Current Management of Fecal Incontinence

Wang, Jennifer Y.; Abbas, Maher A.

doi:10.7812/tpp/12-064

Cited by 33 publications

(33 citation statements)

References 43 publications

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“…There are a few options for the management of rectal hypersensitivity, that include biofeedback or pharmacological treatment such as loperamide or tricyclic antidepressants. 4 Amitriptyline is a tricyclic antidepressant and it is believed that this drug decreases pain ratings in response to rectal distension by reducing activation of a specific area of the brain that is activated during painful rectal distention. …”

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confidence: 99%

Rectal hypersensitivity in patients with quiescent ulcerative colitis

Casanova

Santander

Gisbert

2015

ECCOJC

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Faecal urgency and faecal incontinence in patients with ulcerative colitis [UC] cannot always be explained by the presence of mucosal inflammation. We report two cases of patients diagnosed with UC with mucosal healing, who developed faecal urgency and faecal incontinence secondary to rectal hypersensitivity.A 40-year-old man was diagnosed with left-sided UC in 2005. After a step-up therapeutic approach, the remission of disease was finally induced with infliximab. After 3 years in remission, the patient complained of faecal incontinence. After a colonoscopy, disease activity was ruled out. Anorectal manometry was performed and revealed that both the sensation of urgency to defaecate and the maximum tolerable volume were below the reference values. The patient was diagnosed with rectal hypersensitivity. As symptoms might be worsened by the administration of rectal 5-aminosalicylic acid [ASA], the rectal treatment was stopped and the faecal symptoms disappeared.A-56-year-old man was diagnosed with UC in 2005 and started azathioprine in 2008 owing to cortico-dependency. After 2 years in remission, he complained of faecal urgency and faecal incontinence. A colonoscopy revealed quiescent disease. Anorectal manometry was performed and showed that the maximum tolerable volume was below the reference values and that the rectal sensory threshold was decreased. The patient was diagnosed with rectal hypersensitivity. Treatment with amitriptyline 25 mg/day was started and, after 6 months of treatment, the patient became asymptomatic.Patients with UC may have colonic motility dysfunction that can play an important role in the genesis of symptoms.1 Rectal sensation is an important factor in the defaecatory process. Distension of the rectum initiates rectal wall contractions and creates a desire to defaecate. Anorectal dysfunction is a form of colonic dysmotility that produces faecal urgency and faecal incontinence in patients with quiescent UC, even in the absence of disease activity and inflammation.2 This should be suspected in patients who complain about these symptoms despite having a normal endoscopy. It is thought that rectal hypersensitivity may be responsible for the heightened perception of rectal filling and this may act as a trigger for faecal urgency. There are a few options for the management of rectal hypersensitivity, that include biofeedback or pharmacological treatment such as loperamide or tricyclic antidepressants. 4 Amitriptyline is a tricyclic antidepressant and it is believed that this drug decreases pain ratings in response to rectal distension by reducing activation of a specific area of the brain that is activated during painful rectal distention. 5In conclusion, anorectal hypersensitivity is a rectal dysfunction that can be present in patients with UC. It should be suspected when symptoms such as faecal urgency and faecal incontinence persist after ruling out disease activity, in order to provide appropriate treatment to the patient and to improve both their symptoms and their quality of life. Fundi...

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confidence: 99%

Rectal hypersensitivity in patients with quiescent ulcerative colitis

Casanova

Santander

Gisbert

2015

ECCOJC

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“…[14][15] Dietary adjustments, conformity of medications, and a trial of biofeedback ought to be the first line of treatment in many patients. 13 In this study, Application of biofeedback as a non-surgical management of the FI has shown a significant effect on the improvement of FI symptoms together with improvement of anorectal manometric parameters over the follow up period. Among the 14 studied patients, 6 (42.8%) showed excellent response (cured), 5 (35.7%) showed good response (improved) and 3 patients (21.5%) showed poor response, With a satisfactory result (either with excellent or good response) in management of 11 patients (78.5%).…”

Section: Discussionmentioning

confidence: 98%

“…12 Management of FI includes a variety of options ranging from conservative to surgical management, Conservative non-surgical measures include life style patient education, dietary management, Pharmacological agents, pelvic floor exercises, and biofeedback. 13 Biofeedback is cheap, generally safe, and effortlessly endured by most patients, and achievement rates can be as high as 100%. [14][15] Dietary adjustments, conformity of medications, and a trial of biofeedback ought to be the first line of treatment in many patients.…”

Section: Discussionmentioning

confidence: 99%

Role of recto-anal biofeedback in management of fecal incontinence: early experience for prospective non-surgical management

Marzouk

2017

Int Surg J

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Background: Fecal incontinence is a difficult and debilitating problem with various nonsurgical and surgical modes of treatment. Biofeedback is among the most considerable nonoperative strategies. This study is to review of the short-term effectiveness of the use of biofeedback therapy in management of fecal incontinence.Methods: A retrospective review of 14 patients with fecal incontinence were included and completed the planned biofeedback sessions regarding clinical response and change in anorectal manometric parameters.Results: 14 incontinent patients (9 males and 5 females), mean age 38.0 ± 21.4 years, 6 patients (42.8%) showed excellent response (cured), 5 patients (35.7%) showed good response (improved) and 3 patients (21.5%) showed poor response. There were a highly significant decrease in the grade with mean 3.8±1.4 to 2.4±1.7 (P value =0.003) and a score mean 11.8±5.9 to 6.1±7.1 (P value = 0.002). increase in anal resting pressure by mean 33.6±18.1 mmHg (P value = 0.004) and anal squeeze pressure by mean 75.4±35.2 mmHg (P value = 0.002). Also increase in anal resting pressure from 36.2±13.4 mmHg to 46.0±19.7 mmHg (P value = 0.046) and the anal squeeze pressure 89.3±21.8 mmHg to 106.7±21.0 mmHg (P value = 0.026). the volume required for 1st sensation mean 34.6±10.8 cc. decreased to 29.3±9.4 cc. (P value = 0.048) and the maximum tolerable volume increases from 221.4±55.9 cc to 235.7±54.9 cc (P-value = 0.022).Conclusions: Biofeedback therapy has an effective role in short term efficacy in management of fecal incontinence.

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“…It is also important to look for use of accessory muscles (buttocks), which may be used to augment squeeze and serve as a marker for decreased function. Nerve function may be assessed by evaluating the anocutaneous reflex, which is a brief contraction of the EAS when the perianal skin is lightly stroked and indicates the presence or absence of intact sensory and motor innervation [58]. Proctosigmoidoscopy is done to exclude neoplasm, evidence of ulcerative colitis or Crohn's disease, solitary rectal ulcer, or other disease states.…”

Section: Management Evaluationmentioning

confidence: 99%

“…The desire to pursue treatment of fecal incontinence depends primarily on the patient's subjective symptoms and quality of life. A number of incontinence scales are available to help objectify these symptoms including the Cleveland Clinic Florida Fecal Incontinence (CCF-FI) scale, the Fecal Incontinence Severity Index, and the Fecal Incontinence Quality of Life Scale [58].…”

Section: Management Evaluationmentioning

confidence: 99%