Fecal Incontinence in Men

Burgell, Rebecca; Bhan, Chetan; Lunniss, Peter J.; Scott, S. M.

doi:10.1097/dcr.0b013e318237f37d

Cited by 49 publications

(17 citation statements)

References 31 publications

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“…In patients with symptoms of evacuatory dysfunction, RH is more common in individuals with 'functional' obstructive features on proctography (eg, dyssynergic defecation; poor defecatory dynamics), rather than those with obstructive structural phenomena,37,38 with recent studies showing that RH is not associated with mechanical obstruction as a result of either rectocoele39 or intussusceptions 38. In adult incontinent patients, RH is more frequently seen in conjunction with functional sphincter abnormalities (ie, incompetent, but structurally intact) and also increased prevalence of constipation symptoms,37 suggesting that the incontinence may be a secondary phenomenon (as clearly recognised in both pediatric and geriatric populations).…”

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

“…In adult incontinent patients, RH is more frequently seen in conjunction with functional sphincter abnormalities (ie, incompetent, but structurally intact) and also increased prevalence of constipation symptoms,37 suggesting that the incontinence may be a secondary phenomenon (as clearly recognised in both pediatric and geriatric populations). Incontinent patients with RH are also more likely to have impaired evacuation (ie, prolonged defecation or incomplete rectal emptying on proctography37). In pediatric patients, two-thirds of those with fecal retentive disorders have abnormal sensation thresholds on volumetric studies,15 although more detailed barostat studies indicate that this is predominantly related to rectal wall biomechanical abnormalities such as megarectum or hypercompliance of the rectal wall 40…”

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

“…Secondarily, RH may underscore rectal evacuatory dysfunction (RED) in a significant proportion of patients. A number of studies17,33,37 have now shown RH to be associated with a 'functional' RED, manifest as abnormal defecatory dynamics in up to 32%,33 most commonly poor expulsive effort, failure of the anal canal to relax, or development of a hyperacute anorectal angle with straining (ie, pelvic floor dyssynergia),81 all of which result in inadequate rectal emptying. This indicates that intact sensation is critical to appropriate recto-anal and pelvic floor co-ordination 56.…”

Section: Role Of Rectal Hyposensitivity In the Development Of Hindgutmentioning

confidence: 99%

“…Even in the absence of rectal impaction, RH may contribute to the development of FI via impairment of the reflexive or conscious contraction of the anal sphincters; patients with RH have reflexive relaxation of the internal anal sphincter at volumes lower than that required to induce rectal sensation,91,92 and thus conscious deferral of defecation may not be possible 87. They are also likely to have a functional sphincter defects (ie, reduced manometric pressures in the absence of structural sphincter damage) and pelvic floor dyssynergia 33,37. Finally, RH may contribute to FI through its association with pelvic floor weakness and sphincter incompetence, perhaps related to pelvic nerve damage (see above) 87…”

Section: Role Of Rectal Hyposensitivity In the Development Of Hindgutmentioning

confidence: 99%

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Rectal Hyposensitivity

Burgell¹,

Scott²

2012

J Neurogastroenterol Motil

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Impaired or blunted rectal sensation, termed rectal hyposensitivity (RH), which is defined clinically as elevated sensory thresholds to rectal balloon distension, is associated with disorders of hindgut function, characterised primarily by symptoms of constipation and fecal incontinence. However, its role in symptom generation and the pathogenetic mechanisms underlying the sensory dysfunction remain incompletely understood, although there is evidence that RH may be due to 'primary' disruption of the afferent pathway, 'secondary' to abnormal rectal biomechanics, or to both. Nevertheless, correction of RH by various interventions (behavioural, neuromodulation, surgical) is associated with, and may be responsible for, symptomatic improvement. This review provides a contemporary overview of RH, focusing on diagnosis, clinical associations, pathophysiology, and treatment paradigms.

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Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

Section: Prevalence and Associated Conditionsmentioning

confidence: 99%

Section: Role Of Rectal Hyposensitivity In the Development Of Hindgutmentioning

confidence: 99%

Section: Role Of Rectal Hyposensitivity In the Development Of Hindgutmentioning

confidence: 99%

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Rectal Hyposensitivity

Burgell¹,

Scott²

2012

J Neurogastroenterol Motil

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Sacral nerve stimulation for faecal incontinence and constipation in adults

Thaha

Abukar

Thin

et al. 2015

Cochrane Database of Systematic Reviews

137

103

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The limited evidence from the included trials suggests that SNS can improve continence in a proportion of patients with faecal incontinence. However, SNS did not improve symptoms in patients with constipation. In addition, adverse events occurred in some patients where these were reported. Rigorous high quality randomised trials are needed to allow the effects of SNS for these conditions to be assessed with more certainty.

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Dietary exclusion of fructose and lactose after positive breath tests improved rapid‐transit constipation in children

et al. 2018

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Declaration of conflict of interest: JH is the treating physician for the patients, and the questionnaire was sent to parents to assess the outcomes of treatment. The questionnaire was filled in online and was not anonymous. Data were deidentified for this study. KW and BS had no relationship to patients and analyzed deidentified data. Less than half of the patients returned questionnaires. Author contribution: KW collated and analyzed the data and wrote the first draft. CL, VP, and JW created the 'Google Poll' questionnaire and data collection link and collected data into an Excel file. JH cosupervised KW. He was the treating physician, organized the transit studies and breath tests and interpreted the results, advised the parents on what to exclude from their child's diet, and suggested they contact dietitians/nutritionists for support. He designed the questionnaire; organized the format with CL, VP, and JW; and sent the questionnaires out to patients. He designed the study and edited drafts. BS supervised KW, supervised data collection and analysis, supervised writing the first draft, and edited drafts. BS had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the analysis. AbstractAims: Exclusion of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is effective in alleviating symptoms of irritable bowel syndrome (IBS) in adults. Rapid-transit constipation (RTC) is a recently discovered subset of chronic constipation and has been linked to food intolerance. The aim of this study was to audit the effect of specific FODMAP elimination diets in children with RTC. Methods: This was an audit of children presenting to a tertiary children's hospital surgeon with refractory chronic constipation who had rapid transit in the proximal colon on nuclear imaging; had hydrogen/methane breath tests for fructose, lactose, and/or sorbitol intolerance; and were advised to exclude positive sugar under clinical supervision. Patients filled in a questionnaire rating severity of constipation, abdominal pain, and pain on defecation with a visual analogue scale (VAS, 0 = none, 10 = high) and stool consistency for 6 months before and after dietary exclusion. Results: In responses from 29 children (5-15 years, 21 males), 70% eliminated fructose, and 40% eliminated lactose. There was a significant reduction in the severity of constipation (VAS mean AE SEM, pre 5.8 AE 0.5 vs post 3.3 AE 0.6, P < 0.0001), abdominal pain (5.1 AE 0.6 vs 2.8 AE 0.5, P = 0.0004), pain on defecation (5.8 AE 0.6 vs 2.6 AE 0.5, P < 0.0001), and increase in stool wetness (Bristol Stool Scale pre 3.3 AE 0.3 vs post 3.9 AE 0.2, P = 0.004). Conclusion: Children with RTC showed significant improvements in constipation and pain after excluding the sugar indicated by positive breath tests, suggesting that specific sugar-exclusion diets may have a role in the management of RTC in children.

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Fecal Incontinence in Men

Cited by 49 publications

References 31 publications

Rectal Hyposensitivity

Rectal Hyposensitivity

Sacral nerve stimulation for faecal incontinence and constipation in adults

Dietary exclusion of fructose and lactose after positive breath tests improved rapid‐transit constipation in children

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