Conservative Management Of Faecal Incontinence Research Articles

Evaluation of an anal insert device for the conservative management of faecal incontinence

Evaluation of an anal insert device for the conservative management of faecal incontinence

Short-term Outcomes of a Randomized Pilot Trial of 2 Treatment Regimens of Transcutaneous Tibial Nerve Stimulation for Fecal Incontinence.

Fecal incontinence is a socially disabling condition that affects ≤15% of adults. Neuromodulatory treatments for fecal incontinence are now well established. Less invasive, cheaper, and more ambulatory forms of neuromodulation are under exploration. The purpose of this study was to assess the acceptability and safety of a new ambulatory tibial nerve stimulation device and to determine clinical effect size for 2 differing regimens of therapy. This was a randomized, investigator-blinded, parallel-arm, 6-week pilot trial. The study was conducted at 7 United Kingdom trial centers. Patients were initially reviewed in the trial center, with subsequent applications of the device performed in the patients home setting. A total of 43 eligible patients (38 women) who failed conservative management of fecal incontinence were included in the study. The study intervention involved twice-weekly, 1- versus 4-hour transcutaneous tibial nerve stimulation for 6 weeks (total of 12 treatments). Standard fecal incontinence outcome tools (bowel diary, symptom severity score, and generic quality-of-life instruments) were used to collect data at baseline and at 2 weeks posttreatment cessation. A total of 22 patients were randomly assigned to the 1-hour group and 21 to the 4-hour group. Improvements in fecal incontinence outcomes were observed for both groups, including median urge incontinence episodes per week at baseline and posttreatment (1-hour group 2.0 to 0.5 versus 4-hour group 4.0 to 1.0) and deferment time (1-hour group 2.0 to 2.0 minutes versus 4-hour group 0.5 to 5.0 minutes). Accompanying changes were observed in physical functioning domains of quality-of-life instruments. There were no adverse events, and the treatment was highly acceptable to patients. Limitations included the pilot design and lack of control arm in the study. Future trials would need to address these limitations. This pilot study provides evidence that transcutaneous tibial nerve stimulation with a new ambulatory device is safe and acceptable for the management of fecal incontinence. Additional study is warranted to investigate clinical effectiveness.

Faecal incontinence: Assessment and conservative management

Faecal incontinence can be incapacitating and embarrassing for patients and severely impact on their physical and emotional wellbeing, and that of their carers. It is imperative that health professionals working with this patient population adopt a holistic, patient-centred approach in exploring the causes and treatment options available. This should be done in partnership with the patient and carers, with the view to exploring the best management options through comprehensive assessment. In this article, Daniel Apau looks at the causes, assessment and conservative management of faecal incontinence.

CE Test 3.0 Hours: Conservative Management of Fecal Incontinence

AJN, American Journal of Nursing: September 2010 - Volume 110 - Issue 9 - p 39-40 doi: 10.1097/01.NAJ.0000388263.72298.bc

Conservative Management of Fecal Incontinence

Although fecal incontinence can be both emotionally and socially debilitating, the embarrassment associated with it is so great that it often prevents patients from seeking much needed help from their health care providers. Nursing care begins with case finding and continues through conservative management, which has greatly improved over the past 15 years. This article summarizes the strategies that have proven most effective in uncovering and combating this prevalent yet seldom acknowledged condition. : defecation, diarrhea, fecal incontinence, feces, incontinence, incontinence of stool.

Conservative management of faecal incontinence in adults

Conservative management of faecal incontinence in adults

Conservative management of faecal incontinence in adults

While faecal incontinence is a common problem, many people may be embarrassed to admit having the condition. An understanding of the various factors that contribute to faecal incontinence can increase nurses' awareness of potential continence problems. Nurses can assess patients for faecal incontinence, provide valuable information and implement a range of management strategies to support patients and improve their quality of life. This article explains the reasons for incontinence, outlines comprehensive patient assessment and discusses the various treatment options to help patients overcome or manage the problem. The author describes the role of continence advisers and clinical nurse specialists who can offer additional expertise.

Biofeedback Therapy Plus Anal Electrostimulation for Fecal Incontinence: Prognostic Factors and Effects on Anorectal Physiology

The current literature does not provide unequivocal data on prognostic factors in conservative management of fecal incontinence. Moreover, the physiopathologic effects of pelvic floor rehabilitation on anorectal function are not well understood. Our aim is to identify some prognostic parameters and assess their effects on anorectal physiology of biofeedback therapy plus anal electrostimulation for fecal incontinence. We studied prospectively 45 consecutive adult patients with fecal incontinence treated at our institution with biofeedback plus electrostimulation. The outcome parameter was modification of the Wexner Incontinence Score (WIS) at the end of treatment. In addition, we studied the modifications of anorectal manometry and the rectal sensitivity threshold after treatment. At univariate analysis, age, the pretreatment WIS, and the pretreatment resting and maximum squeeze pressures were correlated with the clinical outcome. Patients showed a significant reduction in the rectal sensitivity threshold but no significant change in manometric parameters after treatment. We identify good sphincter function and mild to moderate symptomatology as favorable prognostic factors in biofeedback and anal electrostimulation therapy. Improvement in rectal sensitivity can be implicated in symptomatic improvement. The impossibility of correlating the clinical results with the effects on anorectal physiology suggests a nonspecific effect of conservative treatment.

Management of fecal incontinence in adults

This article summarises the findings from the Conservative Management of Faecal Incontinence in Adults Committee of the International Consultation on Incontinence. We conducted comprehensive literature searches using the following keywords combined with the relevant intervention: "anal, anorectal, bowel, faecal, fecal, rectal, stool" and "continent$ or incontinent$," Prevalence etimates for faecal or anal incontinence vary widely, from 2.2% to 2.5%. Expert opinion supports the use of general health education, patient teaching about bowel function and advice on lifestyle modification, but the evidence base is small. Unlike urinary incontinence, few "lifestyle" associations have been identified with FI and little is known about whether interventions designed to reduce potential risk factors might improve FI. The article summarises the evidence and recommendations from the committee for clinical practice and future research.

The Conservative Management of Fecal Incontinence in Children

FECAL INCONTINENCE in a child over 3 years of age becomes a matter of most serious psychological and social importance, increasing with age. We have developed a program for controlling this condition, which, with modification, has been successful in children whose difficulty results from various causes ranging from gross anatomical abnormalities and faulty innervation to overtraining and overt psychiatric disease. Emotional problems are commonly associated with fecal incontinence, sometimes as a causative factor, or inevitably as a direct result of the social disgrace of fecal soiling. Although these emotional problems are important, we will confine our discussion to the nonpsychiatric, medical management. Anatomic Causes Included in the group of patients we have had the opportunity to treat, are children with myelodysplasia; children with paraplegia secondary to infectious transverse myelitis or vascular accidents of spinal arteries; children with traumatic transection of the spinal cord; and children who have no anal sphincters,