Cause Of Fecal Incontinence Research Articles

Tight Cutting Seton for Anal Fistulae Revisited

Abstract Background: Anal fistulas are a common medical problem affecting thousands of patients annually well over 2000 years. There are many new novel approaches to this old condition but none with overwhelming success and low complication rates. The aim of this retrospective review was to revisit our experience in the treatment of anal fistulas with a tight cutting seton. Objectives: Observational study of retrospective collected data. Design: Retrospective study. Patients and Methods: Between 2008 - 2018 a retrospective study included all patients with primary or recurrent fistulas who were treated using tight seton were analyzed. Main Outcome Measures: The primary outcomes measured were healing rate, procedure-related complications, and incontinence. Sample Size: The study included 41 cases of anal fistula treated with a tight cutting and complete records of follow-up. Results: Firty-one patients with a median age of 37.9 years with a median follow up of 14.37 months were identified and included in the study. Among these, 66% of the fistulas were primary and 34% persisting or recurrent fistulas. Fistulas were classified as trans-sphincteric in 71% of patients, inter-sphincteric in 20%, horseshoe in 7%, and extra-sphincteric in 2% of the patients. All patients were treated with a cutting seton. The total healing rate was 95%. Two patients developed a persistent fistula. Four patients (9.8%) complained of different degrees of incontinence. There were no incidents of solid stool incontinence. In one case, the cause of fecal incontinence was keyhole deformity which was resolved after a buried island transposition flap. Conclusion: Our study evaluates a series of patients who were treated by a single surgeon in nonrandomized studies, emphasizing that tight cutting seton technique first described by Hippocrates in 430 BCE is a simple, highly effective, and safe procedure that should not be abandoned. Limitations: This study has limitations, including its retrospective nature. We collected data for this study from electronic records and databases of patients after completion of followup. Conflict of Interest Statement: The authors declare that there is no conflict of interests in this study.

Co-occurrence of fecal incontinence with constipation or irritable bowel syndrome indicates the need for personalized treatment.

This study aimed to compare the prevalence and symptoms of fecal incontinence (FI) in relation to irritable bowel syndrome (IBS-associated FI), constipation (constipation-associated FI), and isolation (isolated FI). Data were analyzed from 3145 respondents without organic comorbidities known to influence defecation function from the general Chinese population who filled in the online Groningen Defecation and Fecal Continence questionnaire. FI, IBS, and constipation were evaluated with the Rome IV criteria. The prevalence of FI was 10.5% (n = 329) in the non-comorbidity group. After multivariable logistic regression analysis, IBS (odds ratio [OR]: 12.55, 95% confidence interval [CI]: 9.06-17.36) and constipation (OR: 4.38, 95% CI: 3.27-5.85) were the most significant factors contributing to FI. Based on this finding, 106/329 (32.2%) had IBS-associated FI, 119/329 (36.2%) had constipation-associated FI, and 104/329 (31.6%) had isolated FI. Among the 329 FI respondents, there was a high prevalence of IBS and constipation-related symptoms, including abdominal pain (81.5%) and abdominal bloating (77.8%) for IBS and straining during defecation (75.4%), incomplete defecation (72.3%), defecation blockage (63.2%), anal pain during defecation (59.3%), and hard stools (24%) for constipation. The patients with IBS-associated FI asked for specialists' help less frequently than those with isolated FI. Interestingly, among the patients with constipation-associated FI, 56.3% used anti-diarrhea medicine. The prevalence of IBS-associated FI, constipation-associated FI, and isolated FI is comparably high. It is important to diagnose and target the cause of FI to provide personalized and cause-targeting care instead of treating only the FI symptoms.

Combined 3D Endoanal Ultrasound and Transperineal Ultrasound Improves the Detection of Anal Sphincter Defects.

Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal muscle injury. However, 3D EAUS accuracy may be hampered by regional acoustic effects, such as intravaginal air. Therefore, our aim was to examine whether a combination of transperineal ultrasound (TPUS) and 3D EAUS would improve the accuracy of detection of anal sphincter injury. We prospectively performed 3D EAUS followed by TPUS in every patient evaluated for FI in our clinic between January 2020 and January 2021. The diagnosis of anal muscle defects was assessed in each ultrasound technique by two experienced observers that were blinded to each other's assessments. Interobserver agreement for the results of the 3D EAUS and the TPUS exams was examined. A final diagnosis of anal sphincter defect was based on the results of both ultrasound methods. Discordant results were re-analyzed by the two ultrasonographers for a final consensus on the presence or absence of defects. A total of 108 patients underwent ultrasonographic assessment due to FI (mean age 69 ± 13). Interobserver agreement for the diagnosis of tear on EAUS and TPUS was high (83%) with Cohen's kappa of 0.62. EAUS confirmed anal muscle defects in 56 patients (52%), while TPUS confirmed them in 62 patients (57%). The final consensus agreed on the diagnosis of 63 (58%) muscular defects and 45 (42%) normal exams. The Cohen's kappa coefficient of agreement between the results of the 3D EAUS and the final consensus was 0.63. The combination of 3D EAUS and TPUS improved the detection of anal muscular defects. The application of both techniques for the assessment of the anal integrity should be considered in every patient going through ultrasonographic assessment for anal muscular injury.

Fecal Incontinence as a Symptom of Myasthenia Gravis

I report three cases of fecal incontinence during the clinical course of myasthenia gravis. Fecal incontinence developed after withdrawal from the pyridostigmine and improved after re-administration of the pyridostigmine. Myasthenia gravis could affect external anal sphincter and puborectalis function. Myasthenia gravis is presumably one of the causes of fecal incontinence. We must check for fecal incontinence in the patients with myasthenia gravis.

S2030 Fecal Incontinence Due to Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL)

Introduction: Fecal incontinence, or the accidental passing of solid or liquid stool, is a common condition that occurs in up to 15% of the Western population and significantly impairs quality of life. Common causes of fecal incontinence include structural damage to the anal sphincter, fecal impaction, rectal prolapse, and neurologic impairment (e.g. diabetes, stroke). In the following report, we describe a case of fecal incontinence caused by Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), a rare hereditary neurological disorder of the cerebral vessels that causes recurrent ischemic strokes and progressive loss of cognitive function. Case Description/Methods: A 66-year-old White male with a 15-year history of CADASIL presented to clinic for evaluation of fecal incontinence. He reported that his symptoms began approximately 18 months earlier and improved over time, but then recurred with urinary incontinence and persistent worsening 6 months prior to presentation. He denied having any abdominal pain, unintentional weight loss, rectal bleeding, or history of rectal trauma. He was up to date on screening colonoscopy. On digital rectal exam, the patient was noted to have normal resting tone and diminished sphincter squeeze; there was no evidence of mass, rectal prolapse, or hemorrhoids. Upon review of his prior imaging, it was noted that he had severe small vessel ischemic changes in his brain with multiple infarcts, but no spinal cord compression. He declined anorectal manometry. Given the clinical picture, it was concluded that the patient’s incontinence was due to recurrent strokes secondary to CADASIL. Discussion: Fecal incontinence occurs in up to 40% of patients immediately after stroke. Treatment strategies focus on hygiene and skin protection, regulation of stool consistency, and pelvic floor physical therapy. CADASIL is characterized by multiple, recurrent strokes. Fecal incontinence in these patients is predictive of mortality, with one study showing 72% of patients experiencing fecal incontinence at time of death. Multiple cortical regions of the brain have been shown to be important in controlling the anal sphincter suggesting redundancy of function, which may explain why the presence of persistent fecal incontinence can be a marker of late-stage CADASIL. Our case report highlights the importance of clinical recognition of a rare disease as a potential cause of a common symptom.

Vaginal Distention Rodent Model for Fecal Incontinence: A Pilot Study on the Effect on Defecation Behavior

Abstract Objectives Vaginal balloon inflation simulates the compressive forces on the pelvic floor during the second phase of natural delivery. The foremost use of this animal model of vaginal distention (VD) is to study the mechanisms underlying urinary incontinence. As damage to the pelvic floor during natural birth is a common cause of fecal incontinence, the present paper aimed to investigate the effect of VD on defecation behavior in adult rats. Methods Vaginal distention was performed in 8 rats for 2 hours, and in 3 rats for 4 hours, and sham inflation was performed in 4 rats. With the use of a latrine box in the rat home-cage and 24/7 video tracking, the defecation behavior was examined. The time spent in and outside the latrine was monitored for two weeks preoperatively and three weeks postoperatively, and a defecation behavior index (DBI; range: 0 [continent] to 1 [incontinent]) was defined. Pelvic floor tissue was collected postmortem and stained with hematoxylin and eosin. Results Vaginal balloon inflation for 2 hours resulted in fecal incontinence in 29% of the animals (responders) whereas the DBI scores of non-responders (71%) and control animals did not change in the postoperative phase compared with the baseline score. A 4-hour balloon inflation resulted in fecal incontinence in 1 animal and caused a humane endpoint in 2 animals with markedly more tissue damage in the 4-hour responder compared with the 2-hour responders. Conclusions Vaginal balloon inflation, with an optimum duration between 2 and 4 hours, can be used as a model to study changes in defecation behavior in rats induced by pelvic floor damage.

Laparoscopic vs. Transabdominal Treatment for Overflow Fecal Incontinence Due to Residual Aganglionosis or Transition Zone Pathology in Hirschsprung's Disease Reoperation.

Objective: The aim of this study was to describe the details of laparoscopic-assisted reoperative surgery for Hirschsprung's disease (HSCR) with overflow fecal incontinence, and to retrospectively compare laparoscopic-assisted surgery with transabdominal pull-through surgery.Methods: We retrospectively analyzed patients with HSCR with overflow fecal incontinence after the initial surgery in our center between January 2002 and December 2018. Pre-operative, peri-operative, and post-operative data were recorded for statistical analysis.Results: Thirty patients with overflow fecal incontinence after initial megacolon surgery [17 who underwent transanal pull-through (TA-PT) and 13 who underwent laparoscopic-assisted pull-through (LA-PT)] required a secondary surgery [reoperation with LA-PT (LAR-PT) (n = 16) or reoperation with transabdominal pull-through (TR-PT) (n = 14)]. Indications for reoperation were residual aganglionosis (RA) (7/30, 23.3%) or transition zone pathology (TZP) (23/17, 76.7%). Blood loss was significantly decreased in the LAR-PT group (75 ± 29.2 ml) compared to the TR-PT group (190 ± 51.4 ml) (P = 0.001). The length of hospital stay was significantly shorter in the LAR-PT group (10 ± 1.5 days) than that in the TR-PT group (13 ± 2.4 days). No significant differences were found between two groups in surgical methods, defecation function score, or post-operative complications except for wound infection (LAR-PT vs. TR-PT 0 vs. 28.6%, P < 0.05).Conclusions: It is necessary to make a comprehensive analysis of the causes of fecal incontinence after HSCR surgery and make an accurate judgment using appropriate methods. If a reoperation was inevitable for patients with overflow fecal incontinence due to RA or TZP, a comprehensive evaluation prior to the operation is required to maximize the benefit from reoperation. Although laparoscopic reoperation with heart-shaped anastomosis was safe and feasible for patients with failed initial Soave technique, unnecessary reoperation should be avoided as much as possible.

Diagnostic approach to faecal incontinence: What test and when to perform?

Faecal incontinence (FI) is a debilitating common end result of several diseases affecting the quality of life and leading to patient disability, morbidity, and increased societal burden. Given the various causes of FI, it is important to assess and identify the underlying pathomechanisms. Several investigatory tools are available including high-resolution anorectal manometry, transrectal ultrasound, magnetic resonance imaging, and electromyography. This review article provides an overview on the causes and pathophysiology of FI and the author’s perspective of the stepwise investigation of patients with FI based on the available literature. Overall, high-resolution anorectal manometry should be the first investigatory tool for FI, followed by either transrectal ultrasound or magnetic resonance imaging for anal internal sphincter and external anal sphincter injury, respectively.

Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version.

Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).

Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women-Systematic Review of Methods.

Fecal incontinence (FI) affects approximately 0.25–6% of the population, both men and women. The most common causes of FI are damage to/weakness of the anal sphincter muscle and/or pelvic floor muscles, as well as neurological changes in the central or peripheral nervous system. The purpose of this study is to report the results of a systematic review of the possibilities and effectiveness of physiotherapy techniques for the prevention and treatment of FI in women. For this purpose, the PubMed, Embase, and Web of Science databases were searched for 2000–2020. A total of 22 publications qualified for detailed analysis. The studies showed that biofeedback (BF), anal sphincter muscle exercises, pelvic floor muscle training (PFMT), and electrostimulation (ES) are effective in relieving FI symptoms, as reflected in the International Continence Society recommendations (BF: level A; PFMT and ES: level B). Research has confirmed that physiotherapy, by improving muscle strength, endurance, and anal sensation, is beneficial in the prevention of FI, both as an independent method of conservative treatment or in pre/post-surgery treatment. Moreover, it can significantly improve the quality of life of patients. In conclusion, physiotherapy (in particular, BF, PFMT, or ES, as effective methods) should be one of the key elements in the comprehensive therapy of patients with FI.

S3374 Overflow Diarrhea and AKI as a Presentation of Fecal Impaction That Led to Obstructive Uropathy

INTRODUCTION: Fecal impaction is a known complication of chronic constipation and is particularly bothersome in the elderly. Common complications of fecal impaction include hemorrhoids, megacolon, overflow diarrhea and obstructive uropathy among others. Overflow diarrhea is often misdiagnosed and treated with antidiarrheal medications leading to further worsening of impaction. Obstructive uropathy is a well-established complication of fecal impaction with obstruction occurring at any level of the urinary tract. Children and young adults are at high risk as are the elderly due to multiple risk factors including but not limited to diabetes mellitus, dementia, opioid use and depression. Many case reports have been published with fecal impaction and obstructive uropathy though none have reported overflow diarrhea as a presentation. CASE DESCRIPTION/METHODS: An 82-year-old male patient presented with diarrhea and acute kidney injury that was caused by fecal impaction that led to obstructive uropathy. He had a 4-week history of non-bloody watery diarrhea with associated fecal incontinence and generalized abdominal pain. He reported a long-standing history of constipation prior to this. Generalized abdominal tenderness with mild diffuse distention and a distended urinary bladder were noted on exam, along with normal rectal tone with loose brown stool in absence of hemorrhoids or prostate enlargement. Lab work showed elevated creatinine and hypokalemia. Upon IV fluid resuscitation and foley catheter placement, CT abdomen was done which showed bilateral hydronephrosis. Stool studies showed no evidence of infection. He was managed with laxatives and had significant improvement in kidney function as well as significantly reduced stool burden. DISCUSSION: Our patient had multiple risk factors for impaction including age, immobility, diabetes, and medications including azacitidine. Chronic constipation in our patient led to fecal impaction which eventually led to overflow diarrhea and obstructive uropathy. It is important to consider impaction as a cause of fecal incontinence and diarrhea in the elderly as it can lead to high morbidity and mortality. The treatment of this diarrhea is counter-intuitive since the impaction benefits from catharsis not antidiarrheals. Diet counseling, biofeedback, and rarely surgical intervention can be used in refractory cases.Figure 1.: Computed Tomography imaging showing bilateral hydronephrosis (A) and dilation of rectum (B).Figure 2.: Computed Tomography imaging showing improvement in hydronephrosis and stool burden post catharsis.

New options for managing fecal incontinence in women.

Fecal incontinence often is underreported and can be associated with both social embarrassment and isolation. As patients often do not proactively discuss their symptoms, healthcare providers should screen for this distressing condition. The cause of fecal incontinence often is multifactorial, so no single therapy can guarantee perfect, risk-free outcomes. This article reviews the limited therapies for managing fecal incontinence, including a minimally invasive vaginal control device that may offer hope for managing fecal incontinence in women.

THE ASSOCIATION BETWEEN VITAMIN D AND UTERINE PROLAPSE

Aim: Pelvic organ prolapse, the hernniation of the pelvic organs or beyond the vaginal walls. Vitamin D deficiency appears to be cause for pelvic muscle weakness. The aim of this study is to investigate the lack of vitamin D in patients with uterine prolapse.Methods: The records of patients were evaluated retrospectively in peri- and postmenopausal age group who were diagnosed with ICS stage 3-4 uterine prolapse based on vaginal examination and operated between February 2015-2016 in Izmir Tepecik Education and Research Hospital Gyneology and Obstetrics clinic. The files of 40 patients with ICS stage 0 in the peri- and postmenopausal period, whose 25 (OH) vitamin D were measured at the same time with the patient group and who underwent surgery due to any gynecologic indication, were evaluated as control group. Women were excluded if they had any medical conditions known to impair absorption or metabolism of vitamin D, or to be a major cause of fecal incontinence including Stage ≥3 chronic kidney disease, chronic liver disease, gastric bypass, colovaginal fistula, and pelvic irradiation.Results: 40 patients’ and 40 control cases’ data who met the study criteria were recorded. The patient group had a lower level of 25 (OH) vitamin D (9,5 ± 14,0 ng/ml) than the control group (15,3 ± 20,3 ng/ml). Furthermore, 25 (OH) vitamin D deficiency (25 [OH] vitamin D level &amp;lt;20 ng/mL) was found in 95,0% of the patient group and 77,5% of the control group (p=0,024). A 25 (OH) vitamin D level of &amp;lt;20 ng/mL was found to be the independent risk factor for uterine prolapse (OR=5,8, 95% CI=1,0 – 33,3). Conclusion: Vitamin D deficiency may be a risk factor in the development of uterine prolapse.

Is the extent of obstetric anal sphincter injury correlated with the severity of fecal incontinence in the long term?

Obstetric anal sphincter injury is the most frequent cause of fecal incontinence (FI) in young women. However, the relationship between the extent of anal sphincter defects and the severity of long-term FI (at least 1 year after delivery) has been poorly studied. The aim of the present study was to determine if, in the long term, the extent of anal sphincter defects graded at anal endosonography was linked with the severity of FI. A retrospective study was conducted on women with a history of vaginal delivery, who presented with FI and had three-dimensional anorectal high-resolution manometry and endoanal ultrasound in our center from January 2015 to 2016. The detailed clinical history of each patient was obtained from the institutional database. The severity of FI was assessed with the Jorge and Wexner continence scale. There were 250 women with a mean age of 60 ± 14years. Seventy-six (30.4%) had an isolated defect of the internal anal sphincter, 21 (8.4%) had an isolated defect of the external anal sphincter, and 150 (60%) had both internal and external sphincter defects. The extent of IAS and EAS defects was proportionally correlated with the decrease in mean resting anal pressure (p < 0.01) and the decrease in mean squeeze pressure (p = 0.013) measured by 3DHRAM. No significant correlation was found between the extent and location of the defect (IAS, EAS or both) on endoanal ultrasound and the severity of FI. Menopause was the only independent factor significantly associated with the severity of FI. In our study, no significant correlation was observed between the extent of the anal sphincter defect and the severity of FI. Menopause was the only identified and independent risk factor for FI. These data confirm that, in the long-term, FI is often multifactorial.

Sphincter repair or Sacral Nerve Modulation: Still debatable?

Fecal incontinence (FI) is a debilitating condition with negative consequences to patients. It is recognized as a “quality of life” illness. Sphincter tears resulting often from difficult childbirth or from surgical trauma, are well-identified causes of FI. When conservative measures fail to resolve FI symptoms, a surgical treatment is recommended on the basis of a comprehensive pelvic floor work-up. A sphincter tear is frequently found on endoanal ultrasonography. The best way to surgically approach a patient with FI related/associated with a sphincter lesion is still debatable. International guidelines are inconsistent regarding the role of either sacral neuromodulation (SNM) or anal sphincteroplasty (anal sphincter repair) (AS) in patients with anal sphincter defect. Decision making for an individual patient often relies on expert opinion and personal experience due to the poor quality of the few published studies. Currently the presence of a sphincter defect is no longer considered a contraindication for sacral nerve modulation (SNM) which has several advantages. SNM is a minimally invasive procedure with very low morbidity, its results can be accurately predicted with a test phase, and are sustained with long-term placement of the implant. Nevertheless, AS has clearly a role to play, for instance in young female patients reluctant to get an implanted nerve stimulator early in life and/or in case of a cloacae-like deformity as a sequela of a post-obstetrical 4th degree tear. While waiting for prospective studies directly comparing SNM and AS for various types of FI, we propose in this paper a pragmatic treatment algorithm based on the most recently published studies and recommendations for the management of sphincter defect related/associated FI.

Middle-term bowel function and quality of life in low-type anorectal malformation

BackgroundLow-type anorectal malformations (ARMs) are considered benign; however, in China, data regarding such conditions are limited. Thus, this study aimed to assess the middle-term bowel functions and quality of life (QOL) among children with low-type ARM.MethodsChildren > 3 years of age who underwent treatment for low-type ARM (vestibular fistula [VF] and perineal fistula [PF]) during 2013 and healthy children were included. The children were interviewed during their outpatient visits. The primary outcome measures were bowel function, as assessed using the Baylor Continence Scale (BCS), and QOL, as measured using the Pediatric Quality of Life Inventory (PedsQL 4.0).ResultsA total of 82 patients responded; mean patient age was 6.8 (range, 3–12) years. Mean BCS score in the control group (7.94 ± 4.74) was significantly lower than that in the VF (18.69 ± 11.11, P < 0.001) and PF (15.47 ± 6.50, P < 0.001) groups. However, there were no differences in PedsQL 4.0 scores among the groups. The patients scored the lowest for emotional function and the highest for physical function. Nearly all measurements of QOL significantly decreased with increased BCS score.ConclusionsChildren with low-type ARM can achieve good bowel control and QOL. However, although ARMs are benign, several children with this condition suffer from anal function problems that affect QOL. Redo operations, mislocated anus, and incorrect constipation treatment are the iatrogenic causes of fecal incontinence.

Anal Sphincter Injury Associated with Vaginal Twin Delivery

Obstetric anal sphincter injury remains the most common cause of fecal incontinence in women, and research in twin pregnancies is sparse. This study aimed to examine risk factors for sphincter injury in twin deliveries over a 10-year period. This was a retrospective study of twin vaginal deliveries in a tertiary-level hospital over 10 years. We examined the demographics of women who had a vaginal delivery of at least one twin. Logistic regression analysis was used to examine risk factors. There were 1,783 (2.1%) twin pregnancies, of which 556 (31%) had a vaginal delivery of at least one twin. Sphincter injury occurred in 1.1% (6/556) women with twins compared with 2.9% (1720/59,944) singleton vaginal deliveries. Women with sphincter injury had more instrumental deliveries (83.3 vs. 27.6%; p = 0.008). On univariate analysis, only instrumental delivery was a significant risk factor (odds ratio: 2.93; p = 0.019). Sphincter injury occurs at a lower rate in vaginal twin pregnancies than in singletons. No twin-specific risk factors were identified. Discussion of the risk of sphincter injury should form part of patient counseling with regard to the mode of delivery.

Non-invasive obstetric anal sphincter injury diagnostics using impedance spectroscopy

Obstetric anal sphincter injuries are the most common cause of fecal incontinence in women yet remain under-diagnosed. The aim of this study was to assess the suitability of impedance spectroscopy for diagnosing sphincter injuries arising during delivery. This was a prospective single-center study. 22 female patients were included: 10 with symptoms of sphincter dysfunction, in the early postpartum period, and 12 unaffected, in the distant period of more than 2 years after natural delivery. The presence, extent and severity of anal sphincters injury was assessed by measuring the sphincter parameters in physical examination, the degree of sphincter damage in endoanal ultrasound imaging and the sphincters function parameters in anorectal manometry. All measurements were used as references and compared with the outcomes from the impedance spectroscopy models. Impedance spectroscopy showed the highest precision (with mean accuracy of 83.9%) in relation to transanal ultrasonography. 74.1% of its results corresponded to the results of rectal physical examination and 76.7% - to those of anorectal manometry. The method showed the highest accuracy in the assessment of the sphincter’s parameters, both anatomically and functionally. New impedance spectroscopy techniques hold promise for detecting obstetric anal sphincter injuries.

Non-surgical acute traumatic perianal injuries.

The diagnosis of fecal incontinence is challenging and complex. One of the most significant causes of fecal incontinence is trauma in the perianal area. The most important cause of such trauma is birth trauma. It is hard to evaluate patients and plan treatment. Surgical method is determined by the severity of sphincter damage and injuries formed in the organs in the perianal area. The aim of this study, therefore, was to analyze the cases of patients who had undergone sphincter repair because of acute injuries in the perianal area. The cases of 15 patients with perianal area injuries who had presented to Necmettin Erbakan University Meram Medical School's General Surgery Clinic between 2010 and 2015 were retrospectively analyzed. Data on age, sex, form of injury, severity of injury, time of first response, form of repair, injury problems, and post-operative complications of the patients were investigated. The patients' long-term results were analyzed. While 5 of the patients were male, 10 were female. 9 of the female patients had birth trauma, while one had injury during sexual intercourse. While all of the patients received sphincteroplasty, 10 had levatoroplasty. All the female patients received vaginoplasty. We are of the opinion that it is significant to have surgical intervention before tissue edema develops.

Does perineal body thickness affect faecal incontinence in multiparous patients?

Background. Obstetric trauma is the most common cause of faecal incontinence in multiparous women. The literature has shown that women with obstetric trauma to the anal sphincter have decreased perineal body thickness (PBT). Objective. To determine the role of PBT in the assessment of this type of faecal incontinence in multiparous patients. Methods. Forty-four women with faecal incontinence, and 36 asymptomatic women who had had two or more previous deliveries, were investigated with endoanal ultrasonography from January to December 2016. The patients were divided into three groups on the basis of PBT: 12 mm. The degree of faecal incontinence was measured using the Wexner faecal incontinence score. Sphincter angle defect was separately measured for each patient. Results. The mean (standard error) age of all of our 80 patients was 46.9 (1.3) years (range 26 - 77 years), and the mean PBT in incontinent patients was 8.78 (2.84) mm, and 12.65 (16.76) mm in asymptomatic subjects ( p <0.001). The mean Wexner score was 8.6 (range 2 - 20) in incontinent patients. External anal sphincter defect angles were negatively correlated with PBT ( p =0.045). For 89% of the patients, there was a history of vaginal delivery, and 62.5% had undergone one or more prior episiotomies during delivery. A PBT <10 mm was associated with sphincter defect in most incontinent patients. Conclusion. PBT plays a significantly important role in faecal incontinence, so it is recommended that it should be one of the factors involved in anal incontinency evaluations.