Faecal Incontinence In Adults Research Articles

Faecal incontinence in adults: NICE guideline

AbstractThe NICE guideline on the management of faecal incontinence calls for healthcare professionals to ask people in high‐risk groups, such as the frail and elderly, and women who have recently given birth, about whether they have any symptoms of the condition. In this article, Dr Ismail highlights the main features of this guideline, exploring how it could be implemented in primary care, and provides a simplified care algorithm of patient assessment and management. Copyright © 2008 Wiley Interface Ltd.

WITHDRAWN: Physical therapies for prevention of urinary and faecal incontinence in adults.

Physical therapies, particularly pelvic floor muscle training, have been recommended for prevention of incontinence associated with childbearing, and prostate surgery. To assess the effectiveness of physical therapies in preventing incontinence in adults. The Cochrane Incontinence Group trials register was searched to September 2001. Trials were also sought from the Reference Lists of relevant articles and from experts in the field. Randomised and quasi-randomised trials in adults without incontinence symptoms that compared a physical therapy with no treatment, or any other treatment to prevent incontinence. Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook. Two trials in men (155 men) and 13 trials in women (4661 women) were included. As most trials recruited regardless of continence status, and there was much heterogeneity, only a qualitative synthesis was undertaken. Three of seven trials in childbearing women reported less urinary incontinence after pelvic floor muscle training compared to control treatment three months postpartum. Two trials selected women at higher risk of postnatal incontinence. The third used an intensive training programme. Four trials did not find any difference between the groups at the primary endpoint. Two trials compared pre-prostate surgery pelvic floor muscle training with control treatment, and no difference in the occurrence of postoperative urinary incontinence was reported between the groups. There is insufficient evidence to determine whether physical therapies can prevent incontinence in childbearing women, or men following prostate surgery. Further, better quality research is needed.

Nice Clinical Guideline on Managing Faecal Incontinence: Evidence of the Effectiveness and Cost-Effectiveness of Surgical Interventions

This article outlines the recommendations for surgical options and the underlying clinical and cost-effective evidence base for the recently published NICE clinical guideline on the management of faecal incontinence in adults ( ). Faecal incontinence affects over half a million adults in the UK and often has a very profound impact on patients' lives. Despite this, faecal incontinence has been a neglected health-care problem, in the UK and around the world. This, and a paucity of high quality evidence for most assessment and treatment methods, including surgical interventions, has made the task of producing a guideline on the management of faecal incontinence in adults particularly challenging. Consequently, some of the recommendations in the guideline concerning costly, unproven surgical interventions, at least in the absence of very specific indications, may seem conservative. This reflects the reality that, although more sophisticated second treatments are available, referral for these is not common. Therefore, the guideline developers wished to avoid potentially harmful interventions, pending the availability of better research.

Electrical stimulation for faecal incontinence in adults.

Faecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. Electrical stimulation has been used with apparent success in the treatment of faecal incontinence. However, standards of treatment are still lacking and the magnitude of alleged benefits has yet to be established. To determine the effects of electrical stimulation for the treatment of faecal incontinence in adults. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 13 March 2007) and reference lists of potentially eligible articles. All randomised or quasi-randomised trials evaluating electrical stimulation in adults with faecal incontinence. Two reviewers assessed the methodological quality of potentially eligible trials and independently extracted data from the included trials. A wide range of outcome measures were considered. Four eligible trials with 260 participants were identified. Findings from one trial suggest that electrical stimulation with anal biofeedback and exercises provides more short-term benefits than vaginal biofeedback and exercises for women with obstetric-related faecal incontinence. Another study found contradictory results, with no added benefit from electrical stimulation over biofeedback and exercises alone. Although all trials report that patient's symptoms are generally improved, it is not clear that this is the effect of electrical stimulation. No further conclusions could be drawn from the data available. At present, there are insufficient data to allow reliable conclusions to be drawn on the effects of electrical stimulation in the management of faecal incontinence. There is a suggestion that electrical stimulation may have a therapeutic effect, but this is not certain. Larger, more generalisable trials are needed.

Management of faecal incontinence in adults: summary of NICE guidance

The prevalence of faecal incontinence in adults living in the community is 1-10%, depending on the definition used.1 2 Faecal incontinence is a neglected problem that receives limited medical attention,...

Fecal Incontinence in Adults

A 53-year-old otherwise healthy woman presents with a 2-year history of intermittent fecal incontinence. Because of embarrassment, she has curtailed her social and professional activities. Physical activity often precipitates an episode, and she wears absorbent pads. She has occasional urinary incontinence when she coughs or sneezes. There is no history of gastrointestinal or rectal surgery and no neurologic symptoms. Physical examination reveals no perianal deformity or rectal prolapse. The tone of the anal canal is adequate, whereas contractions of the anal sphincter muscle and the puborectalis muscle are weak. On the patient’s bearing down, there is no rectal prolapse, and the perineal descent is approximately 2 cm. How should she be evaluated and treated? T h e C l i nic a l Probl e m Fecal incontinence is a devastating nonfatal illness, resulting in considerable embarrassment and anxiety in those who have it. It affects 2 to 17% of people living in the community and almost half of all nursing home residents. 1 Many affected persons do not voluntarily report fecal incontinence to their physicians and must be asked about it directly. 2 The prevalence of fecal incontinence is increased among women, the elderly, persons with poor health status or physical limitations, and those residing in nursing homes. 2 Other risk factors associated with fecal incontinence in adults include rectal radiation therapy (e.g., for prostate cancer), pregnancy, injury to the sphincter or nerve damage associated with vaginal delivery, anorectal surgical procedures (e.g., sphincterotomy for anal fissures), diarrhea alone or in association with the irritable bowel syndrome, and fecal impaction. Neurologic conditions (e.g., stroke, multiple sclerosis, spinal cord injury, and Parkinson’s disease) and diabetes are also risk factors. Continence relies on the appropriate functioning of the puborectalis muscle and the internal and external anal sphincter muscles, which encircle the anal canal (Fig. 1). Factors such as stool consistency, rectal and colonic storage capacity, perception of rectal sensation, and cognitive and behavioral functioning also play important roles. An abnormality in any of these factors may result in fecal incontinence.

Outcome of antegrade continence enema procedures for faecal incontinence in adults

Faecal incontinence has major consequences. Colostomy has been the mainstay of therapy when other options fail. Operations such as the Malone procedure have been proposed as an alternative. The aim of this study was to evaluate the outcomes and quality of life of patients having a Malone procedure for the treatment of faecal incontinence. Charts of patients who had had a Malone procedure or equivalent between 1998 and 2004 were reviewed. The patients completed a Short Form (SF) 36 quality of life questionnaire. The study included 25 patients (17 female; median age 47 years). In seven, the appendix was used; an ileoneoappendicostomy was performed in the other 18. Three patients were lost to follow-up; the remaining 22 were followed for a median (range) of 21 (1-61) months. Five patients had a cutaneous stenosis; another had the appendicostomy removed and replaced by a colostomy. Four patients no longer used the stoma for irrigation. All other patients were completely clean except one, who reported occasional night-time seepage. The mean SF-36 showed a good physical recovery (43.9) but persisting psychological distress (36.0). The Malone procedure or equivalent achieves good results in the management of faecal incontinence, although psychological distress persists after surgery.

Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

The epidemiology of fecal incontinence (FI) is incompletely understood. We report the prevalence, clinical spectrum, health care-seeking behavior, and quality of life (QOL) in community women with FI. A questionnaire was mailed to an age-stratified random sample of 5300 Olmsted County, Minnesota, women identified by the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale, and impact on QOL was evaluated for subjects who had any FI during the past year. The prevalence of FI was calculated with direct age adjustment to the 2000 US white female population. Altogether, 2800 of 5300 women (53%) responded to the survey. The overall age-adjusted prevalence of FI in the past year was 12.1 per 100 (95% confidence interval, 11.0-13.1). The prevalence increased with age from 7 (third decade) to 22 (sixth decade) per 100 and was steady thereafter. Symptoms were mild (45%), moderate (50%), or severe (5%), and symptom severity was related to the impact of FI on QOL and physician-consulting behavior. Moderate to severe impact on >/=1 domain of QOL was reported by 6% with mild, 35% with moderate, and 82% with severe symptoms, whereas 5% with mild, 10% with moderate, and 48% with severe FI had consulted a physician for FI in the past year. More than 1 of 10 adult women in the population have FI; almost 1 of 15 have moderate to severe FI. FI significantly impacts QOL and prompts health care utilization predominantly in women with moderate to severe symptoms.

Behavioral management of fecal incontinence in adults

Biofeedback has been advocated as first-line therapy for patients whose symptoms of mild to moderate fecal incontinence have not responded to simple dietary advice or medication. Three main modalities have been described: (1) use of an intra-anal electromyographic sensor, a probe to measure intra-anal pressure, or perianal surface electromyographic electrodes to teach the patient how to exercise the anal sphincter; (2) use of a 3-balloon system to train the patient to correctly identify the stimulus of rectal distention and to respond without delay; and (3) use of a rectal balloon to retrain the rectal sensory threshold, usually with the aim of enabling the patient to discriminate and respond to smaller rectal volumes. Although a systematic review found that biofeedback eliminated symptoms in up to one half of patients and decreased symptoms in up to two thirds, these studies suffered from methodological problems, a lack of controls, and a lack of validated outcome measures. No studies have compared different exercise instructions, measured patient compliance with those instructions, or determined any trends in symptom response to the exercises prescribed. A recent study by the author suggests that patient-therapist interaction and patient coping strategies may be more important in improving continence than performing exercises or receiving physiological feedback on sphincter function. Better-designed randomized, controlled trials are needed to evaluate different exercise programs and different elements of biofeedback. Development and validation of outcome measures are important, and predictors of outcome and effects in patient subgroups, especially elderly and neurologically impaired patients, should also be investigated.

Faecal incontinence in adults.

Faecal incontinence is a distressing condition, which adversely affects the quality of life of adults of all ages. It is often preventable and easily treatable once a diagnosis has been made. Nurses should provide support and information for patients and their families and ensure they understand the causes of faecal incontinence and the treatment regimens available.

Digestive health in the elderly: faecal incontinence in adults.

Digestive health in the elderly: faecal incontinence in adults.

Fecal incontinence 1,2

Fecal incontinence 1,2

Physical Therapies for Prevention of Urinary and Faecal Incontinence in Adults

Physical Therapies for Prevention of Urinary and Faecal Incontinence in Adults

Drug treatment for faecal incontinence in adults.

Faecal incontinence is a common symptom which causes significant distress and reduction in quality of life. Available treatment options for faecal incontinence include conservative treatments (biofeedback, pelvic floor muscle training, dietary manipulation or drug therapy) or surgical treatments (e.g. sphincter repair, post anal repair, neosphincter). Drug treatment is often given either alone or in combination with other treatment modalities. To assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities. We searched the Cochrane Incontinence Group trials register (January 2003) and the reference lists of relevant articles. Date of the most recent search: January 2003. All randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults. Working independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data. Eleven trials were identified for inclusion in this review. Nine trials were of cross-over design. Seven trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea or following ileoanal pouch surgery). Three trials (total 58 participants) compared topical phenylephrine gel with placebo. Two trials (56 participants) compared loperamide with placebo. One trial (11 participants) compared loperamide oxide with placebo. One trial (15 participants) compared diphenoxylate plus atropine with placebo. One trial (17 participants) compared sodium valproate with placebo. One trial (30 participants) compared loperamide with codeine with diphenoxylate plus atropine. Two further trials (total 265 participants) assessed the use of lactulose in elderly people.No studies comparing drugs with other treatment modalities were identified. There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. However, the trials were small and of short duration. The small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.

Physical therapies for prevention of urinary and faecal incontinence in adults.

Physical therapies, particularly pelvic floor muscle training, have been recommended for prevention of incontinence associated with childbearing, and prostate surgery. To assess the effectiveness of physical therapies in preventing incontinence in adults. The Cochrane Incontinence Group trials register was searched to September 2001. Trials were also sought from the Reference Lists of relevant articles and from experts in the field. Randomised and quasi-randomised trials in adults without incontinence symptoms that compared a physical therapy with no treatment, or any other treatment to prevent incontinence. Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook. Two trials in men (155 men) and 13 trials in women (4661 women) were included. As most trials recruited regardless of continence status, and there was much heterogeneity, only a qualitative synthesis was undertaken. Three of seven trials in childbearing women reported less urinary incontinence after pelvic floor muscle training compared to control treatment three months postpartum. Two trials selected women at higher risk of postnatal incontinence. The third used an intensive training programme. Four trials did not find any difference between the groups at the primary endpoint. Two trials compared pre-prostate surgery pelvic floor muscle training with control treatment, and no difference in the occurrence of postoperative urinary incontinence was reported between the groups. There is insufficient evidence to determine whether physical therapies can prevent incontinence in childbearing women, or men following prostate surgery. Further, better quality research is needed.

Prevalence of faecal incontinence in adults aged 40 years or more living in the community.

Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed. To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage, degree of soiling, and level of impact on quality of life. In a cross sectional postal survey, 15 904 adults aged 40 years or more (excluding residents of nursing and residential homes) were selected randomly by household from the Leicestershire Health Authority patient register. Participants were asked to complete a confidential health questionnaire. Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more. Respondents were also asked if bowel symptoms had an impact on their quality of life. From a total sample of 10 116 respondents, 1.4% reported major faecal incontinence and 0.7% major faecal incontinence with bowel symptoms that had an impact on quality of life. Major faecal incontinence was significantly associated with a lot of impact on quality of life (odds ratio 12.4, 95% confidence interval 7.5-20.6). Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women. This study has confirmed that faecal incontinence is a fairly common symptom, particularly in older people. Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high. Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life.

Absorbent products for containing urinary and/or fecal incontinence in adults

Objectives: The objectives of this study were to assess the effectiveness and cost-effectiveness of different types of absorbent product for people with incontinence. Design: A systematic review of randomized and quasi-randomized controlled trials was performed to compare different types of absorbent products for the containment of urinary and/or fecal incontinence in adults. Setting and Methods: Randomized and quasi-randomized trials available by March 2000 were used. Trials were identified through searches of major bibliographic and research databases. Investigators in the field were also contacted to locate studies. Subjects: The trials reviewed comprised a total of 345 participants. Results: Five trials were identified. The following comparisons were considered: disposable versus nondisposable pad-and-pant systems or all-in-one diapers (bodyworns), disposable versus nondisposable underpads, bodyworns versus underpads, and superabsorbent versus fluff-pulp products. Outcomes and type of intervention were heterogeneous among trials. Combining data from more than one trial proved to be impracticable. In a single trial, fewer people who used disposable products complained of skin problems compared with those who used nondisposable products (odds ratio, 0.08; 95% confidence interval 0.03 to 0.20). Similarly, people who used superabsorbent products experienced less severe skin problems than those who used fluff pulp products (P < .03). Conclusions: The data were too few and of insufficient quality to provide a firm basis for practice. However, the data suggest that disposable products are more costly but more effective than nondisposable products in decreasing the incidence of skin problems and that superabsorbent products perform better than fluff pulp products. (J WOCN 2002;29:45-54.)

Absorbent Products for Containing Urinary and/or Fecal Incontinence in Adults

Absorbent Products for Containing Urinary and/or Fecal Incontinence in Adults

Surgical management of faecal incontinence in adults

Faecal incontinence has a long list of aetiology. Definitive treatment depends on the underlying condition. If a non‐surgical cause is identified, conservative treatment is often appropriate. Surgical management is more often successful when a structural damage of the anal sphincter is found. Overlapping sphincter repair has a high success rate when the anal sphincter is disrupted. Surgery has a clear role to play in the case of idiopathic faecal incontinence; and sacral nerve stimulation is the most promising treatment presently available. Dynamic muscle transposition and artificial bowel sphincter are the remaining alternatives after unsuccessful attempts at sphincter repair or in the case of end‐stage faecal incontinence. Spinal cord injury or diseases contribute significantly to faecal incontinence. Malone’s antegrade continence enema has been shown to be helpful to these patients. The greatest benefit of this treatment modality appears to occur with children. With adults, experience is sparse. For the debilitated geriatric patient whose faecal incontinence has led to perianal skin excoriation, bed sores or perianal sepsis, a well‐sited colostomy is sometimes the kindest option apart from diligent nursing care. Biofeedback and pelvic floor exercises are helpful adjuncts and sometimes the primary mode of therapy. It carries no risk in its own right and is worth trying provided the patient is motivated and a dedicated therapist is available.

Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults--a systematic review.

Faecal incontinence is a common health care problem. Biofeedback is extensively used in clinical practice to treat faecal incontinence. To systematically review and evaluate the evidence from clinical studies on the effectiveness of biofeedback as a treatment for faecal incontinence in adults. A systematic literature search was undertaken using electronic databases, with review of the retrieved references. The search identified 46 studies published in English using biofeedback to treat adults complaining of faecal incontinence. Those studies included a total of 1364 patients. Of those studies with adequate data, 275 out of 566 patients (49%) were said to be cured of symptoms of faecal incontinence following biofeedback therapy and 617 out of 861 (72%) patients were reported to be cured or improved. Studies varied in the method of biofeedback used, criteria for success and the outcome measures used. Only eight of the 46 studies employed any form of control group. The data suggest that biofeedback and exercises help a majority of patients with faecal incontinence. However, methodological variation, lack of controls and a lack of validated outcome measures are problems in evaluating these results.