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Published in: Current Obstetrics and Gynecology Reports 3/2014

01-09-2014 | Pelvic Organ Prolapse (KL Noblett, Section Editor)

An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women

Authors: Isuzu Meyer, Holly E. Richter

Published in: Current Obstetrics and Gynecology Reports | Issue 3/2014

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Abstract

Fecal incontinence (FI) is a debilitating disorder that negatively impacts quality of life. The etiology often is multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI also can be hindered by a lack of understanding of the mechanisms and current options. This article provides a review of the evidence-based evaluation and management for FI.
Literature
2.
go back to reference Markland AD, Richter HE, Burgio KL, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J. 2011;22(9):1151–7.PubMedCentralPubMedCrossRef Markland AD, Richter HE, Burgio KL, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J. 2011;22(9):1151–7.PubMedCentralPubMedCrossRef
4.
go back to reference Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111:678–85.PubMedCrossRef Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111:678–85.PubMedCrossRef
5.
go back to reference Gleason JL, Markland AD, Greer WJ, et al. Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures. Int Urogynecol J. 2011;22(12):1587–92.PubMedCentralPubMedCrossRef Gleason JL, Markland AD, Greer WJ, et al. Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures. Int Urogynecol J. 2011;22(12):1587–92.PubMedCentralPubMedCrossRef
6.
7.
go back to reference Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58:1341.PubMedCentralPubMedCrossRef Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58:1341.PubMedCentralPubMedCrossRef
9.
go back to reference Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66(11):1101–8.PubMedCrossRef Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66(11):1101–8.PubMedCrossRef
10.
go back to reference Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.10.PubMedCrossRef Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.10.PubMedCrossRef
11.
go back to reference Brown HW, Wexner SD, Segall MM, et al. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract. 2012;66(11):1109–16.PubMedCrossRef Brown HW, Wexner SD, Segall MM, et al. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract. 2012;66(11):1109–16.PubMedCrossRef
12.
go back to reference Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4.PubMed Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4.PubMed
13.
go back to reference Rao SSC, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gasteroenterol. 1997;92:469–75. Rao SSC, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gasteroenterol. 1997;92:469–75.
14.
go back to reference Rao SSC. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence Am J Gastroenterol. 2004;99:1585–604.CrossRef Rao SSC. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence Am J Gastroenterol. 2004;99:1585–604.CrossRef
15.
go back to reference Watson NFS, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012;14(suppl3):29–33.PubMedCrossRef Watson NFS, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012;14(suppl3):29–33.PubMedCrossRef
16.
go back to reference Thekkinkattil DK, Dunham RJ, O’Herlihy S, et al. Measurement of anal cushions in idiopathic faecal incontinence. Br J Surg. 2009;96:680–4.PubMedCrossRef Thekkinkattil DK, Dunham RJ, O’Herlihy S, et al. Measurement of anal cushions in idiopathic faecal incontinence. Br J Surg. 2009;96:680–4.PubMedCrossRef
17.
go back to reference Thekkinkattil DK, Lim M, Stojkovic SG, et al. A classification system for faecal incontinence based on anorectal investigations. Br J Surg. 2008;95:222–8.PubMedCrossRef Thekkinkattil DK, Lim M, Stojkovic SG, et al. A classification system for faecal incontinence based on anorectal investigations. Br J Surg. 2008;95:222–8.PubMedCrossRef
18.
go back to reference Stojkovic SG, Lim M, Burke D, et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg. 2006;93:1514–8.PubMedCrossRef Stojkovic SG, Lim M, Burke D, et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg. 2006;93:1514–8.PubMedCrossRef
19.•
go back to reference Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg. 2011;24(1):64–70. This article provides a comprehensive review on current recommendations regarding evaluation and treatment of fecal incontinence from the colorectal surgery prospective.PubMedCentralPubMedCrossRef Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg. 2011;24(1):64–70. This article provides a comprehensive review on current recommendations regarding evaluation and treatment of fecal incontinence from the colorectal surgery prospective.PubMedCentralPubMedCrossRef
20.
21.
go back to reference Pretlove SJ, Thompson PJ, Toozs-Hobson PM, et al. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review BJOG. 2008;115:421. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, et al. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review BJOG. 2008;115:421.
22.
go back to reference Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010;CD006756. Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010;CD006756.
23.
go back to reference Handa VL, Blomquist JL, Knoepp LR, et al. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777.PubMedCentralPubMed Handa VL, Blomquist JL, Knoepp LR, et al. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777.PubMedCentralPubMed
24.
go back to reference MacArthur C, Glazener C, Lancashire R, et al. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG. 2011;118:1001.PubMedCrossRef MacArthur C, Glazener C, Lancashire R, et al. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG. 2011;118:1001.PubMedCrossRef
25.•
go back to reference Hehir MP, O’Connor HD, Higgins S, et al. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26(15):1514–6. This prospective observational study from 2003 to 2010 compares the incident rates based on potential risk factors for obstetric anal sphincter injury (OASIS) and demonstrates that OASIS remains a significant cause of maternal morbidity.PubMedCrossRef Hehir MP, O’Connor HD, Higgins S, et al. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26(15):1514–6. This prospective observational study from 2003 to 2010 compares the incident rates based on potential risk factors for obstetric anal sphincter injury (OASIS) and demonstrates that OASIS remains a significant cause of maternal morbidity.PubMedCrossRef
26.
go back to reference Baumann P, Hammoud AO, McNeeley SG, et al. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:985.PubMedCrossRef Baumann P, Hammoud AO, McNeeley SG, et al. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:985.PubMedCrossRef
27.
go back to reference Minaglia SM, Ozel B, Gatto NM, et al. Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1399.PubMedCrossRef Minaglia SM, Ozel B, Gatto NM, et al. Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1399.PubMedCrossRef
28.
go back to reference Sultan AH, Kamm MA, Hudson CN, et al. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887.PubMedCentralPubMedCrossRef Sultan AH, Kamm MA, Hudson CN, et al. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887.PubMedCentralPubMedCrossRef
29.
go back to reference Nager CW, Helliwell JP. Episiotomy increases perineal laceration length in primiparous women. Am J Obstet Gynecol. 2001;185:444.PubMedCrossRef Nager CW, Helliwell JP. Episiotomy increases perineal laceration length in primiparous women. Am J Obstet Gynecol. 2001;185:444.PubMedCrossRef
30.
go back to reference Fenner DE, Genberg B, Brahma P, et al. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189:1543.PubMedCrossRef Fenner DE, Genberg B, Brahma P, et al. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189:1543.PubMedCrossRef
31.
go back to reference Sultan AH, Kamm MA, Hudson CN, et al. Anal sphincter disruption during vaginal delivery. New Engl J Med. 1993;329:1905–11.PubMedCrossRef Sultan AH, Kamm MA, Hudson CN, et al. Anal sphincter disruption during vaginal delivery. New Engl J Med. 1993;329:1905–11.PubMedCrossRef
32.
go back to reference Varma A, Gunn J, Gardiner A, et al. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum. 1999;42:1261–4.PubMedCrossRef Varma A, Gunn J, Gardiner A, et al. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum. 1999;42:1261–4.PubMedCrossRef
33.
go back to reference Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:917.PubMedCrossRef Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:917.PubMedCrossRef
34.
go back to reference Cesarean delivery on maternal request. Committee Opinion No 559. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:904–7 Cesarean delivery on maternal request. Committee Opinion No 559. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:904–7
35.
go back to reference Elfaghi I, Johansson-Ernste B, Rydhstroem H. Rupture of the sphincter ani: the recurrence rate in second delivery. BJOG. 2004;111:1361.PubMedCrossRef Elfaghi I, Johansson-Ernste B, Rydhstroem H. Rupture of the sphincter ani: the recurrence rate in second delivery. BJOG. 2004;111:1361.PubMedCrossRef
36.
go back to reference McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003;189:1251.PubMedCrossRef McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003;189:1251.PubMedCrossRef
37.
go back to reference Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43(6):352–6.PubMedCrossRef Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43(6):352–6.PubMedCrossRef
38.
go back to reference Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am. 1987;16:17.PubMed Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am. 1987;16:17.PubMed
39.
go back to reference Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum. 2010;53:1656.PubMedCrossRef Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum. 2010;53:1656.PubMedCrossRef
40.
go back to reference Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM. Investigation of anorectal function. Br J Surg. 1988;75:53–5.PubMedCrossRef Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM. Investigation of anorectal function. Br J Surg. 1988;75:53–5.PubMedCrossRef
41.
go back to reference Eckhardt VF, Kanzler G. How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis. 1993;8:95–7.CrossRef Eckhardt VF, Kanzler G. How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis. 1993;8:95–7.CrossRef
42.
go back to reference Hill J, Corson RJ, Brandon H, et al. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(5):473–7.PubMedCrossRef Hill J, Corson RJ, Brandon H, et al. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(5):473–7.PubMedCrossRef
43.
go back to reference Rao SSC. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Gastroenterol Hepatol. 2008;2:323–5. Rao SSC. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Gastroenterol Hepatol. 2008;2:323–5.
44.
go back to reference Zutshi M, Salcedo L, Hammel J, et al. Anal physiologic testing in fecal incontinence: is it of any value? Int J Colorectal Dis. 2010;25(2):277–82.PubMedCrossRef Zutshi M, Salcedo L, Hammel J, et al. Anal physiologic testing in fecal incontinence: is it of any value? Int J Colorectal Dis. 2010;25(2):277–82.PubMedCrossRef
45.
go back to reference Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Br J Surg. 1994;160:167–74. Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Br J Surg. 1994;160:167–74.
46.
go back to reference Keating JP, Stewart PJ, Eyers AA, et al. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum. 1997;40:896.PubMedCrossRef Keating JP, Stewart PJ, Eyers AA, et al. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum. 1997;40:896.PubMedCrossRef
47.•
go back to reference Costilla VC, Foxx-Orenstein AE, Mayer AP, et al. Office-based management of fecal incontinence. Gastroenterol Hepatol. 2013;9(7):423–33. This article attempts to provide an up-to-date comprehensive review of office-based management of fecal incontinence from the gastroenterology perspective. Costilla VC, Foxx-Orenstein AE, Mayer AP, et al. Office-based management of fecal incontinence. Gastroenterol Hepatol. 2013;9(7):423–33. This article attempts to provide an up-to-date comprehensive review of office-based management of fecal incontinence from the gastroenterology perspective.
48.
go back to reference Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association Gastroenterology. 1999;116:732. Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association Gastroenterology. 1999;116:732.
49.
go back to reference Remes-Troche JM, Rao SSC. Neurophysiological testing in anorectal disorders. Gastroenterol Hepatol. 2008;2:323–35. Remes-Troche JM, Rao SSC. Neurophysiological testing in anorectal disorders. Gastroenterol Hepatol. 2008;2:323–35.
50.
go back to reference Gurland B, Hull T. Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg. 2008;21(3):157–66.PubMedCentralPubMedCrossRef Gurland B, Hull T. Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg. 2008;21(3):157–66.PubMedCentralPubMedCrossRef
51.
go back to reference Rao SSC, Sun WM. Current techniques of assessing defecation dynamics. Dig Dis. 1997;15(Suppl1):64–7.PubMedCrossRef Rao SSC, Sun WM. Current techniques of assessing defecation dynamics. Dig Dis. 1997;15(Suppl1):64–7.PubMedCrossRef
52.
go back to reference Rao SSC, Hatfield R, Leistikow J, et al. Manometric tests of anorectal function in healthy humans. Am J Gastroenterol. 1999;116:735–60. Rao SSC, Hatfield R, Leistikow J, et al. Manometric tests of anorectal function in healthy humans. Am J Gastroenterol. 1999;116:735–60.
53.
go back to reference Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: A simultaneous comparison with water-perfused manometry. Am J Gastroenterol. 2007;102:850–5.PubMedCrossRef Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: A simultaneous comparison with water-perfused manometry. Am J Gastroenterol. 2007;102:850–5.PubMedCrossRef
54.
go back to reference Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–4.PubMedCrossRef Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–4.PubMedCrossRef
55.
go back to reference Bartrum C. Radiological evaluation of anorectal disorders. In: Rao SCC, ed. Disorders of anorectum. Gastroenterol Clin North Am. W.B. Saunders, 2001;30(1):55–76 Bartrum C. Radiological evaluation of anorectal disorders. In: Rao SCC, ed. Disorders of anorectum. Gastroenterol Clin North Am. W.B. Saunders, 2001;30(1):55–76
56.
go back to reference Williams AB, Bartram CI, Halligan S, et al. Anal sphincter damage after vaginal delivery using three dimensional endosonography. Obstet Gynecol. 2001;97:770–5.PubMedCrossRef Williams AB, Bartram CI, Halligan S, et al. Anal sphincter damage after vaginal delivery using three dimensional endosonography. Obstet Gynecol. 2001;97:770–5.PubMedCrossRef
57.
go back to reference Sentovich SM, Wong WD, Blatchford GJ. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury. Dis Colon Rectum. 1998;41:1000–4.PubMedCrossRef Sentovich SM, Wong WD, Blatchford GJ. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury. Dis Colon Rectum. 1998;41:1000–4.PubMedCrossRef
58.
go back to reference Oberwalder M, Thaler K, Baig M, et al. Anal ultrasound and endo sonographic measurements of perineal body thickness: a new evaluation for fecal incontinence in females. Surg Endosc. 2004;18:650–4.PubMedCrossRef Oberwalder M, Thaler K, Baig M, et al. Anal ultrasound and endo sonographic measurements of perineal body thickness: a new evaluation for fecal incontinence in females. Surg Endosc. 2004;18:650–4.PubMedCrossRef
59.
go back to reference Rose S, Magnotta J, Kim R. Anorectal manometry pressures do not predict the results of endoanal ultrasound in patients with fecal incontinence (abstract). Gastroenterology. 1996;110:747. Rose S, Magnotta J, Kim R. Anorectal manometry pressures do not predict the results of endoanal ultrasound in patients with fecal incontinence (abstract). Gastroenterology. 1996;110:747.
60.
go back to reference Voyvodic F, Rieger N, Skinner S, et al. Endosonographic imaging of anal sphincter injuries: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum. 2003;46:735–41.PubMedCrossRef Voyvodic F, Rieger N, Skinner S, et al. Endosonographic imaging of anal sphincter injuries: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum. 2003;46:735–41.PubMedCrossRef
61.
go back to reference Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007;22(7):783–90.PubMedCrossRef Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007;22(7):783–90.PubMedCrossRef
62.•
go back to reference Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85(1015):865–75. The endoanal ultrasound is currently considered the gold standard for evaluating anal sphincter pathology in evaluation of anal incontinence. The article provides a comprehensive review of the different ultrasound modalities in evaluating anal sphincter integrity based on a MEDLINE literature search.PubMedCentralPubMedCrossRef Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85(1015):865–75. The endoanal ultrasound is currently considered the gold standard for evaluating anal sphincter pathology in evaluation of anal incontinence. The article provides a comprehensive review of the different ultrasound modalities in evaluating anal sphincter integrity based on a MEDLINE literature search.PubMedCentralPubMedCrossRef
63.
go back to reference Remes-Troche JM, Paulson J, Attaluri A, et al. A comprehensive assessment of the efferent motor pathways to the anorectum in humans. Neuorgastroenterol Motil. 2007;19:A330. Remes-Troche JM, Paulson J, Attaluri A, et al. A comprehensive assessment of the efferent motor pathways to the anorectum in humans. Neuorgastroenterol Motil. 2007;19:A330.
65.
go back to reference Hobday DI, Hobson AR, Sarkar S, et al. Cortical processing of human gut sensation: an evoked potential study. Am J Physiol Gastrointest Liver Physiol. 2002;283:335–9. Hobday DI, Hobson AR, Sarkar S, et al. Cortical processing of human gut sensation: an evoked potential study. Am J Physiol Gastrointest Liver Physiol. 2002;283:335–9.
66.
go back to reference Chan YK, Herkes GK, Badcock C, et al. Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome. Am J Gastroenterol. 2001;96:2413–7.PubMedCrossRef Chan YK, Herkes GK, Badcock C, et al. Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome. Am J Gastroenterol. 2001;96:2413–7.PubMedCrossRef
67.
go back to reference Sinhamahaptra P, Saha SP, Chowdhury A, et al. Visceral afferent hypersensitivity in irritable bowel syndrome – evaluation by cerebral evoked potential after rectal stimulation. Am J Gastroenterol. 2001;96:2150–7. Sinhamahaptra P, Saha SP, Chowdhury A, et al. Visceral afferent hypersensitivity in irritable bowel syndrome – evaluation by cerebral evoked potential after rectal stimulation. Am J Gastroenterol. 2001;96:2150–7.
69.
go back to reference Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for fecal incontinence: Review. Dis Colon Rectum. 2006;50:641–9.CrossRef Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for fecal incontinence: Review. Dis Colon Rectum. 2006;50:641–9.CrossRef
70.
go back to reference Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807.PubMedCrossRef Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807.PubMedCrossRef
71.
go back to reference Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6, CD002116.PubMed Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6, CD002116.PubMed
72.
go back to reference Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272.PubMed Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272.PubMed
73.
go back to reference NICHD Pelvic Floor Disorders Network. Controlling Anal Incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe). NCT02008565. Retrieved March 20, 2014, from clinicaltrials.gov. NICHD Pelvic Floor Disorders Network. Controlling Anal Incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe). NCT02008565. Retrieved March 20, 2014, from clinicaltrials.gov.
74.
75.
go back to reference Byrne CM, Solomon MJ, Young JM, et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum. 2007;50:417.PubMedCrossRef Byrne CM, Solomon MJ, Young JM, et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum. 2007;50:417.PubMedCrossRef
76.
go back to reference Norton C. Cody, JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults Cochrane Database Syst Rev. 2012;6, CD002111. Norton C. Cody, JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults Cochrane Database Syst Rev. 2012;6, CD002111.
77.
go back to reference Moscovitz I, Rotholtz NA, Baig MK, et al. Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome? Colorectal Dis. 2002;4(4):275–9.PubMedCrossRef Moscovitz I, Rotholtz NA, Baig MK, et al. Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome? Colorectal Dis. 2002;4(4):275–9.PubMedCrossRef
78.•
go back to reference Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: A systematic review. Dis Colon Rectum. 2012;55:482–90. A systematic review of long-term outcomes beyond 5 years of anal sphincter repair for fecal incontinence. Although continence deteriorated over the long-term (no patients remained continence at 10 year followup), patient QOL and satisfaction remained relatively high.PubMedCrossRef Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: A systematic review. Dis Colon Rectum. 2012;55:482–90. A systematic review of long-term outcomes beyond 5 years of anal sphincter repair for fecal incontinence. Although continence deteriorated over the long-term (no patients remained continence at 10 year followup), patient QOL and satisfaction remained relatively high.PubMedCrossRef
79.
go back to reference Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009;98:234–8. Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009;98:234–8.
80.
go back to reference Tjandra JJ, Han WR. Goh J, et al. Direct repair vs overlapping sphincter repair: a randomized controlled trail Dis Colon Rectum. 2003;46(7):937–43. Tjandra JJ, Han WR. Goh J, et al. Direct repair vs overlapping sphincter repair: a randomized controlled trail Dis Colon Rectum. 2003;46(7):937–43.
81.
go back to reference Garcia V, Rogers RG, Kim SS, et al. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005;192(5):1697.PubMedCrossRef Garcia V, Rogers RG, Kim SS, et al. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005;192(5):1697.PubMedCrossRef
82.
go back to reference Farrell SA, Flowerdew G, Gilmour D, et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears. Three-year follow-up of a randomized controlled trial Obstet Gynecol. 2012;120(4):803–8. Farrell SA, Flowerdew G, Gilmour D, et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears. Three-year follow-up of a randomized controlled trial Obstet Gynecol. 2012;120(4):803–8.
83.
go back to reference Khaikin M, Wexner SD. Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol. 2006;12:3168.PubMedCentralPubMed Khaikin M, Wexner SD. Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol. 2006;12:3168.PubMedCentralPubMed
84.
go back to reference Matzel KE. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis. 2011;13 Suppl 2:10–4.PubMedCrossRef Matzel KE. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis. 2011;13 Suppl 2:10–4.PubMedCrossRef
85.
go back to reference Al-Sannan B, Banakhar M, Hassouna MM. The role of sacral nerve stimulation in female pelvic floor disorders. Curr Obstet Gynecol Rep. 2013;2:159–68.CrossRef Al-Sannan B, Banakhar M, Hassouna MM. The role of sacral nerve stimulation in female pelvic floor disorders. Curr Obstet Gynecol Rep. 2013;2:159–68.CrossRef
86.•
go back to reference Patton V, Wiklendt L, Arkwright JW, et al. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg. 2013;100:959–68. This prospective double-blind randomized crossover trail compares distal colonic motility in patients with FI using SNS vs sham. The study suggests that SNS improves continence by modulating colonic motility in patients with urge FI.PubMedCrossRef Patton V, Wiklendt L, Arkwright JW, et al. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg. 2013;100:959–68. This prospective double-blind randomized crossover trail compares distal colonic motility in patients with FI using SNS vs sham. The study suggests that SNS improves continence by modulating colonic motility in patients with urge FI.PubMedCrossRef
87.
go back to reference Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodynam. 2008;27:155–61.CrossRef Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodynam. 2008;27:155–61.CrossRef
88.
go back to reference Bharucha AE, Rao SSC. An update on anorectal disorders for gastroenterologists. Gastroenterol. 2014;146:37–45.CrossRef Bharucha AE, Rao SSC. An update on anorectal disorders for gastroenterologists. Gastroenterol. 2014;146:37–45.CrossRef
89.•
go back to reference Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9. This multi-center (16 centers in North America and Australia), prospective trial investigated the safety and efficacy of SNS at 12 months post-implant compared with the baseline. The study reported a high degree of efficacy with a nominal and acceptable rate of morbidity.PubMedCrossRef Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9. This multi-center (16 centers in North America and Australia), prospective trial investigated the safety and efficacy of SNS at 12 months post-implant compared with the baseline. The study reported a high degree of efficacy with a nominal and acceptable rate of morbidity.PubMedCrossRef
90.•
go back to reference Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56:234–45. This multicenter, prospective study included 67 patients to assess the long-term outcome (a minimum of 5 years) of SNS. The study showed the therapeutic effect and improved QOL was maintained > 5 years after SNS.PubMedCrossRef Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56:234–45. This multicenter, prospective study included 67 patients to assess the long-term outcome (a minimum of 5 years) of SNS. The study showed the therapeutic effect and improved QOL was maintained > 5 years after SNS.PubMedCrossRef
91.
go back to reference Chiarioni G, Palsson OS, Asteria CR, et al. Neuromodulation for fecal incontinence: an effective surgical intervention. World J Gastroenterol. 2013;19(41):7048–54.PubMedCentralPubMedCrossRef Chiarioni G, Palsson OS, Asteria CR, et al. Neuromodulation for fecal incontinence: an effective surgical intervention. World J Gastroenterol. 2013;19(41):7048–54.PubMedCentralPubMedCrossRef
92.•
go back to reference Thin NN, Horrocks EJ, Hotouras A, et al. Systematic review of the clinical effectiveness of Neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013;100:1430–47. This systematic review explored the current evidence on the clinical effectiveness of neuromodulation treatments for FI, including SNS, PTNS, and transcutaneous nerve stimulation(TTNS). The clinical effectiveness of PTNS is shown to be comparable to that of SNS at 12 months. There is currently a paucity of evidence available for the effectiveness of TTNS.PubMedCrossRef Thin NN, Horrocks EJ, Hotouras A, et al. Systematic review of the clinical effectiveness of Neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013;100:1430–47. This systematic review explored the current evidence on the clinical effectiveness of neuromodulation treatments for FI, including SNS, PTNS, and transcutaneous nerve stimulation(TTNS). The clinical effectiveness of PTNS is shown to be comparable to that of SNS at 12 months. There is currently a paucity of evidence available for the effectiveness of TTNS.PubMedCrossRef
93.•
go back to reference Hotouras A, Murphy J, Walsh U, et al. Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: A prospective cohort study. Ann Surg. 2013;00:1–5. This prospective cohort study of 115 patients investigated the outcome of PTNS for FI. The study showed that PTNS is a well-tolerated treatment with high acceptability, with a sustained improvement with a median follow up of 26 months (up to 42).CrossRef Hotouras A, Murphy J, Walsh U, et al. Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: A prospective cohort study. Ann Surg. 2013;00:1–5. This prospective cohort study of 115 patients investigated the outcome of PTNS for FI. The study showed that PTNS is a well-tolerated treatment with high acceptability, with a sustained improvement with a median follow up of 26 months (up to 42).CrossRef
94.
go back to reference Marti L. Comparison of Sacral Nerve Modulation and Pudendal Nerve Stimulation in Treatment of Fecal Incontinence. NCT 01069016. Retrieved March 28, 2014, from clinicaltrials.gov. Marti L. Comparison of Sacral Nerve Modulation and Pudendal Nerve Stimulation in Treatment of Fecal Incontinence. NCT 01069016. Retrieved March 28, 2014, from clinicaltrials.gov.
95.
go back to reference Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilized hyaluronic acid for treatment of faecal incontinence: a randomized, sham-controlled trial. Lancet. 2011;377:997–1003.PubMedCrossRef Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilized hyaluronic acid for treatment of faecal incontinence: a randomized, sham-controlled trial. Lancet. 2011;377:997–1003.PubMedCrossRef
96.
go back to reference Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2, CD007959.PubMed Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2, CD007959.PubMed
97.
go back to reference Parisien CJ, Corman ML. The Sicca® procedure for the treatment of fecal incontinence: Definitive therapy or short-term solution. Clin in Colon Rectal Surg. 2005;18(1):371.CrossRef Parisien CJ, Corman ML. The Sicca® procedure for the treatment of fecal incontinence: Definitive therapy or short-term solution. Clin in Colon Rectal Surg. 2005;18(1):371.CrossRef
98.
go back to reference Takahashi-Monroy T, Morales M, et al. SECCA procedure for the treatment of fecal incontinence: Results of five-year follow-up. Dis Colon Rectum. 2008;51(3):355–9.PubMedCrossRef Takahashi-Monroy T, Morales M, et al. SECCA procedure for the treatment of fecal incontinence: Results of five-year follow-up. Dis Colon Rectum. 2008;51(3):355–9.PubMedCrossRef
99.
go back to reference National Institute for Health and Clinical Excellence (NICE). Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence. Interventional Procedure Guidance 393. London, UK: NICE; May 2011. Retrieved March 22, 2014, from http://www.nice.org.uk National Institute for Health and Clinical Excellence (NICE). Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence. Interventional Procedure Guidance 393. London, UK: NICE; May 2011. Retrieved March 22, 2014, from http://​www.​nice.​org.​uk
100.
go back to reference Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950.PubMedCrossRef Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950.PubMedCrossRef
101.
go back to reference Frudinger A, Kolle D, Schwaiger W, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010;59:55–61.PubMedCrossRef Frudinger A, Kolle D, Schwaiger W, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010;59:55–61.PubMedCrossRef
102.
go back to reference Autologous myoblast intrasphincteric injection for fecal incontinence (MIAS). NCT01523522. Retrieved March 20, 2014, from clinicaltrials.gov. Autologous myoblast intrasphincteric injection for fecal incontinence (MIAS). NCT01523522. Retrieved March 20, 2014, from clinicaltrials.gov.
103.
go back to reference Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4, CD005086.PubMed Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4, CD005086.PubMed
104.
go back to reference Renew Medical. A study to evaluate the safety, tolerability, and effectiveness of the Renew Insert in treating accidental bowel leakage (REST). NCT01475474. Retrieved March 29, 2014, from clinicaltrials.gov. Renew Medical. A study to evaluate the safety, tolerability, and effectiveness of the Renew Insert in treating accidental bowel leakage (REST). NCT01475474. Retrieved March 29, 2014, from clinicaltrials.gov.
105.
go back to reference Lukacz ES, Segall MM, Wexner SD. A novel, convenient, and safe non surgical approach to the management of accidental bowel leakage. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC Lukacz ES, Segall MM, Wexner SD. A novel, convenient, and safe non surgical approach to the management of accidental bowel leakage. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC
106.
go back to reference Richter HE, Matthews CA, Varma M, et al. Clinical efficacy and safety evaluation of a vaginal bowel control (VBC) device for the treatment of fecal incontinence. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC) Richter HE, Matthews CA, Varma M, et al. Clinical efficacy and safety evaluation of a vaginal bowel control (VBC) device for the treatment of fecal incontinence. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC)
Metadata
Title
An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women
Authors
Isuzu Meyer
Holly E. Richter
Publication date
01-09-2014
Publisher
Springer US
Published in
Current Obstetrics and Gynecology Reports / Issue 3/2014
Electronic ISSN: 2161-3303
DOI
https://doi.org/10.1007/s13669-014-0085-8

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