Stuhlinkontinenz: Therapieoptionen

Abstract

Diagnosis and management of fecal incontinence requires exact understanding of the anatomic and pathophysiologic principles involved and demands a methodical, stepwise approach. Despite the potential appeal of surgical intervention, a considerable number of patients can be helped by comparatively simple, noninvasive measures. Initial treatment should be medical, including biofeedback in combination with a bowel management program. In the presence of a severely denervated pelvic floor, physiotherapeutic techniques rarely give rise to a satisfactory and long-lasting response. Obvious external sphincter defects and patients who failed medical management are treated surgically. Many injuries of the external sphincter can be treated by direct sphincter repair. If patients with intact external sphincters are unresponsive to medical measures, descending perineum and resultant idiopathic fecal incontinence will improve by radio-frequency delivery, sacral nerve stimulation, or postanal plication. Patients with complex neurologic disorders or extensive sphincter defects or who have undergone previous unsuccessful attempts at repair of the puborectalis itself should be considered for dynamic gracilis plastic or an artificial sphincter.

Electrical stimulation and biofeedback for the treatment of fecal incontinence: a systematic review

“…We identified 128 potentially relevant studies from titles and abstracts (Supplementary Fig. S 1 ), including several systematic reviews (Supplementary Table S 1 ) [ 4 , 17 , 19 , 23 – 36 ]. Twenty-three studies were retrospective chart reviews or prospective case series [ 37 – 59 ], and four current trials [ 60 – 63 ] were found in trial registries, but not in the literature.…”