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Cerdán Miguel J, Arroyo Sebastián A, Codina Cazador A, de la Portilla de Juan F, de Miguel Velasco M, de San Ildefonso Pereira A, Jiménez Escovar F, Marinello F, Millán Scheiding M, Muñoz Duyos A, Ortega López M, Roig Vila JV, Salgado Mijaiel G. Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology. Cir Esp 2024; 102:158-173. [PMID: 38242231 DOI: 10.1016/j.cireng.2023.07.008] [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: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 01/21/2024]
Abstract
Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.
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Affiliation(s)
| | - Antonio Arroyo Sebastián
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Coloproctología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Antonio Codina Cazador
- Servicio de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital Universitario de Girona, Girona, Spain
| | | | | | | | | | - Franco Marinello
- Unidad de Cirugía Colorrectal, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Millán Scheiding
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Arantxa Muñoz Duyos
- Unidad de Coloproctología, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Mario Ortega López
- Unidad de Coloproctología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Chilaka C, Toozs-Hobson P, Chilaka V. Pelvic floor dysfunction and obesity. Best Pract Res Clin Obstet Gynaecol 2023; 90:102389. [PMID: 37541114 DOI: 10.1016/j.bpobgyn.2023.102389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.
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Affiliation(s)
| | | | - Victor Chilaka
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
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Gabr AA, Shalaby A, Elham Fares A, Hussein Bahaaeldin K, Nabhan Kaddah S, El Tagy G, Ahmed Gad M. Medium-term outcomes of antegrade continent enema (ACE): Cairo University Specialized Pediatric Hospital (CUSPH) experience. J Pediatr Surg 2022:S0022-3468(22)00769-2. [PMID: 36628693 DOI: 10.1016/j.jpedsurg.2022.11.016] [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: 05/17/2022] [Revised: 10/29/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
AIM OF THE STUDY To assess the medium-term outcomes of ACE in children with fecal incontinence (FI). METHOD Eligible children were recruited from the colorectal clinic between December 2016 and January 2020 and were followed prospectively for 2-6 years. A series of questionnaires were used to assess QOL, patients and parent satisfaction, and to assess the outcomes of the ACE. RESULT 24 children aged 6-12 years (mean age 8.17 ± 1.95), including 18 males (75%) and 6 females (25% were studied. Cases included anorectal malformations (45.83%)., Hirschsprung disease (25%), neural tube defects (16.66%), sacrococcygeal teratoma (4.16%), and intractable pseudoincontinence (8.33%). QOL improved from (3) [3 -3] to (16) [16-16],p < 0.05. Fecal incontinence index showed significant improvement: 20 [20-20] versus 3 [0-4],p < 0.05. Bowel symptoms demonstrated improvement in the ability to decide when to pass stools and a decrease in soiling. Stooling survey showed lower scores representing better outcome. ACE questionnaire showed that the range of irrigation volumes used by parents is wide, and that all families recommend the ACE for children with similar condition. Postoperative complications were stenosis (16.66%), stomal prolapse (12.5%), leakage (4.16%), and false passage (4.16%). Satisfaction questionnaire showed a median score of 9 (range, 5-10). CONCLUSION ACE is an effective method to keep the child with FI clean, more socially active, and with a better QOL and FII in the medium-term. The reported complications were stenosis, false passage, and leakage. ACE mucosa prolapse is a novel complication picked up on medium-term follow up.
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Affiliation(s)
- Ahmed Adel Gabr
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
| | - Aly Shalaby
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
| | | | | | | | - Gamal El Tagy
- Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
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Evolving Evidence Supporting Use of Rectal Irrigation in the Management of Bowel Dysfunction: An Integrative Literature Review. J Wound Ostomy Continence Nurs 2021; 48:553-559. [PMID: 34781312 DOI: 10.1097/won.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Disorders of bowel function are prevalent, particularly among patients with spinal cord injuries and other neurological disorders. An individual's bowel control significantly impacts quality of life, as predictable bowel function is necessary to actively and independently participate in everyday activities. For many patients with bowel dysfunction, initial lifestyle adjustments and other conservative therapeutic interventions (eg, digital stimulation, oral laxatives, suppositories) are insufficient to reestablish regular bowel function. In addition to these options, rectal irrigation (RI) is a safe and effective method of standard bowel care that has been used for several decades in adults and children suffering from bowel dysfunction associated with neurogenic or functional bowel etiologies. Rectal irrigation is an appropriate option when conservative bowel treatments are inadequate. Unlike surgical options, RI can be initiated or discontinued at any time. This report summarizes the clinical, humanistic, and economic evidence supporting the use of RI in clinical practice, noting features (eg, practical considerations, patient education) that can improve patients' success with RI treatment.
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Yates A. Faecal incontinence: a healthcare taboo. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:226-228. [PMID: 33641392 DOI: 10.12968/bjon.2021.30.4.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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Sipaviciute A, Aukstikalnis T, Samalavicius NE, Dulskas A. The Role of Traditional Acupuncture in Patients with Fecal Incontinence-Mini-Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2112. [PMID: 33671548 PMCID: PMC7927042 DOI: 10.3390/ijerph18042112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fecal incontinence affects up to 15% of the general population, with higher rates of incidence among women and the elderly. Acupuncture is an old practice of Traditional Chinese Medicine that might be used to treat fecal incontinence. The aim of this mini review was to assess the effect of acupuncture for fecal incontinence. MATERIALS AND METHODS Cochrane Library, Web of Science, Embase, PubMed, and CENTRAL electronic databases were searched until August 2020. The following keywords were used: acupuncture, electroacupuncture, moxibustion, fecal incontinence, diarrhea, irritable bowel syndrome, and bowel dysfunction. In addition, references were searched. Five studies (two randomized controlled trials), out of 52,249 predefined publications after an electronic database search, were included into the review. RESULTS Overall, 143 patients were included. All studies report significant improvements in continence, although they all apply different acupuncture regimens. Randomized controlled trials show significant differences in experimental groups treated with acupuncture in improving continence. Significant improvement in quality of life scores was reported. In addition, improvement in fecal continence remained significantly improved after 18 months of follow-up. CONCLUSION Acupuncture is a promising treatment alternative for fecal incontinence. Based on small, low-quality studies, it might be a safe, inexpensive, and efficient method. However, more high-quality studies are needed in order to apply this treatment technique routinely.
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Affiliation(s)
| | | | | | - Audrius Dulskas
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (A.S.); (T.A.); (N.E.S.)
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Chen SC, Futaba K, Leung WW, Wong C, Mak T, Ng S, Gregersen H. Simulated stool for assessment of anorectal physiology. Am J Physiol Gastrointest Liver Physiol 2020; 319:G462-G468. [PMID: 32783614 DOI: 10.1152/ajpgi.00242.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fecal continence is maintained by several mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength, mobility, and psychological factors. The homeostatic balance is easily disturbed, resulting in symptoms including fecal incontinence and constipation. Current technologies for assessment of anorectal function have limitations. Overlap exist between data obtained in different patient groups, and there is lack of correlation between measurements and symptoms. This review describes a novel technology named Fecobionics for assessment of anorectal physiology. Fecobionics is a simulated stool, capable of dynamic measurements of a variety of variables during defecation in a single examination. The data facilitate novel analysis of defecatory function as well as providing the foundation for modeling studies of anorectal behavior. The advanced analysis can enhance our physiological understanding of defecation and future interdisciplinary research for unraveling defecatory function, anorectal sensory-motor disorders, and symptoms. This is a step in the direction of improved diagnosis of anorectal diseases.
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Affiliation(s)
- Ssu-Chi Chen
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kaori Futaba
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Wa Leung
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cherry Wong
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tony Mak
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Ng
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hans Gregersen
- Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong
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Kim CN. Usefulness of Patient-Reported Outcome Measures and Anorectal Physiologic Tests in Predicting Clinical Outcome for Fecal Incontinence. Ann Coloproctol 2020; 35:289-290. [PMID: 31937067 PMCID: PMC6968716 DOI: 10.3393/ac.2019.11.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chang-Nam Kim
- Department of Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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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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Liao D, Chen AS, Lo KM, Zhao J, Futaba K, Gregersen H. Theoretical tools to analyze anorectal mechanophysiological data generated by the Fecobionics device. J Biomech Eng 2019; 141:2737406. [PMID: 31242283 DOI: 10.1115/1.4044134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 12/14/2022]
Abstract
A mechanical approach is needed for understanding anorectal function and defecation. Fecal continence is achieved by several interacting mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength, motility, and psychological factors. The balance is easily disturbed, resulting in symptoms such as fecal incontinence and constipation. Novel technologies have been developed in recent years for studying anorectal function. Especially the Fecobionics device, a simulated feces, has gained attention recently. This facilitates new analysis of anorectal mechanical function. In this study a theoretical model is developed to analyze anorectal mechanophysiological data generated by the Fecobionics device. Theoretical approaches can enhance future interdisciplinary research for unraveling defecatory function, sensory-motor disorders and symptoms. This is a step in the direction of personalized treatment for gastrointestinal disorders based on optimized subtyping of anorectal disorders.
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Affiliation(s)
- Donghua Liao
- GIOME Academia, Department of Clinical Medicine, Aarhus University, Incuba, Skejby, DK-8200 Aarhus, Denmark
| | - Abbey Sc Chen
- GIOME, Department of Surgery, 4/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kar Man Lo
- Giome DB, Unit 16D, Crystal Court, Discovery Bay, N.T., Hong Kong
| | - Jingbo Zhao
- GIOME Academia, Department of Clinical Medicine, Inkuba, Aarhus University, DK-8200 Aarhus, Denmark
| | - Kaori Futaba
- GIOME, Department of Surgery, 4/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
| | - Hans Gregersen
- GIOME, Department of Surgery, 4/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong; California Medical Innovations Institute, 11007 Roselle St., 92122 San Diego, California, USA
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Huang J, Ren Y, Wu X, Li Z, Ren J. Gut bioengineering promotes gut repair and pharmaceutical research: a review. J Tissue Eng 2019; 10:2041731419839846. [PMID: 31037215 PMCID: PMC6475831 DOI: 10.1177/2041731419839846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
The gastrointestinal (GI) tract has a diverse set of physiological functions, including peristalsis, immune defense, and nutrient absorptions. These functions are mediated by various intestinal cells such as epithelial cells, interstitial cells, smooth muscle cells, and neurocytes. The loss or dysfunction of specific cells directly results in GI disease, while supplementation of normal cells promotes gut healing. Gut bioengineering has been developing for this purpose to reconstruct the damaged tissues. Moreover, GI tract provides an accessible route for drug delivery, but the collateral damages induced by side effects cannot be ignored. Bioengineered intestinal tissues provide three-dimensional platforms that mimic the in vivo environment to study drug functions. Given the importance of gut bioengineering in current research, in this review, we summarize the advances in the technologies of gut bioengineering and their applications. We were able to identify several ground-breaking discoveries in our review, while more work is needed to promote the clinical translation of gut bioengineering.
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Affiliation(s)
- Jinjian Huang
- School of Medicine, Southeast University, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
| | - Yanhan Ren
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Xiuwen Wu
- Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
| | - Zongan Li
- School of NARI Electrical and Automation Engineering, Nanjing Normal University, Nanjing, China
| | - Jianan Ren
- School of Medicine, Southeast University, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
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Vitton V, Luciano L, Ortiz S, Baumstarck K, Bouvier M. Can wearing high heels influence anal canal pressure and the severity of fecal incontinence? Int Urogynecol J 2019; 30:2049-2054. [PMID: 30796476 DOI: 10.1007/s00192-019-03902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/05/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence. METHODS In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: "high heels" vs "no high heels." RESULTS The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with "high heels." No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure. CONCLUSIONS In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.
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Affiliation(s)
- Veronique Vitton
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Laure Luciano
- Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France. .,Department of Gastroenterology, French Military Hospital Laveran, 13384, Marseille Cedex, France.
| | - Sandra Ortiz
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
| | - Karine Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit, University Hospital, Aix-Marseille Université, APHM, Marseille, France
| | - Michel Bouvier
- Service de Gastroentérologie, CHU Nord, Aix-Marseille Université, Marseille, France
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Lal N, Simillis C, Slesser A, Kontovounisios C, Rasheed S, Tekkis PP, Tan E. A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults. Acta Chir Belg 2019; 119:1-15. [PMID: 30644337 DOI: 10.1080/00015458.2018.1549392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To perform a review of the literature reporting on randomised controlled trials (RCTs) comparing treatments for faecal incontinence (FI) in adults. METHODS A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify RCTs reporting on treatments for FI. RESULTS The review included 60 RCTs reporting on 4838 patients with a mean age ranging from 36.8 to 88 years. From the included RCTs, 32 did not identify a significant difference between the treatments compared. Contradictory results were identified in RCTs comparing percutaneous posterior tibial nerve stimulation and transcutaneous tibial nerve stimulation versus sham stimulation, biofeedback-pelvic floor muscle training (BF-PFMT) versus PFMT, and between bulking agents such as PTQTM versus Durasphere®. In two separate RCTs, combination treatment of amplitude-modulated medium frequency stimulation and electromyography-biofeedback (EMG-BF), was noted to be superior to EMG-BF and low-frequency electrical stimulation alone. Combination of non-surgical treatments such as BF with sphincteroplasty significantly improved continence scores compared to sphincteroplasty alone. Surgical treatments were associated with higher rates of serious adverse events compared to non-surgical interventions. CONCLUSIONS The current evidence has not identified significant differences between treatments for FI, and where differences were identified, the results were contradictory between RCTs.
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Affiliation(s)
- Nikhil Lal
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Constantinos Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Alistair Slesser
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shahnawaz Rasheed
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Paris P. Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Emile Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Medium-term outcome of percutaneous tibial nerve stimulation in the treatment of fecal incontinence. Tech Coloproctol 2018; 22:875-879. [PMID: 30565161 DOI: 10.1007/s10151-018-1892-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Fecal incontinence (FI) is a multifactorial disease that affects patients' quality of life. The aim of this study was to evaluate the efficacy of posterior tibial nerve stimulation (PTNS) in the treatment of FI and to assess the medium-term results. METHODS A prospective cohort of patients with FI treated with PTNS between 2012 and 2014 was analysed. Endoluminal ultrasound and anorectal physiologic studies were performed in all patients. The efficacy of PTNS was assessed using a validated questionnaire (Cleveland Clinic Incontinence Score) at baseline, after treatment, and 2 years later. The Vaizey score was also used at 2-year follow-up to assess urge incontinence. RESULTS Fifty-six patients (38 females; mean age 59.7 years) with FI were treated. The causes of FI were mainly obstetric injury and previous colorectal surgery. A decrease of 50% from baseline CCIS was seen in 41.1% of patients after PTNS. One-third maintained a minimum of 50% decrease of their initial CCIS after 2 years. Comparing CCIS at baseline, after treatment, and at 2-year follow-up, a statistically significant difference was observed (p < 0.0001 and p < 0.0004 respectively). Medium-term improvement was not maintained in patients with passive and mixed FI, while it was maintained in those with urge incontinence. At 2 years, patients with mild incontinence maintained the greatest response. CONCLUSIONS PTNS is a safe, effective, non-invasive treatment for FI with good results in almost half of the patients at the end of the treatment. There is also an acceptable maintained response at 2-year follow-up. It seems to be most successful in patients with mild incontinence and urge incontinence.
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RIOS ATAXCA BLANCAN, GARCÍA BELTRÁN CARLOSD, RODRÍGUEZ LELIS JOSÉM, OLIVARES PEREGRINO VÍCTORH, DE LA CONCHA BERMEJILLO FLORENCIO, CASTRO GÓMEZ LAURAL. A PASSIVE STATE SIMULATION OF AN ANAL SPHINCTER USING SIMMECHANICS. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nowadays, different mechanical artificial sphincters can be found implanted in human beings, trying to overcome a deficiency in the performance of the natural one. However, they do not take into account the natural anal sphincter’s (AS) dimensions, and autonomous response; they also lack in basic contraction and relaxation properties. In this paper, by addressing the AS behavior, an AS model designed with Matlab/SimMechanics is shown. The model comprises bodies of concentrated mass interconnected by springs. The mass–spring system is arranged in concentric rings where every concentrated mass is interconnected by a spring. Each spring takes specific stiffness, which varies with length, in accordance to an experimental curve. The system described can be loaded or unloaded, describing then the muscle behavior. Each element that forms the model of rings is subject to displacements caused by forces of traction and compression, when a radial force is applied from the center towards the inner ring. The springs of the inner ring experience forces of traction, whereas the springs that connect the body of the inner ring with the outer ring perpendicularly are submitted to compression forces.The data used in the proposed model corresponded to dimensions of the humanAS: width, height, rigidity, stress, tension, basically obtaining an initial deformation behavior according to the sphincter in the passive state. The model remained stable with some mechanical oscillations due to the elastic elements; by modifying one of the parameters, the behavior became unstable and unmanageable. It was verified that it is a sensitive model when modifying the initial conditions that the concrete data requires in case of reproducing the sphincter muscle with particular dimensions.
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Affiliation(s)
- BLANCA N. RIOS ATAXCA
- Department of Electronics, National Center for Research and Technological Development, Cuernavaca, Morelos, C.P. 62490, México
| | - CARLOS D. GARCÍA BELTRÁN
- Department of Electronics, National Center for Research and Technological Development, Cuernavaca, Morelos, C.P. 62490, México
| | - JOSÉ M. RODRÍGUEZ LELIS
- Department of Mechanics, National Center for Research and Technological Development, Cuernavaca, Morelos, México
| | - VÍCTOR H. OLIVARES PEREGRINO
- Department of Electronics, National Center for Research and Technological Development, Cuernavaca, Morelos, C.P. 62490, México
| | | | - LAURA L. CASTRO GÓMEZ
- Faculty of Chemical Sciences and Engineering, University Autonomous, State of Morelos, Cuernavaca, Morelos, México
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Bardsley A. Assessment, prevention and treatment of faecal incontinence in older people. Nurs Older People 2018; 30:39-47. [PMID: 30230289 DOI: 10.7748/nop.2018.e1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Abstract
Faecal incontinence is an impaired ability to control the passage of stool, often described as involuntary loss of solid or liquid stool, and the symptom of an underlying diagnosis. It is a common problem in older adults. Although not a life-threatening condition, it can have a significant negative effect on an individual's quality of life and adverse medical, social and economic consequences. Due to the taboo and stigmatising nature of the condition many individuals do not seek assistance. Healthcare professionals should take every opportunity to ask about faecal incontinence symptoms so that symptomatic relief and treatment interventions can be initiated. There are several conservative approaches available for the treatment of faecal incontinence, which should be considered as first line to target symptomatic relief.
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Yeap ZH, Simillis C, Qiu S, Ramage L, Kontovounisios C, Tekkis P. Diagnostic accuracy of anorectal manometry for fecal incontinence: a meta-analysis. Acta Chir Belg 2017; 117:347-355. [PMID: 29103343 DOI: 10.1080/00015458.2017.1394674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anorectal manometry (ARM) is conventionally used to assess patients with fecal incontinence (FI). This review aims to establish the diagnostic accuracy of ARM for FI. METHOD A search of MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library was performed. Studies examining the sensitivity and specificity of ARM measures, either individually or combined, in the diagnosis of FI, were included. Data analysis was conducted using the bivariate statistical method. RESULTS Seven studies were included out of an initial search of 1499 studies. The summary sensitivity and specificity for ARM as an overall test were 0.80 (95% confidence interval (CI): 0.69-0.88) and 0.80 (95% CI: 0.65-0.90), respectively. The diagnostic odds ratio (DOR) for ARM was found to be 16.61 (95% CI: 5.52-50.03). The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for ARM were found to be 4.09 (95% CI: 2.11-7.94) and 0.25 (95% CI: 0.14-0.42), respectively. Subgroup analysis based on four studies reporting on maximum resting pressure (MRP) demonstrated a sensitivity, specificity, DOR, PLR and NLR of 0.60 (95% CI: 0.38-0.79), 0.93 (95% CI: 0.80-0.97), 20.0 (95% CI: 4.00-91.00), 8.60 (95% CI: 3.00-24.30) and 0.43 (95% CI: 0.24-0.76), respectively. CONCLUSION ARM has been shown to be an accurate test for diagnosing FI. Further studies are required to establish the diagnostic accuracy of individual ARM measures.
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Affiliation(s)
- Zhu Hui Yeap
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Constantinos Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Shengyang Qiu
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Lisa Ramage
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Paris Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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Weledji EP. Electrophysiological Basis of Fecal Incontinence and Its Implications for Treatment. Ann Coloproctol 2017; 33:161-168. [PMID: 29159162 PMCID: PMC5683965 DOI: 10.3393/ac.2017.33.5.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
Abstract
The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%-80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery and Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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de Sousa HA, da Silva MDG, Barbosa KDP, Vianna LMDS, Pacheco YG, de Godoy JRP, Kuckelhaus SAS. Electrical stimulation structurally affects the tissues of the rectum and anus of nulliparous rats. J Anat 2017; 231:398-404. [PMID: 28547814 PMCID: PMC5554829 DOI: 10.1111/joa.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
Considering that the muscles of the anus perform a critical role in maintaining continence, losses in their structure can negatively affect the physiological control of the intestinal contents. Anorectal electro-stimulation (ARES) has been reported to have a positive effect on the functionality of treated patients, but how ARES affects the structural tissues of the anorectal segment remains unknown. Because the study of how ARES structurally affects human tissues is not possible, this study aimed to clarify these effects in a murine model, which has a similar anorectal segment (structure and physiology) to humans. For the descriptive and comparative study, randomly selected nulliparous adult Wistar rats (n = 5) were submitted to 30 anorectal sessions of ARES with a biphasic current (700 μs, 50 Hz from 2 to 4 mA). After treatment, the animals were euthanized, and the anorectal segments were dissected and processed for histopathological analysis. Our results showed that ARES increased the widths of the mucosal, submucosal and muscle layers of the rectum, as well as the number of leukocytes in the mucosa. ARES also caused hyperplasia of the smooth muscle of the internal anal sphincter and hypertrophy of the external anal sphincter muscle. In conclusion, our results showed that ARES had not only a positive effect on the structure (morphology) of all tissues associated with the rectum and anus but, more importantly, on the structural gain of the muscles (hyperplasia and hypertrophy), which could point to a functional gain of the anal sphincter, reinforcing the applicability of ARES as a non-invasive treatment for anal incontinence.
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Affiliation(s)
- Hugo Alves de Sousa
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - Maria da Glória da Silva
- Laboratory of HistologyArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | | | | | - Yolanda Galindo Pacheco
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - José Roberto Pimenta de Godoy
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
| | - Selma Aparecida Souza Kuckelhaus
- Laboratory of Molecular Anatomy and NanomedicineArea of MorphologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
- Laboratory of Cell ImmunologyArea of PathologyFaculty of MedicineUniversity of BrasiliaBrasiliaFederal DistrictBrazil
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Prospective evaluation of transanal irrigation for fecal incontinence and constipation. Tech Coloproctol 2017; 21:363-371. [PMID: 28550422 DOI: 10.1007/s10151-017-1635-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/17/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the effect of transanal irrigation on bowel function and quality of life in a prospective cohort of Danish patients with fecal incontinence or constipation. METHODS Patients with fecal incontinence or constipation of heterogeneous origin were treated by a specialist nurse at the Anal Physiology Clinic/Department of Surgery at Aarhus University Hospital, Aarhus, Denmark. If satisfactory results were not obtained after conservative bowel management, patients were instructed in the use the transanal irrigation procedure and were consecutively recruited for this observational cohort study in the period from March 2010 to September 2013. Patients completed questionnaires regarding bowel function, quality of life and the transanal irrigation procedure at baseline and after 12 months. RESULTS A total of 507 were introduced to transanal irrigation. Eighty-three percent were females. The median age was 56 (range 19-86) years. At follow-up, 216 (43%) patients still used transanal irrigation, 174 (34%) reported that they had discontinued the treatment for various reasons, while no response was obtained from the remaining 117 (23%) patients. The main reason for not adhering to the treatment was an unsatisfactory outcome, which was reported by 86 (49.4%) of those who discontinued the treatment. Among patients still using the procedure at follow-up, a statistically significant improvement of bowel function scores (St. Marks/Wexner incontinence score, Wexner constipation score and obstructed defecation syndrome score) was detected: the Wexner incontinence score decreased from 12.4 at baseline to 10.2 at follow-up (p < 0.001); the St. Marks incontinence score decreased from 14.9 to 12.7 (p < 0.001); the Wexner constipation score decreased from 14.3 to 12.4 (p < 0.001); and the obstructed defecation syndrome score also dropped, from 15.1 to 11.8 (p < 0.001). Furthermore, the influence of bowel dysfunction on daily activities and quality of life diminished significantly, while the general satisfaction with bowel function increased significantly (p < 0.001 in all three measures). CONCLUSIONS Bowel function and quality of life improved in the group of patients adhering to transanal irrigation after 12 months. However, more than one-third of the patients discontinued the treatment within the first year with transanal irrigation. Thus, further studies are needed in order to identify factors predicting success and failure with this treatment and to improve supervision during initiation and follow-up.
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