Fecal Incontinence Episodes Research Articles

Clinical efficacy of lead revisions during the test phase in sacral neuromodulation for fecal incontinence

BackgroundSuccess rates of up to 80% have been reported for the SNM screening period in the treatment of fecal incontinence (FI). Some patients who have an unsuccessful index implantation are successfully treated with SNM after a lead revision. There is a lack of studies comparing the outcomes of successful index implantations and successful lead revision. Therefore, the results of index implantations were compared with lead revisions in a single-center cohort.MethodsPatients treated with SNM for FI between 2008 and 2016 were retrospectively reviewed. Patients with a successful index implantation were compared with patients who underwent lead revision after SNM screening. Primary outcome was a decrease in episodes of fecal incontinence of ≥ 50% documented by a 3-week bowel habit diary.ResultsTwo hundred sixty-one patients (232 index group, 29 revision group) were eligible for SNM. Two hundred thirty-one patients (208 index group, 23 revision group) received permanent SNM. Follow-up was 68.8 months for the index group and 62.2 months for the revision group. The number of episodes of FI decreased from 20.6 (SD 19.3) to 3.4 (SD 4.2) in the index group and from 12.6 (SD 5.8) to 2.0 (SD 2.3) in the revision group. This effect was maintained up to 5 and 2 years in the index and revision group, respectively. Adverse events such as loss of efficacy which required surgical intervention did not differ between the two groups.ConclusionLead revision during the test phase is a valid option in patients with FI treated by SNM who suffer from loss of efficacy of the index electrode.

Trans-anal irrigation should be offered to patients with severe bowel dysfunction.

Severe bowel dysfunction can present with faecal incontinence (FI), constipation, or both, and can have neurogenic and non-neurogenic aetiologies. The prevalence in the population for patients experiencing at least one episode of FI per month is high, with up to 12.4% affected.1 The prevalence of severe functional constipation is less well documented, but together these patients present a significant health burden to primary and secondary care. Last year the National Institute for Health and Care Excellence (NICE) published medical technology guidelines supporting the use of trans-anal irrigation (TAI) in patients with bowel dysfunction as it can reduce the severity of constipation/incontinence, improve quality of life, and promote dignity and independence.2 The benefits of TAI in patients with neurogenic bowel dysfunction secondary to spinal cord injuries are long established, and supported by the only randomised controlled trial by Christensen et al in …

Faecal incontinence: investigation and treatment

Up to 10% of adults can experience faecal incontinence in their lives, which can be caused by many factors. Linda Nazarko investigates the causes of incontinence as well as treatment and management pathways that nurses can consider for their patients Faecal incontinence (FI) is a hidden problem that is under diagnosed, under investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8–6.2%, a recent North American research indicated a prevalence of 8.3% in adults living in the community ( Ditah et al, 2014 ). This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.

Topical Oxymetazoline for Fecal Incontinence in Patients with Spinal Cord Injury: A Double-Blind Randomized Controlled Crossover Study

Topical α-agonists contract the internal anal sphincter muscle; therefore, they may serve as treatment for fecal incontinence. The aim of this study was to investigate the effect of the α-agonist oxymetazoline 1.0% on fecal incontinence in patients with spinal cord injury. This was a double-blind, crossover study. Before randomization, all patients underwent a 1-day, open-label anal manometry and pharmacokinetic study. The study was conducted at the Department of Internal Medicine, Semmelweis University, Hungary. Nineteen patients were enrolled into a randomized double-blind, placebo-controlled clinical trial with 2 arms: placebo for 4 weeks followed by oxymetazoline for 4 weeks, or vice versa, with an interval 2-week washout period, in a crossover trial design. Treatment order was randomly assigned, and fecal incontinence was captured with daily diaries. The primary outcome measured was the number of fecal incontinence episodes in the 8 and 12 hours after drug administration. Resting anal pressure increased in response to oxymetzoline (25.2%). The change in the mean fecal incontinence episodes per month (12 hours post drug application) favored oxymetazoline over placebo: 26.3 (SD ±28.4) versus 36 (SD ±39.8) (p = 0.021). When only nongas episodes were included, the mean number of episodes decreased from 10.1 (+4.3) to 6.3 (±2.1) fecal incontinence episodes per month (p = 0.022). No difference was observed in adverse events between treatment and placebo periods. All pharmacokinetic samples were below the detection limit. The study was limited by the small number of participants. In this study, oxymetazoline gel presented a clear clinical beneficial effect accompanied by a favorable safety and tolerability profile. Results of the pharmacokinetic analysis indicate that the clinical benefit was mainly due to a local effect of oxymetazoline. Future studies are planned to investigate higher doses of oxymetazoline for this indication. See Video Abstract at http://links.lww.com/DCR/A797.

Posterior Tibial Nerve Stimulation in Fecal Incontinence: A Systematic Review and Meta-Analysis.

Introduction:The present systematic review and meta-analysis aims to investigate the role of Posterior Tibial Nerve Stimulation (PTNS) in the control of Fecal Incontinence (FI).Methods:Two independent reviewers extensively searched in the electronic databases of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, CINAHL, and Scopus for the studies published until the end of 2016. Only randomized clinical trials were included. The studied outcomes included FI episodes, FI score, resting pressure, squeezing pressure, and maximum tolerable pressure. The data were reported as Standardized Mean Differences (SMD) with 95% confidence interval.Results:Five articles were included in the present study (249 patients under treatment with PTNS and 239 in the sham group). Analyses showed that PTNS led to a significant decrease in the number of FI episodes (SMD=−0.38; 95% CI: −0.67–0.10; P=0.009). Yet, it did not have an effect on FI score (SMD=0.13; 95% CI: −0.49–0.75; P=0.68), resting pressure (SMD=0.12; 95% CI: −0.14–0.37; P=0.67), squeezing pressure (SMD=−0.27; 95% CI: −1.03–0.50; P=0.50), and maximum tolerable pressure (SMD=−0.10; 95% CI: −0.40–0.24; P=0.52).Conclusion:Based on the results, it seems that the prescription of PTNS alone cannot significantly improve FI.

Faecal incontinence: investigation, treatment and management.

Faecal incontinence (FI) is a hidden problem that is under-diagnosed, under-investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8-6.2%. Recent North American research indicates a prevalence of 8.3% in adults living in the community. This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.

Conservative treatment of severe defecatory urgency and fecal incontinence: minor strategies with major impact.

Bowel disturbances have been identified as the most important risk factor for fecal incontinence (FI). However, few studies have evaluated the impact of fiber supplementation. Our aim was to assess the correlation between the improvement in stool consistency by fiber supplementation and the changes in urgency and number of FI episodes and in the QoL of patients with FI. Eighty-three patients who came to our institution with FI and/or fecal urgency associated with loose stools or diarrhea were prospectively included in the study The intervention included dietary advice and methylcellulose 500mg every 8h for 6weeks. All assessments were carried out at baseline and 6weeks after the start of the intervention, and included a Bristol Stool Scale, a 3-week bowel diary, the St Mark's score, the Fecal Incontinence Quality of Life scale (FIQL) and a bowel satisfaction score. Sixty-one patients completed the study. At baseline 50 reported episodes of urge incontinence, while 11 did not report FI episodes because they rarely left home to avoid leakage. The Bristol score improved to normal stools in 65.6% of patients after treatment. Bowel diaries showed a statistically significant reduction in the number of bowel movements, urge episodes, urge fecal incontinence episodes and soiling per week. The St Mark's score and the bowel satisfaction score significantly improved after methylcellulose and overall deferment time also increased. FIQL significantly improved in two subdomains (lifestyle, coping/behavior). Thirty-one patients (51.7%) were discharged with methylcellulose as the only treatment. FI may significantly improve with methylcellulose in selected cases. Assessment of fecal consistency and initial treatment with methylcellulose could be started at primary care level to reduce the need for specialist referral.

Validation of the Brazilian Portuguese version of the pelvic floor bother questionnaire.

The Pelvic Floor Bother Questionnaire (PFBQ) was designed to identify the presence and degree of bother associated with common pelvic floor symptoms. The PFBQ can be used in clinical practice and for research purposes, but it is not available in Brazilian Portuguese. We aimed to validate a cross-culturally adapted Brazilian Portuguese version of the PFBQ. A pilot-tested version of the PFBQ translated from English was evaluated with Brazilian patients suffering from pelvic floor disorders. Internal reliability, test-retest reliability, validity, and responsiveness to change were assessed. A total of 147 patients (mean age, 60.49years) were enrolled in the study. The Brazilian Portuguese version of the PFBQ demonstrated good reliability (α= 0.625; ICC = 0.981). There was strong agreement beyond chance for each item (κ= 0.895-1.00). The PFBQ correlated with stage of prolapse (p< 0.01), number of urinary (ρ= 0.791, p< 0.001) and fecal (ρ= 0.78, p< 0.001) incontinence episodes, and obstructed defecation (ρ= 0.875, p< 0.001). The Brazilian Portuguese version of the PFBQ is a reliable, valid, and user-friendly instrument that can be used for assessing the presence and severity of pelvic floor symptoms in clinical and research settings in Brazil.

Clinical Evaluation of a Novel Intrarectal Device for Management of Fecal Incontinence in Bedridden Patients.

The primary objective of the study was to evaluate the safety and efficacy of a stool management kit (SMK) for containment of fecal incontinence in hospitalized bedridden patients. A single-group quasi-experimental study. Twenty bedridden adults who had at least 1 episode of fecal incontinence in the prior 24 hours participated in the study. The study setting was the neurological unit of the All India Institute of Medical Sciences in New Delhi, India. The study was carried out in 2 phases. The device was placed in situ for up to 24 hours in 10 patients during phase I of the study and up to 120 hours in an additional 10 patients during phase II. Participants were assessed for anorectal injury and peripheral device leakage on a 4- to 6-hourly basis. Sigmoidoscopy was performed to evaluate for any mucosal trauma or alteration of anorectal pathology after retrieval of the device. The device was successfully placed in all patients following the first attempt to place the device; 80% of patients retained the device until planned removal. The SMK diverted fecal matter without anal leakage in 174 (93.5%) out of 186 assessment points in a group of 20 patients. The devices remained in situ for 21 ± 0.2 and 84.5 ± 38.9 hours during phase I and phase II, respectively. None experienced anorectal bleeding, sphincter injury, or mucosal ulceration with device usage. Post-device sigmoidoscopy revealed erythema at the site of diverter placement in 2 participants. Study findings suggest that the SMK successfully diverted liquid to semiformed fecal exudate without peripheral device leakage in 93.5% of bedridden patients. No serious adverse events occurred. Additional research is needed to compare its effectiveness with that of currently available intrarectal balloon devices.

Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up.

To assess whether sacral nerve stimulation (SNS) is an effective treatment for severe fecal incontinence (FI) after radiotherapy (RT)/chemoRT (CRT) in combination with pelvic surgery. A multicenter study was conducted on patients with FI that developed after multimodal therapy for pelvic tumors and was refractory to non-operative management, who were treated with SNS between November 2009 and November 2012. Data were prospectively collected and retrospectively analyzed. Cleveland Clinic FI score (CCFIS), FI episodes per week, FI Quality of Life (FIQoL), anorectal manometry and pudendal nerve terminal motor latency were evaluated before and after SNS. Eleven patients (seven females, mean age 67.3±4.8years) were evaluated in the study period. Multimodal treatments included surgery and CRT (four rectal, two cervical and one prostate cancers), surgery and RT (one cervical and two endometrial cancers) and CRT (one anal cancer). The mean radiation dose was 5.3Gy, and mean interval between the end of RT and onset of FI was 43.7±23months. Before SNS, the mean CCFIS and the mean number of FI episodes per week were 15.7±2.8 and 12.3±4.2, respectively. At 12-month follow-up, mean CCFIS improved to 3.6±1.8 (p=0.003) and the mean number of FI episodes decreased to 2.0±1.9 per week (p=0.003). These results persisted at 24-month follow-up. Significant improvement was also observed for each of the four domains of FIQoL at 12- and 24-month follow-up. Anorectal manometry values did not change significantly at follow-up. SNS is feasible and may be an effective therapeutic option for FI after multimodal treatment of pelvic malignancies.

The short-term effects of posterior tibial nerve stimulation on anorectal physiology in patients with faecal incontinence: a single centre experience.

Background:Posterior tibial nerve stimulation (PTNS) is a novel treatment for patients with faecal incontinence (FI) and may be effective in selected patients; however, its mechanism of action is unknown. We sought to determine the effects of PTNS on anorectal physiological parameters.Methods:Fifty patients with FI underwent 30 min of PTNS treatment, weekly for 12 weeks. High-resolution anorectal manometry, bowel diaries and Vaizey questionnaires were performed before and after treatment. Successful treatment was determined as a greater than 50% reduction in FI episodes.Results:Fifty patients with FI were studied; 39 women, median age 62 years (range 30–82). Compared with pretreatment, there were reductions in episodes of urgency (16.0 versus 11.4, p = 0.006), overall FI (14.5 versus 9.1, p = 0.001), urge FI (5.4 versus 3.2, p = 0.016) and passive FI (9.1 versus 5.9, p = 0.008). Vaizey score was reduced (16.1 versus 14.5, p = 0.002). Rectal sensory volumes (ml) decreased (onset 40.3 versus 32.6, p = 0.014, call 75.7 versus 57.5, p < 0.001, urge 104.1 versus 87.4, p = 0.004). There was no significant change in anal canal pressures (mmHg) (maximum resting pressure 41.4 versus 44.2, p = 0.39, maximum squeeze pressure, 78.7 versus 88.2, p = 0.15, incremental squeeze pressure 37.2 versus 44.1, p = 0.22). Reduction in FI episodes did not correlate with changes in physiological parameters (p > 0.05). Treatment success of 44% was independent of changes in manometric parameters (p > 0.05).Conclusions:PTNS has a measureable physiological effect on rectal sensory volumes without an effect on anal canal pressures. It also reduces FI episodes; however, this effect is independent of changing physiology, suggesting that PTNS has a complex mechanism of action.

Meta-analysis of sacral nerve stimulation for fecal incontinence

To evaluate the efficacy of sacral nerve stimulation (SNS) therapy for fecal incontinence. Clinical researches which evaluated the efficacy of SNS and were published between 1946 and 2016 were systematically searched from electronic databases, including PubMed, Ovid Medline, Web of Science, Wanfang database and Chinese Journal Full-text Database. Grey area literatures were also searched. Influence of SNS therapy on fecal incontinence episodes (FIE) or Wexner incontinence score (WIS) was systematically evaluated. The statistical analysis was performed by RevMan5.2. A total of 6 studies including 270 patients (147 patients in SNS group and 123 patients in control group) with fecal incontinence were enrolled in this systematic review. SNS therapy was associated with a significant reduction in FIE (SMD=-0.69, 95%CI: -0.97 to -0.41, P<0.001) and a significant reduction in WIS (SMD=-5.05, 95%CI: -8.73 to -1.36, P=0.007). Sensitivity analysis showed that the results of this study were stable and the direction and significance of results were not changed (P=0.000 for both). Publication bias was not found by funnel picture in this study. SNS significantly improves the outcome of patients with fecal incontinence.

Is Home Biofeedback Training Useful for Fecal Incontinence: Preliminary Fesults of RCT With New Home Device

Introduction: Biofeedback therapy (BT) is useful in fecal incontinence (FI), but it is labor intensive, not widely available and reimbursement is problematic. We tested the efficacy of home device assisted BT against standard office BT. Methods: Patients with FI (at least 1 episode / week) were randomized to office BT or home BT using a novel biofeedback device (InToneMV, InControl Medical, WI, USA). Home device consists of a probe with balloon, a pump for balloon inflation, a hand held monitor with voice guided therapy, and both mechanical and electrical stimulation of anal sphincters. Home BT patients were asked to use home device twice daily for 20 minute session. Office BT patients practiced Kegel exercise twice daily at home and had 6, one hour, weekly office BT consisting of anal strengthening, endurance training and coordination training for 6 weeks. All participants kept daily stool diaries. Bowel symptoms, fecal incontinence severity index (FISI), fecal incontinence and constipation assessment (FICA), subject's global assessment (SGA) and physiological changes (anorectal manometry) were assessed at baseline and post-treatment period. Responder was defined as ≥50% decrease in weekly FI episodes compared to baseline. Results: Eighteen (16 females, 63.6±13.4 years old) FI patients were enrolled: 11 (home BT) and 7 (office BT). There were 6/11 (55%) responders in Home BT and 3/7(43%) in Office BT (p=1.000). In Home BT, FI symptom severity (visual analog scale, VAS) improved in 10 (91%) and unchanged in 1 (9%), compared to 3 (43%) improved in Office BT and was unchanged in 1 (17%) and worse in 3 (43%). Similarly, 9% reported completely relief and 64% reported considerable relief with Home BT compared to 29% reported considerable relief with Office BT (Table 1). The mean FISI score increased and FICA score decreased in Home BT when compared to baseline (3.6 and 3.3, p=0.016 and p=0.033) and in Office BT (1.0 and 1.2 p=0.435 and p=0.330). The mean anal resting, maximal squeeze and sustained squeeze pressure increases were comparable (6.8, 25.3 and 5.21 mmHg in Home BT and 21.3, 37.6 and 14.4mmHg in Office BT respectively).Table: Table. Patients' self-assessment of the treatment effectConclusion: Home BT using a voice guided program of mechanical and electrical stimulation is a promising approach for treatment of FI, and provides comparable physiologic and somewhat better symptomatic benefit when compared to office BT. The convenience of home BT may prove beneficial in long term and reduce health care burden.

Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence

The aim was to assess the effects of percutaneous tibial nerve stimulation (PTNS) in the treatment of faecal incontinence (FI) by means of an RCT. Patients aged over 18 years with FI were included in a multicentre, single-blinded RCT. The primary endpoint was reduction in the median or mean number of FI episodes per week. Secondary endpoints were changes in measures of FI severity, and disease-specific and generic quality of life. Outcomes were compared between PTNS and sham stimulation after 9 weeks of treatment. A higher proportion of patients in the PTNS (13 of 29) than in the sham (6 of 30) group showed a reduction of at least 50 per cent in the median number of FI episodes/week (incidence rate ratio (IRR) 2·40, 95 per cent c.i. 1·10 to 5·24; P = 0·028), but not in the mean number of episodes/week (10 of 29 versus 8 of 30; IRR 1·42, 0·69 to 2·92; P = 0·347). The absolute median number of FI episodes per week decreased in the PTNS but not in the sham group (IRR 0·66, 0·44 to 0·98; P = 0·041), as did the mean number (IRR 0·65 (0·45 to 0·97); P = 0·034). Scores on the Cleveland Clinic Florida faecal incontinence scale decreased significantly in both groups, but more steeply in the PTNS group (mean difference -1·3, 95 per cent c.i. -2·6 to 0·0; P = 0·049). The aggregated mental component score of Short Form 36 improved in the PTNS but not in the sham group (mean difference 5·1, 0·5 to 9·6; P = 0·028). PTNS may offer a small advantage in the clinical management of FI that is insufficiently responsive to conservative treatment. The key challenge will be to identify patients who may benefit most from this minimally invasive surgical procedure. Registration number: NCT00974909 (http://www.clinicaltrials.gov).

Factors Associated With Efficacy of Percutaneous Tibial Nerve Stimulation for Fecal Incontinence, Based on Post-Hoc Analysis of Data From a Randomized Trial

A recent randomized, multi-center, phase 3 trial, performed in the United Kingdom (Control of Fecal Incontinence using Distal Neuromodulation Trial), demonstrated no significant clinical benefit of percutaneous tibial nerve stimulation (PTNS) compared to sham stimulation in patients with fecal incontinence (FI). However, this study did not analyze predictors of response. We used data from this trial to identify factors that predict the efficacy of PTNS in adults with FI. The study population comprised 205 patients from the CONtrol of Fecal Incontinence using Distal NeuromodulaTion Trial. The primary outcome was a binary indicator of success (≥50% reduction in weekly FI episodes after 12 weeks of treatment) or failure, as per the original trialcharacteristics including baseline FI symptom type, defecatory urgency, and co-existent symptoms of baseline liquid stool consistency and obstructive defecation (OD) were defined a priori. Univariable and multivariable analyses were performed to explore these factors as predictors of response to PTNS and sham. In both univariable and multivariable analysis, the presence of OD symptoms negatively predicted outcome in patients who received PTNS (OR, 0.38; 95% CI, 0.16-0.91; P= .029), and positively predicted sham response (OR, 3.45; 95% CI, 1.31-9.21; P= .012). No other tested variable affected outcome. Re-analysis of the primary outcome excluding patients with OD symptoms (n= 112) resulted in a significant clinical effect of PTNS compared to sham (48.9% vs 18.2% response, P= .002; multivariable OR, 4.71; 95% CI, 1.71-12.93; P= .003). Concomitant OD symptoms negatively affected the clinical outcome of PTNS vs sham in a major randomized controlled trial. Future appropriately designed studies could further explore this observation with potential for future stratified patient selection.

Sacral neuromodulation for faecal incontinence following obstetric sphincter injury - outcome of percutaneous nerve evaluation.

The purpose of this study was to assess the efficacy of percutaneous nerve evaluation (PNE) in women with faecal incontinence (FI) following obstetric anal sphincter injury and to relate the outcomes to baseline factors, with special emphasis on the extent of the sphincter defect. This was a prospective study at a tertiary colorectal referral unit at the University Hospital of North Norway conducted from 2012 to 2014. Sixty-three women underwent a 3-week PNE using a tined lead and the Verify® external neurostimulator. The primary outcome was efficacy, defined as the percentage reduction in weekly FI episodes, and patients with a reduction of 50% or more were defined as responders. Baseline factors affecting the primary outcome were explored. Sphincter defects were classified with a validated three-dimensional endoanal ultrasound defect score. Fifty-six (89%) of the 63 women were responders with a reduction in weekly FI episodes of 94.5%, from a median (interquartile range) of 4.8 (2.0-11.0) to 0.5 (0-2.0) (P<0.001). Twenty-nine (52%) reported no weekly FI episodes, and urgency episodes disappeared in 18 (32%). In the multivariable linear regression model, efficacy was related to concomitant urinary incontinence (P=0.04), body mass index (BMI) (P=0.03) and pain during PNE (P=0.046) but not to the extent of the sphincter defect (P=0.1). Responders had a higher St Mark's score than nonresponders (P=0.046). The vast majority of women had successful PNE tests. Responders had higher baseline St Mark's scores than nonresponders. Efficacy was related to concomitant urinary incontinence, BMI and pain, not to the extent of the sphincter defect.

Transanal Irrigation in the Treatment of Children With Intractable Functional Constipation.

The aim of the study was to assess the treatment efficacy of transanal irrigation and parental satisfaction in children with intractable functional constipation (FC) treated with Peristeen. Cross-sectional survey study among parents of children (age 0-18 years) treated with Peristeen for FC (based on the Rome III criteria). Anonymous questionnaires were sent out to parents via mail, these consisted of 25 self-developed, multiple-choice questions regarding the use of Peristeen, current gastrointestinal symptoms, adverse effects of Peristeen, concomitant medication use, and parental satisfaction. Out of 91 invited families, 67 (74%) returned the questionnaire. In total, 84% of patients experienced fecal incontinence prior to treatment. Out of all children who still used Peristeen at the time of survey (n = 49), fecal incontinence had resolved completely in 41%, 12% experienced occasional episodes of fecal incontinence (<1 episode per week) and the remaining 47% still experienced episodes of fecal incontinence regularly (≥1 time per week). A total of 28 children (42%) experienced pain during rectal irrigation, especially during insertion of the catheter, inflating the balloon, or during irrigation. Overall, 86% of the parents were satisfied with the result of transanal irrigation and 67% reported that they would continue using transanal irrigation for the treatment of their child's symptoms. Transanal irrigation may be effective in the treatment of children with FC and renders a high parental satisfaction. Future prospective studies, preferably RCTs, are necessary to further evaluate this treatment option.

Fecal incontinence treated by sacral neuromodulation: Long-term follow-up of 325 patients

Long-term results of large patient cohorts with fecal incontinence treated by sacral neuromodulation are limited. This study shows the long-term results after a mean follow-up of 7.1years in 325 patients with fecal incontinence treated by continuous sacral neuromodulation. All patients with fecal incontinence and eligible for sacral neuromodulation between 2000 and 2015 were evaluated retrospectively. Primary outcome was a decrease in episodes of fecal incontinence, which was defined as involuntary fecal loss at least once per week and documented by a 3week bowel habit diary. Quality of life was assessed using the Short-Form 36 and the Fecal Incontinence Quality of Life Score. In the study, 374 patients were included for sacral neuromodulation screening and 325 patients (32male, 9.7%) received permanent, continuous sacral neuromodulation. Mean age was 56.5years (17-82years) and mean follow-up was 7.1years (3.0-183.4months). In the 325 patients with permanent sacral neuromodulation, fecal incontinence episodes decreased from a mean of 16.1±14.5 to 3.0±3.7 per 3-week period after sacral neuromodulation (P<.001) according to the bowel habit diary. Sacral neuromodulation was removed due to unsatisfactory results in 81 patients. Quality of life (both Short-Form 36 and Fecal Incontinence Quality of Life Score) showed no significant difference compared with the Dutch population during follow-up. Long-term efficacy of sacral neuromodulation can be maintained in about half (52.7%) of all patients screened with sacral neuromodulation for fecal incontinence after a mean follow-up of 7.1years. Importantly, the quality of life of patients with sacral neuromodulation for fecal incontinence did not differ from the general population.

Functional Evaluation of Obese Patients with Symptoms of Fecal Incontinence Using Anorectal Electromanometry

Obesity is a modifiable risk factor to fecal incontinence (FI) and weight loss result in improvement in the frequency and severity of FI. Introduction: Fecal incontinence (FI) has a multifactorial etiology and is most common in women. The prevalence is variable, though generally underestimated due to embarrassment. Since the incidence of pelvic floor disorders is higher among obese individuals, obesity may be considered a modifiable risk factor for FI. Weight loss seems to result in improvement in the frequency and severity of FI episodes. However, little has been published on FI in obese subjects and on its impact on quality of life in this patient population. Objective: Perform functional evaluations of obese patients with FI using anorectal electromanometry and determine the incidence of anismus. Materials and methods: Retrospective study including 58 obese subjects with FI aged 18-60 years. The patients were diagnosed clinically, and then submitted to physical examination followed by ARM. Results: The sample included 58 obese patients with an average BMI of 35 kg/m² (range: 30-52). The female gender was predominant: n=44 (75.87%) vs. male n=14 (24.13%). The average age was 49 years (23-60), the average pressure at rest was 49 mmHg (8-94) and the average pressure during straining was 124 mmHg (34-263). Half the patients (50%) presented hypotonia at rest and/or during straining, and 45% had anismus. Conclusion: Obesity is a modifiable risk factor for fecal incontinence, the etiology can be varied and needs to be established. In our results show that functional evaluation is necessary to determine the etiology of FI in obese patients and choose the best therapeutic approach in each case.

Novel insights into fecal incontinence in men.

Fecal incontinence in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. We provide evidence that men, compared with women, with fecal incontinence have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with anorectal biofeedback therapy.