic subjects are scarce. We aimed to describe 3DARM values in asymptomatic volunteers and those with fecal incontinence (FI) or chronic constipation (CC), and identify which variables differentiate best these groups. METHODS Asymptomatic subjects were stratified by sex, age, and parity. Those with FI or CC were included according to anorectal symptom questionnaires. Endoanal ultrasound examination and 3DARM were performed the same day. Anal pressures were analyzed at rest, during voluntary squeeze, and during push maneuver, and compared between the 3 groups. Anal pressure defects were defined and compared to ultrasound defects. KEY RESULTS A total of 126 subjects (113 female, mean age 52 years, range 18-83) were included; 36 asymptomatic, 38 FI, 42 CC. Anal resting and squeeze pressures, and rectal sensitivity values were lower in FI women than in the other groups. Typical anal sphincter asymmetry during squeezing was less frequently observed in FI women. A dyssynergic pattern during push maneuver was found in 70% of asymptomatic subjects, and with a similar frequency in the 2 symptomatic groups. There was slight concordance between 3D-pressure defects and ultrasound defects. CONCLUSIONS & INFERENCES 3D anal pressures in asymptomatic women were significantly lower than in men, and in FI compared to asymptomatic women. The classical dyssynergic pattern during push maneuver was found as frequently in asymptomatic and symptomatic patients. Further studies should try to identify 3DARM variables that could reliably identify dyssynergic defecation.
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Affiliation(s)
- F Mion
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - A Garros
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - C Brochard
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - V Vitton
- Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - A Ropert
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - M Bouvier
- Digestive Physiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - H Damon
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - L Siproudhis
- Digestive Physiology and Gastroenterology, Pontchaillou Hospital, CHU de Rennes, Rennes, France
| | - S Roman
- Exploration Fonctionnelle Digestive, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
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Melchior C, Gourcerol G, Bridoux V, Ducrotté P, Quinton JF, Leroi AM. Efficacy of antibiotherapy for treating flatus incontinence associated with small intestinal bacterial overgrowth: A pilot randomized trial. PLoS One 2017; 12:e0180835. [PMID: 28763464 PMCID: PMC5538639 DOI: 10.1371/journal.pone.0180835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/20/2017] [Indexed: 12/12/2022] Open
Abstract
Aim An increase in intestinal gas production due to small intestinal bowel overgrowth (SIBO) is a contributing factor for flatus incontinence. The aims of our study were to assess the efficacy of metronidazole in a select population of patients with flatus incontinence associated with SIBO and to compare its efficacy with that of a combination of simethicone and activated charcoal (SC; Carbosylane) in randomized experimental arms. Methods Adult patients suffering from flatus incontinence associated with SIBO diagnosed by a glucose breath test were enrolled in the study. They were given metronidazole or Carbosylane (SC) for 10 days. The reduction in the mean daily number of gas leakages reported in a 3-day diary before and at the end of the treatment was used as the primary endpoint. Results Of 52 consecutive subjects with flatus incontinence, 23 (44%) had SIBO, 16 (33%) of whom were included in and completed the study. The relative reduction in flatus incontinence episodes was significantly higher in the metronidazole than in the SC group (66.8±34.8% vs. 25±50%, P = 0.03), decreasing by more than 50% in 7 (87.5%) of the subjects in the metronidazole group compared with only 1 (12.5%) in the SC group (odds ratio 1.9, 95% confidence interval 0.9–56.9, P = 0.06). Conclusion Our results show a promising trend indicating that metronidazole might significantly improve flatus incontinence associated with SIBO and might be more successful in treating flatus incontinence than gas absorbents.
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Affiliation(s)
- Chloé Melchior
- INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France
| | - Guillaume Gourcerol
- INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France
| | - Valérie Bridoux
- INSERM U1073, Service de Chirurgie Digestive, CHU Rouen, Rouen, France
| | - Philippe Ducrotté
- INSERM U1073, Service d'Hépato-Gastroentérologie, CHU Rouen, Rouen, France
| | | | - Anne-Marie Leroi
- INSERM U1073, Service de Physiologie Digestive, CHU Rouen, INSERM CIC 0204 Rouen, Rouen, France
- * E-mail:
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Richard N, Hudson M, Gyger G, Baron M, Sutton E, Khalidi N, Pope JE, Carrier N, Larché M, Albert A, Fortin PR, Thorne C, Masetto A. Clinical correlates of faecal incontinence in systemic sclerosis: identifying therapeutic avenues. Rheumatology (Oxford) 2017; 56:581-588. [PMID: 28013205 DOI: 10.1093/rheumatology/kew441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives The aim was to establish the prevalence and severity of faecal incontinence (FI) in SSc, its association with other intestinal manifestations and potential predictors of FI, and its impact on quality of life. Methods A multicentre, cross-sectional study of 298 SSc subjects followed in the Canadian Scleroderma Research Group cohort was performed using validated questionnaires: Jorge-Wexner score (an FI severity scale), Bristol stool scale (a visual scale of stool consistency) and FI Quality-of-Life scale. Constipation was defined by the Rome III criteria. Associations between the Jorge-Wexner score and other clinical variables were determined using multivariate regression analyses. Results Eighty-one (27.2%) subjects had FI, which was mild in 37 (12.4%) and moderate to severe in 44 (14.8%). Most patients had well-formed stools, 111 (38.8%) reported constipation and 38 (13.4%) had been previously treated for small intestinal bacterial overgrowth (SIBO). Variables independently associated with FI were: loose vs well-formed stools [odds ratio (OR) = 7.01, 95% CI: 2.09, 23.51)], constipation (OR = 3.64, 95% CI: 1.61, 8.27, P = 0.002), history of SIBO (OR = 2.97, 95% CI: 1.06, 8.27) and urinary incontinence (OR = 2.45, 95% CI: 1.14, 5.27). Quality of life measured with the FI Quality-of-Life scale was inversely correlated with FI severity (correlation coefficients between -0.602 and -0.702, P < 0.001). Conclusion FI was common and often severe in SSc. Loose stools, SIBO, constipation and urinary incontinence were strongly associated with FI. Other than targeting anorectal dysfunction, concomitant treatment of clinical correlates could lead to improvement in FI and quality of life in SSc.
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Affiliation(s)
- Nicolas Richard
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Geneviève Gyger
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Evelyn Sutton
- Division of Rheumatology, Nova Scotia Rehabilitation Centre, Dalhousie University, Halifax, Nova Scotia
| | - Nader Khalidi
- Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton
| | - Janet E Pope
- Division of Rheumatology, St Joseph Health Care, University of Western Ontario, London, Ontario
| | - Nathalie Carrier
- Department of Biostatistics, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke
| | - Maggie Larché
- Division of Rheumatology, St Joseph's Healthcare, McMaster University, Hamilton
| | - Alexandra Albert
- Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec, Université Laval, Quebec City, Quebec
| | - Carter Thorne
- Division of Rheumatology, Southlake Regional Health Centre, Newmarket, Ontario
| | - Ariel Masetto
- Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Abstract
BACKGROUND Fecal incontinence is common in women with Crohn's disease, but little is known about the impact of childbirth, perianal Crohn's disease, and past surgical history on fecal incontinence. METHODS Self-administered questionnaires were mailed to consecutive women referred to a tertiary gastroenterology centre with a focus on fecal incontinence and childbirth. These data were cross-referenced with a prospective database of the same patients' own Crohn's disease histories. Fecal incontinence was defined as a Cleveland Clinic Incontinence Score ≥5. Factors associated with fecal incontinence were analyzed. RESULTS A total of 173 patients were assessed, including 113 parous women. The prevalence of fecal incontinence was 37.5% (95% CI, 30.7-45.0). The disease duration, a history of anal surgery for fistula, the number of childbirths per woman and Crohn's activity were all independently associated with fecal incontinence in a multivariate analysis model. Specifically, among the group of parous women, fecal incontinence was associated with prior abdominal surgery, prior anal surgery, and Crohn's activity. The mode of delivery was not statistically associated with fecal incontinence. CONCLUSIONS Fecal incontinence is a significant complaint in at least one-third of women of childbearing age with Crohn's disease. Patients'disease and treatment histories seem to have a comparable effect to their childbirth history concerning the presence of fecal incontinence. Both physicians and surgeons who are involved in the management of Crohn's disease need to keep this in mind.
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Long-Term Morbidity and Quality of Life in Cervical Cancer Survivors: A Multicenter Comparison Between Surgery and Radiotherapy as Primary Treatment. Int J Gynecol Cancer 2017; 27:350-356. [DOI: 10.1097/igc.0000000000000880] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo compare long-term morbidity and quality of life after primary surgery or primary radiotherapy for stage IB/II cervical cancer.MethodsA cross-sectional study was performed. Patients treated for stage IB/II cervical cancer between 2000 and 2010 were approached to participate. Primary treatment consisted of radical hysterectomy with pelvic lymphadenectomy (RHL), for selected cases followed by adjuvant (chemo-)radiotherapy, or primary (chemo)radiotherapy (PRT). European Organization for Research and Treatment of Cancer-C30 and European Organization for Research and Treatment of Cancer-CX24 questionnaires were administered. A multivariable analysis was performed to identify factors associated with morbidity/quality of life. In a subgroup analysis, we compared patients with RHL + adjuvant radiotherapy with those after PRT.ResultsThree hundred twenty-three cervical cancer survivors were included (263 RHL/60 PRT). In the PRT group, International Federation of Gynecology and Obstetrics stage was higher and women were older. In the RHL group, more women had a partner. Women treated with PRT reported lower physical (β, −6.01) and social functioning (β, −15.2), more financial problems (β, 10.9), diarrhea (β, 9.98), symptom experience (β, 6.13), sexual worry (β, 11.3), and worse sexual/vaginal functioning (β, 11.4). Women treated with RHL reported significantly more lymphedema (β, −16.1). No differences in global health were found. In the subgroup analysis, women after PRT (n = 60) reported poorer social functioning, less sexual enjoyment, and higher symptoms experience than women after RHL and adjuvant radiotherapy (n = 60). The latter reported more lymphedema.ConclusionsAlthough global health scores are not significantly different, women after PRT report more physical, social, and sexual symptoms. These results can be well used by physicians to inform their patients about treatment-related morbidity.
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Garros A, Marjoux S, Khouatra C, Coppere B, Grange C, Hot A, Roman S, Damon H, Mion F. Prevalence of fecal incontinence in a cohort of systemic sclerosis patients within a regional referral network. United European Gastroenterol J 2017; 5:1046-1050. [PMID: 29163972 DOI: 10.1177/2050640616688129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/12/2016] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence of gastrointestinal involvement in systemic sclerosis is higher than 75%. The estimated prevalence of fecal incontinence varies from 22% to 77%, but suffers from recruitment bias and patient reluctance. Our goal was to evaluate the prevalence of fecal incontinence in systemic sclerosis, and to identify associated risk factors. Methods Patients were recruited in the referral systemic sclerosis network of the Lyon University Hospitals, using self-administered questionnaires including constipation, fecal incontinence and Bristol Stool scales, quality of life, anxiety and depression. The cohort was compared with the historical ORALIA cohort that established the prevalence of fecal incontinence in the general population of the Rhône-Alpes region (France). Results Seventy-seven patients were included (mean age: 60 years, range: 32-84), and 86% were female. These were compared to 153 ORALIA individuals matched for age and sex. Fecal incontinence was present in 38% of patients and 6% of the general population. A longer duration of systemic sclerosis was the only characteristic associated with fecal incontinence. Abnormal stool consistency was more frequent in patients with fecal incontinence. Conclusion Fecal incontinence and abnormal stool consistency are common in systemic sclerosis and should be systematically addressed.
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Affiliation(s)
- A Garros
- Hospices Civils de Lyon, Hospital Edouard Herriot, Digestive Physiology, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - S Marjoux
- Hospices Civils de Lyon, Hospital Edouard Herriot, Digestive Physiology, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - C Khouatra
- Hospices Civils de Lyon, Hospital Louis Pradel, Pneumology, Bron, France
| | - B Coppere
- Hospices Civils de Lyon, Hospital Edouard Herriot, Internal Medicine, Lyon, France
| | - C Grange
- Hospices Civils de Lyon, Hospital Jules Courmont, Internal Medicine, Lyon, France
| | - A Hot
- Hospices Civils de Lyon, Hospital Edouard Herriot, Internal Medicine, Lyon, France
| | - S Roman
- Hospices Civils de Lyon, Hospital Edouard Herriot, Digestive Physiology, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - H Damon
- Hospices Civils de Lyon, Hospital Edouard Herriot, Digestive Physiology, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
| | - F Mion
- Hospices Civils de Lyon, Hospital Edouard Herriot, Digestive Physiology, Lyon I University, and INSERM 1032 LabTAU, Lyon, France
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Sharma A, Yuan L, Marshall RJ, Merrie AEH, Bissett IP. Systematic review of the prevalence of faecal incontinence. Br J Surg 2016; 103:1589-1597. [PMID: 27704537 DOI: 10.1002/bjs.10298] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/18/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Faecal incontinence (FI) is widely recognized as a significant problem in the community. Conjecture exists around the proportion of the population affected. This systematic review evaluated studies reporting the community prevalence of FI in terms of methodology, design and definitions. METHODS MEDLINE, Embase, CINAHL, the Cochrane Collaboration and National Guideline databases were searched for studies investigating the prevalence of FI in community-based adults published from January 1966 to February 2015. Study data, including methodology, sample size, response rate, definition of FI and prevalence rates, were extracted on to a pro forma and appraised critically. Where possible, FI prevalence estimates were pooled. RESULTS Thirty studies were analysed from 4840 screened articles. FI prevalence estimates varied from 1·4 to 19·5 per cent. This variation was explained by differences in data collection method and two factors within definitions of FI: type of stool and frequency of FI episodes. When these factors were accounted for, the FI prevalence at a threshold of at least once per month for liquid or solid stool was 8·3-8·4 per cent for face-to-face or telephone interviews, and 11·2-12·4 per cent for postal surveys. The pooled prevalence rate from studies for functional FI (defined by ROME II criteria) was 5·9 (95 per cent c.i. 5·6 to 6·3) per cent. CONCLUSION When comparable methodologies and definitions are used, studies produce remarkably similar prevalence rates in different community populations. FI remains an unspoken symptom, with lower rates reported in personal interviews compared with anonymous postal questionnaires.
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Affiliation(s)
- A Sharma
- Department of Surgery, University of Auckland, New Zealand
| | - L Yuan
- Department of Surgery, University of Auckland, New Zealand
| | - R J Marshall
- Department of Surgery, University of Auckland, New Zealand
| | - A E H Merrie
- Department of Surgery, Auckland City Hospital, New Zealand
| | - I P Bissett
- Department of Surgery, University of Auckland, New Zealand. .,Department of Surgery, Auckland City Hospital, New Zealand.
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Horrocks EJ, Bremner SA, Stevens N, Norton C, Gilbert D, O'Connell PR, Eldridge S, Knowles CH. Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial). Health Technol Assess 2016; 19:1-164. [PMID: 26422980 DOI: 10.3310/hta19770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Faecal incontinence (FI) is a common condition which is often under-reported. It is distressing for those suffering from it, impacting heavily on their quality of life. When conservative strategies fail, treatment options are limited. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive outpatient treatment, shown in preliminary case series to have significant effectiveness; however, no randomised controlled trial has been conducted. OBJECTIVES To assess the effectiveness of PTNS compared with sham electrical stimulation in the treatment of patients with FI in whom initial conservative strategies have failed. DESIGN Multicentre, parallel-arm, double-blind randomised (1 : 1) controlled trial. SETTING Eighteen UK centres providing specialist nurse-led (or equivalent) treatment for pelvic floor disorders. PARTICIPANTS Participants aged > 18 years with FI who have failed conservative treatments and whose symptoms are sufficiently severe to merit further intervention. INTERVENTIONS PTNS was delivered via the Urgent(®) PC device (Uroplasty Limited, Manchester, UK), a hand-held pulse generator unit, with single-use leads and fine-needle electrodes. The needle was inserted near the tibial nerve on the right leg adhering to the manufacturer's protocol (and specialist training). Treatment was for 30 minutes weekly for a duration of 12 treatments. Validated sham stimulation involved insertion of the Urgent PC needle subcutaneously at the same site with electrical stimulation delivered to the distal foot using transcutaneous electrical nerve stimulation. MAIN OUTCOME MEASURES Outcome measures were assessed at baseline and 2 weeks following treatment. Clinical outcomes were derived from bowel diaries and validated, investigator-administered questionnaires. The primary outcome classified patients as responders or non-responders, with a responder defined as someone having achieved ≥ 50% reduction in weekly faecal incontinence episodes (FIEs). RESULTS In total, 227 patients were randomised from 373 screened: 115 received PTNS and 112 received sham stimulation. There were 12 trial withdrawals: seven from the PTNS arm and five from the sham arm. Missing data were multiply imputed. For the primary outcome, the proportion of patients achieving a ≥ 50% reduction in weekly FIEs was similar in both arms: 39 in the PTNS arm (38%) compared with 32 in the sham arm (31%) [odds ratio 1.28, 95% confidence interval (CI) 0.72 to 2.28; p = 0.396]. For the secondary outcomes, significantly greater decreases in weekly FIEs were observed in the PTNS arm than in the sham arm (beta -2.3, 95% CI -4.2 to -0.3; p = 0.02), comprising a reduction in urge FIEs (p = 0.02) rather than passive FIEs (p = 0.23). No significant differences were found in the St Mark's Continence Score or any quality-of-life measures. No serious adverse events related to treatment were reported. CONCLUSIONS PTNS did not show significant clinical benefit over sham electrical stimulation in the treatment of FI based on number of patients who received at least a 50% reduction in weekly FIE. It would be difficult to recommend this therapy for the patient population studied. Further research will concentrate on particular subgroups of patients, for example those with pure urge FI. TRIAL REGISTRATION Current Controlled Trials ISRCTN88559475. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma J Horrocks
- National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, UK
| | - Stephen A Bremner
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary University of London, London, UK
| | - Natasha Stevens
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary University of London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Deborah Gilbert
- National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, UK
| | - P Ronan O'Connell
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary University of London, London, UK
| | - Charles H Knowles
- National Centre for Bowel Research and Surgical Innovation, Blizard Institute, Queen Mary University of London, London, UK
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Electrical Stimulation Followed by Mesenchymal Stem Cells Improves Anal Sphincter Anatomy and Function in a Rat Model at a Time Remote From Injury. Dis Colon Rectum 2016; 59:434-42. [PMID: 27050606 DOI: 10.1097/dcr.0000000000000548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND We have explored cell-based therapy to aid anal sphincter repair, but a conditioning injury is required to direct stem cells to the site of injury because symptoms usually manifest at a time remote from injury. OBJECTIVE We aimed to investigate the effect of local electrical stimulation followed by mesenchymal stem cell delivery on anal sphincter regeneration at a time remote from injury. DESIGN AND MAIN OUTCOME MEASURES With the use of a rat model, electrical stimulation parameters and cell delivery route were selected based on in vivo cytokine expression and luciferase-labeled cell imaging of the anal sphincter complex. Three weeks after a partial anal sphincter excision, rats were randomly allocated to 4 groups based on different local interventions: no treatment, daily electrical stimulation for 3 days, daily stimulation for 3 days followed by stem cell injection on the third day, and daily electrical stimulation followed by stem cell injection on the first and third days. Histology-assessed anatomy and anal manometry evaluated physiology 4 weeks after intervention. RESULTS The electrical stimulation parameters that significantly upregulated gene expression of homing cytokines also achieved mesenchymal stem cell retention when injected directly in the anal sphincter complex in comparison with intravascular and intraperitoneal injections. Four weeks after intervention, there was significantly more new muscle in the area of injury and significantly improved anal resting pressure in the group that received daily electrical stimulation for 3 days followed by a single injection of 1 million stem cells on the third day at the site of injury. LIMITATION This was a pilot study and therefore was not powered for functional outcome. CONCLUSIONS In this rat injury model with optimized parameters, electrical stimulation with a single local mesenchymal stem cell injection administered 3 weeks after injury significantly improved both new muscle formation in the area of injury and anal sphincter pressures.
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Abramowitz L, Soudan D, Souffran M, Bouchard D, Castinel A, Suduca JM, Staumont G, Devulder F, Pigot F, Ganansia R, Varastet M. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Colorectal Dis 2016; 18:279-85. [PMID: 26382623 DOI: 10.1111/codi.13121] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/03/2015] [Indexed: 12/21/2022]
Abstract
AIM The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. METHOD A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. RESULTS Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0-11) and 2.0 (0-18) (P = 0.032) and the median Vaizey scores were 2.0 (0-14) and 3.0 (0-21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0-5: 88%, 86%; 6-10: 10.7%, 10.7%; 11-15: 1.0%, 2.6%; and 16-20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0-5: 86%, 66%; 6-10: 4.5%, 20%; 11-15: 9%, 11%; and 16-20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0-14) vs. 4 (0-19) (P < 0.001), and the median Vaizey scores were 1.5 (0-11) vs. 4 (0-20) (P < 0.001). Eighty-eight per cent of the patients were satisfied. CONCLUSION Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.
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Affiliation(s)
- L Abramowitz
- Proctologie Médico-Chirurgicale, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - D Soudan
- Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France
| | - M Souffran
- Service de Proctologie, Clinique Saint Augustin, Nantes, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - A Castinel
- Clinique Théodore Ducos, Bordeaux, France
| | - J M Suduca
- Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France
| | - G Staumont
- Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France
| | | | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - R Ganansia
- Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France
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Pierce H, Perry L, Chiarelli P, Gallagher R. A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. J Adv Nurs 2016; 72:1718-34. [PMID: 26887537 DOI: 10.1111/jan.12909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 11/27/2022]
Abstract
AIM To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. BACKGROUND Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity. DESIGN A systematic review of observational studies. DATA SOURCES Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014. REVIEW METHODS The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool. RESULTS Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity. CONCLUSION Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.
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Affiliation(s)
- Heather Pierce
- Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Nursing Research and Practice Development, Prince of Wales Hospital & Sydney, Sydney Eye Hospitals, New South Wales, Australia
| | - Pauline Chiarelli
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robyn Gallagher
- Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Charles Perkins Centre, Sydney School of Nursing, University of Sydney, New South Wales, Australia
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Duelund-Jakobsen J, Lehur PA, Lundby L, Wyart V, Laurberg S, Buntzen S. Sacral nerve stimulation for faecal incontinence - efficacy confirmed from a two-centre prospectively maintained database. Int J Colorectal Dis 2016; 31:421-8. [PMID: 26490052 DOI: 10.1007/s00384-015-2411-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Sacral nerve stimulation (SNS) has been recognised as an effective treatment for faecal incontinence. Many unresolved questions could be answered when comparing large data-series from different centres providing prospective data. AIM To present data, from an international two-centre SNS prospective database (SNSPD) on functional outcome and management of surgical complications in patients treated with SNS for faecal incontinence. METHOD The SNSPD was designed in order to gather detailed pre- and perioperative information followed by a close follow-up in all patients undergoing SNS for bowel dysfunction. The SNSPD was open for inclusion of newly SNS implanted patients in May 2009, and closed on 31 December 2013. Two-centres Aarhus, Denmark, and Nantes, France, included and monitored all patients implanted due to bowel dysfunction according to database criteria. RESULTS In total, 164 faecal incontinent patients with a median follow-up of 22 (range 1-50) months were implanted. The Wexner incontinence score improved from 15 (range, 3-20) at baseline to 9 (range, 0-20) at latest follow-up (P < 0.001) and VAS impact on daily life improved from 85.5 (range, 3-100) to 20 (range, 0-100) (P < 0.001). Additional surgical intervention was required in 19.5 % during follow-up. Repositioning of the pacemaker due to pain or migration was the most common complication in 12.1 %. Infections leading to explantation occurred in 3.0 %.
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Duelund-Jakobsen J, Worsoe J, Lundby L, Christensen P, Krogh K. Management of patients with faecal incontinence. Therap Adv Gastroenterol 2016; 9:86-97. [PMID: 26770270 PMCID: PMC4699277 DOI: 10.1177/1756283x15614516] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Faecal incontinence, defined as the involuntary loss of solid or liquid stool, is a common problem affecting 0.8-8.3% of the adult population. Individuals suffering from faecal incontinence often live a restricted life with reduced quality of life. The present paper is a clinically oriented review of the pathophysiology, evaluation and treatment of faecal incontinence. First-line therapy should be conservative and usually include dietary adjustments, fibre supplement, constipating agents or mini enemas. Biofeedback therapy to improve external anal sphincter function can be offered but the evidence for long-term effect is poor. There is good evidence that colonic irrigation can reduce symptoms and improve quality of life, especially in patients with neurogenic faecal incontinence. Surgical interventions should only be considered if conservative measures fail. Sacral nerve stimulation is a minimally invasive procedure with high rate of success. Advanced surgical procedures should be restricted to highly selected patients and only performed at specialist centres. A stoma should be considered if other treatment modalities fail.
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Affiliation(s)
- Jakob Duelund-Jakobsen
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Jonas Worsoe
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Denmark
| | - Lilli Lundby
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Denmark
| | - Peter Christensen
- Pelvic Floor Unit, Department of Surgery P, Aarhus University Hospital, Denmark
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
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