Fecal Incontinence In Patients Research Articles

Effects of multifunctional butterfly-shaped chassis ostomy bag in incontinence-associated dermatitis

Objective To explore the effects of multifunctional butterfly-shaped chassis ostomy bag for faeces drainage in incontinence-associated dermatitis (IAD) . Methods From January to September 2019, this study selected 84 fecal incontinence patients with IAD of Intensive Care Unit in Zhejiang Provincial People's Hospital by convenient sampling. All of patients were divided into observation group (n=42) and control group (n=42) with the method of random number table. Control group carried out the IAD skin management trilogy combined with the common ostomy bag, while observation group implemented the IAD skin management trilogy combined with the multifunctional butterfly-shaped chassis ostomy bag. We compared the overall effective rate of treatment for IAD, nursing time of nurses for IAD, average retention time, average use time and replacement frequency of ostomy bag, family members satisfaction of patients between two groups. Results The overall effective rate of treatment for IAD in observation group was 95.24% (40/42) higher than that 73.81% (31/42) in control group with a statistical difference (P<0.05) . The nursing time and retention time of observation group was (1.89±0.32) h/d and (5.2±0.4) days per person respectively shorter than those [ (5.73±1.64) h/d and (9.4±1.2) days per person] of control group with statistical differences (P<0.05) . The use time of observation group was (98.27±12.18) hours per bag longer than that (72.18±4.63) hours per bag of control group with a statistical difference (P<0.05) . The replacement frequency of observation group was (1.20±0.10) times per person also statistically less than that [ (3.10±0.70) times per person] of control group (P<0.05) . Family members satisfaction of observation group was significantly higher than that of control group (P<0.05) . Conclusions Compared with traditional ostomy bag, the multifunctional butterfly-shaped chassis ostomy bag has effective treatments for IAD can shorten the nursing time for IAD, lengthen the use time of ostomy bag, reduce the average retention time and replacement frequency and improve family members satisfaction which can be widely used in clinical application. Key words: Butterfly-shaped; Ostomy bag; Incontinence- associated dermatitis

Propiverine Hydrochloride as a Treatment for Fecal Incontinence.

PurposePropiverine hydrochloride (PH) is widely used for the treatment of urinary incontinence (UI) due to bladder overactivity. Moreover, the comorbidity of UI with fecal incontinence (FI) is known to be due to the relationship of both to nervous system disorders and dysfunction or weakening of the pelvic floor muscles. The aim of this single-arm prospective study was to evaluate the therapeutic value of PH for FI.MethodsPatients (n = 24) who were diagnosed as having both FI and UI from April 2015 to November 2016 were included in the study and administered a dosage of 10–20 mg PH every day for 1 month. The primary endpoint was to create a reduction in the frequency of FI per week. An evaluation criterion of ≥50% reduction in frequency was determined as effective. The percentage of the patients who achieved the ≥50% endpoint (responders) was also calculated.ResultsThe frequency of FI per week was 6.0 ± 8.2 (0.25–30) at baseline and reduced to 1.6 ± 2.1 (0–7) at the posttherapeutic state (P = 0.005). A reduction of ≥50% was seen in 14 of the patients (58.3%).ConclusionPH reduced the frequency of FI in patients with both FI and UI. This study introduces a possible therapeutic option for the pharmacological treatment of FI.

Assessment of a novel artificial anal sphincter with constant force

Fecal incontinence caused by sphincter dysfunction is an unresolved problem which has a serious effect on patients, both physically and psychologically. For patients with severe symptoms, treatment with an artificial anal sphincter could be a potential option to restore continence. Acticon Neosphincter still has safety and efficacy problems, which is the only device certified by the US Food and Drug Administration. The biomechanical compatibility is the key problem of artificial anal sphincter in the clinical application. This paper describes an artificial anal sphincter with superelastic shape memory alloys and its mechanical properties assessment in artificial intestine models. The new design was developed as a low invasive and constant force or pressure prosthesis with a simple structure to solve the problem of severe fecal incontinence in patients.

Loop analysis of the anal sphincter complex in fecal incontinent patients using functional luminal imaging probe.

Cardiac loops have been used extensively to study myocardial function. With changes in cardiac pump function, loops are shifted to the right or left. Functional luminal imaging probe (FLIP) recordings allow for loop analysis of the anal sphincter and puborectalis muscle (PRM) function. The goal was to characterize anal sphincter area-pressure/tension loop changes in fecal incontinence (FI) patients. Fourteen healthy subjects and 14 patients with FI were studied. A custom-designed FLIP was placed in the vagina and then in the anal canal, and deflated in 20-ml steps, from 90 to 30 ml. At each volume, subjects performed maximal voluntary squeezes. Area-pressure (AP) and area-tension (AT) loops were generated for each squeeze cycle. Three-dimensional ultrasound imaging of the anal sphincter and PRM were obtained to determine the relationship between anal sphincter muscle damage and loop movements. With the increase in bag volume, AP loops and AT loops shifted to the right and upward in normal subjects (both anal and vaginal). The shift to the right was greater, and the upward movement was less in FI patients. The difference in the location of AP loops and AT loops was statistically significant at volumes of 50 ml to 90 ml (P < 0.05). A similar pattern was found in the vaginal loops. There is a significant relationship between the damage to the anal sphincter and PRM, and loop location of FI patients. We propose AP and AT loops as novel ways to assess the anal sphincter and PRM function. Such loops can be generated by real-time measurement of pressure and area within the anal canal.NEW & NOTEWORTHY We describe the use of area-pressure (AP) and area-tension (AT)-loop analysis of the anal sphincters and puborectalis muscles in normal subjects and fecal incontinent patients using the functional luminal imaging probe (FLIP). There are differences in the magnitude of the displacement of the loops with increase in the FLIP bag volume between normal subjects and patients with fecal incontinence. The latter group shifts more to the right in AP and AT space.

Clinical efficacy of Japanese herbal medicine daikenchuto in the management of fecal incontinence: A single-center, observational study.

Objectives: The purpose of this study was to investigate whether the symptoms of fecal incontinence (FI) or anal sphincter dysfunction are improved by daikenchuto (DKT). Methods: This is a retrospective observational study that analyzes the effects of DKT. The study was conducted at Kunimoto Hospital. Patients who visited the hospital from January 2012 to December 2016 due to symptoms of FI with a certain degree of chronic constipation and who took DKT were enrolled. The drug to be evaluated was “Tsumura Daikenchuto Extract Granules for Ethical Use (TJ-100)” manufactured by Tsumura & Co., Tokyo, Japan. The primary outcome measures were changes in the scores of the Cleveland Clinic Incontinence Score (CCIS) and Constipation Scoring System (CSS) before and after the administration of DKT. Results: A total of 157 patients were enrolled. On the CCIS, “leakage of solid stool,” “leakage of liquid stool,” “pad use,” and “total score” were significantly improved. On the contrary, on the CSS, the score of “type of assistance” was significantly improved after the administration of DKT, but no significant difference was found in the total score. On the Bristol Stool Form Scale, the administration of DKT showed a tendency to normalize stool consistency. Maximum resting anal pressure and maximum squeeze anal pressure significantly increased after the administration of DKT. No side effects caused by DKT were observed during the study. Conclusions: DKT appears to be a safe and useful agent for the management of FI in patients with defecation disorders and internal anal sphincter dysfunction.

Anorectal Function and Quality of Life in IBD Patients With A Perianal Complaint

Purpose Anorectal function of inflammatory bowel disease (IBD) patients is still poorly understood, with contradictory results. This prospective observational study aimed to analyze the effect of perianal disease on anorectal function and quality of life in IBD patients. Methods: Patient assessment included full clinical examination, validated scores, anorectal manometry, three-dimensional endoanal ultrasonography, and endoscopy. The Inflammatory Bowel Disease Questionnaire was adopted to evaluate patients’ quality of life. Results: From January to November 2016, 37 consecutive IBD patients (30 Crohn’s disease, 7 ulcerative colitis) and 20 controls were enrolled in the study. Twenty-five patients had a history of perianal fistula, 9 reported fecal incontinence, and 2 had anal fissure. Fecal incontinent patients were older, had a longer disease duration, and higher bowel movement number than continent patients. Endoanal ultrasound findings were normal in all volunteers, while pathological features were found in 31/37 patients. Rectal sensory testing and anal pressure did not differ between the IBD patients and controls. However, the rectoanal inhibitory reflex was normally elicited in all controls vs. 32/37 (86%) IBD patients; 25/37 (68%) IBD patients showed manometric features of dyssynergic defecation. Rectal inflammation and incontinence were associated with low maximum anal resting pressure. The quality of life score was lower in ulcerative colitis patients than in Crohn’s patients and significantly lower in fecal incontinent patients. Conclusions: Anorectal function is impaired in IBD patients with perianal disease. Fecal incontinence correlates with poorer quality of life. Anorectal manometry and ultrasonography are useful tools for evaluating IBD patients.

CN77 - Effect of Kegel exercises on prevention of urinary and fecal incontinence in patients with prostate cancer undergoing radiotherapy

BackgroundProstate cancer (PC) is the second most common type of cancer among men. During radiotherapy (RT), some of the healthy tissues can be irradiated and side effects such as urinary (UI) and fecal incontinence (FI) may occur. MethodsThis non-randomized study was conducted to determine the effect of Kegel exercises on prevention of UI and FI in PC patients undergoing RT at the Gazi Hospital in the dates of 10.12.2016-03.01.2018. 60 patients were included in the study, 30 in the experimental and 30 in the control group. Data was collected with information form, CTCAE, EORTC QLQ-C30, REALM, weekly exercise follow-up schedule. The experimental group was provided individual training on Kegel exercises, training booklet was given, and patients were followed up weekly. Data collection forms were repeated before training, at the end of the first month and second month. No similar intervention was provided for the control group. Chi-square, Mann-Whitney U, Kruskal-Wallis, Friedman, Wilcoxon tests, variance analysis were used for the data analysis. ResultsExperimental and control groups were found to have been distributed homogeneously. At the end of first month, 10% of the experimental group and 13.3% of the control group had first grade UI. At the end of second month, only 1% of the control group had first grade UI, 3.3% of the experimental group and 6,7% of the control group had second grade UI. Besides, FI was not developed in both groups. It was found that social function of the EORTC QLQ-C30 increased in the experimental group. Additionally, diarrhea, insomnia, loss of appetite in the symptom sub-scale decreased in the same group. Improvement was observed in the overall health condition of the experimental group, whereas the control group was observed to be worse (p<0,05). ConclusionsAlthough Kegel exercises were not found effective, UI rate was lower in the experimental group. It has been recommended that Kegel exercises should be performed in larger groups with long-term observations. Legal entity responsible for the studyAydan Eda Urvaylıoğlu, Sevinç Kutlutürkan, Diclehan Kılıç. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Sacral Nerve Stimulation in Treating Low Anterior Resection Syndrome or Fecal Incontinence in Patients With Locally Advanced Rectal Cancer or Other Pelvic Cancer, the RESTORE Study

Sacral Nerve Stimulation in Treating Low Anterior Resection Syndrome or Fecal Incontinence in Patients With Locally Advanced Rectal Cancer or Other Pelvic Cancer, the RESTORE Study

Treatment of Urinary Urgency Incontinence Using a Rechargeable SNM System: 6-Month Results of the ARTISAN-SNM Study

Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.

Resting vector volume measured before ileostomy reversal may be a predictor of major fecal incontinence in patients with mid or low rectal cancer: a longitudinal cohort study using a prospective clinical database.

Despite a high incidence of fecal incontinence following sphincter-preservation surgery (SPS), there are no definitive factors measured before ileostomy reversal that predict fecal incontinence. We investigated whether vector volume anorectal manometry before ileostomy reversal predicts major fecal incontinence following SPS in patients with mid or low rectal cancer. This longitudinal prospective cohort study comprised 173 patients who underwent vector volume anorectal manometry before ileostomy reversal. The Fecal Incontinence Severity Index was measured 1year after the primary SPS and classified as major incontinence (FISI score ≥ 25) or continent/minor incontinence (FISI score < 25). Multivariable logistic regression analysis was used to identify predictors of major incontinence. Ninety-two patients (53.1%) had major incontinence. Although tumor stage, location, and neoadjuvant chemoradiotherapy were comparable, the major incontinence group had lower resting pressure (28.4 vs. 34.3mmHg, P = 0.027), greater asymmetry at rest (39.1% vs. 34.1%, P = 0.002) and squeezing (34.2% vs. 31.4%, P = 0.046), shorter sphincter length (3.3 vs. 3.7cm, P = 0.034), and lower resting vector volume (143,601 vs. 278,922mmHg2mm, P < 0.001) compared with the continent/minor incontinence group. Resting vector volume was the only independent predictor of major incontinence (odds ratio = 0.675 per 100,000mmHg2mm, 95% confidence interval, 0.532-0.823; P = 0.006). This study revealed that resting vector volume before ileostomy reversal may predict major fecal incontinence. We suggest that the physiology of the anorectum should be discussed with patients before ileostomy reversal in patients at high risk of fecal incontinence.

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.

An investigation into the effect of biofeedback on urinary and fecal incontinence in patients with anal sphincter dysfunction.

Introduction:Fecal incontinence refers to the inability to control bowel movements, causing feces to leak unexpectedly from the rectum. People suffering from this disorder are emotionally distressed. This problem causes social degradation, anxiety, fear, and social isolation. The present study aimed to evaluate the effect of biofeedback (BFB) on fecal incontinence in patients with anal sphincter abnormalities in 2017.Methods:This quasi-experimental study was performed on 30 patients with fecal incontinence, referring to the gastroenterology clinic of Taleghani and Mehrad hospitals. Patients were first evaluated by Wexner criteria and then, with the aid of a manometer, information was obtained on the amount of sphincter muscle tone, squeeze pressure, and rectal sensation. Manometric results and Waxner's questionnaire were compared before and after BFB. Data were analyzed using SPSS (version 20).Findings:In this study, 18 women and 12 men were studied. There was no significant relationship between fluid intake, fiber, exercise, sex, and incontinence (P < 0.05). According to Wuxner's components, the sphincter muscle tone increased significantly after BFB in patients. The total score of the squeeze pressure increased significantly after the BFB application (P < 0.05). The mean total score of rectal sensation (individual awareness of rectal contents) decreased after the BFB application.Conclusion:In addition to the fact that it can improve incontinence in patients with anal sphincter abnormalities, BFB is also helpful for patients whose sphincter and rectum are not seriously affected and only show incontinence symptoms.

Gut-Directed Pelvic Floor Behavioral Treatment for Fecal Incontinence and Constipation in Patients with Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) often experience functional bowel symptoms despite achieving disease remission. Although behavioral treatment (bowel and pelvic floor muscle retraining) is effective for managing constipation or fecal incontinence in non-IBD patients, there is limited evidence for its efficacy in patients with quiescent inflammatory bowel disease. The aim of this study was to evaluate the outcome of gut-directed behavioral treatment, including pelvic floor muscle training, for symptoms of constipation or fecal incontinence in patients with IBD in disease remission. The outcome of consecutive patients with IBD in remission and symptoms of constipation or fecal incontinence was evaluated. Patients referred to a multidisciplinary gastroenterology clinic underwent gut-directed behavioral treatment, including pelvic floor muscle training. The primary outcome was patient-reported rating of change in symptoms on a 7-point Likert scale at the completion of treatment. Forty IBD patients (median age, 35 years; 80% female; 24 Crohn's disease [CD], 12 ulcerative colitis [UC], 4 UC with ileoanal pouch) with ongoing symptoms of constipation (55%) or fecal incontinence (45%), despite drug therapy, were included. The median symptom duration at referral was 2 years. Thirty-five (87%) completed treatment with a median of 2 sessions. Improvement of "6 = much better" or "7 = very much better" was reported by 77% (17/22) with fecal incontinence and 83% (15/18) with constipation. Improvement occurred irrespective of IBD diagnosis, previous perianal fistulae, colorectal surgery, presence of an ileoanal pouch, or past obstetric trauma. Behavioral treatment effectively improves functional gut symptoms in a large majority of patients who are in IBD disease remission and who have not responded to drug therapy. 10.1093/ibd/izy344_video1 izy344.video1 5968879349001.

Current status and predictors of fecal incontinence in patients with inflammatory bowel disease

Objective To investigate the frequency and severity of fecal incontinence (FI) in inflammatory bowel disease (IBD) patients, and to explore the predictors of FI. Methods A total of 315 IBD patients treated in the First Hospital of China Medical University from September 2015 to November 2017 were selected in this study. The participants were investigated using general information questionnaire, International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B) , Inflammatory Bowel Disease Questionnaire (IBD-Q) , Hospital Anxiety and Depression Scale-Anxiety (HADS-A) , and Hospital Anxiety and Depression Scale-Depression (HADS-D) . The univariate analysis and Logistic regression were used to explore the predictors of FI. Results There were 300 questionnaires available. Approximately 72.0% of the patients had experienced FI. The incidence of anxiety and depression in patients with IBD were 57.4% and 45.4%, which were significantly higher compared with patients without IBD (χ2=5.145, 4.354; P<0.05) . The multivariate Logistic regression showed that IBD activity (OR=1.962) , age (OR=6.183) , gender (OR=1.759) , history of intestinal surgery (OR=3.312) , urinary incontinence (OR=2.029) , and anal fissure (OR=4.989) were independent predictors of FI (P<0.05) . Conclusions Patients with IBD are suffered from FI that harms their quality of life, especially the emotions. The predictors of FI such as IBD activity, age, gender, and history of intestinal surgery should be fully concerned. Key words: Fecal incontinence; Nursing care; Quality of life; Emotion; Inflammatory bowel disease

Fecal Incontinence after Posterior Sagittal Anorectoplasty for Anorectal Malformation: A Single-Center Study.

Background Fecal incontinence is one of the worst functional complications of posterior sagittal anorectoplasty for treatment of anorectal malformation. Objectives In this study, we aimed to identify the prevalence of fecal incontinence in patients with the diagnosis of high or low anorectal malformation who underwent three-stage posterior sagittal anorectoplasty surgery in our center. Patients and Methods Children with the diagnosis of anorectal malformation who underwent posterior sagittal anorectoplasty at the Department of Pediatric Surgery of Besat Hospital, Hamadan University of Medical Sciences, Iran, from 2012 to 2016 were enrolled in the study. Parents or guardians were recruited and asked to fill the study questionnaire including the Templeton and Ditesheim Scoring System to assess the status of fecal continence of the patients. Results Thirty-four patients including 10 (29.4%) males were enrolled in the study. High type of anorectal malformation was diagnosed in 23 (67.6%) patients. The overall mean scores of fecal continence were 4.57 ± 0.84 (range 1.5–5) after a mean follow-up time of 50.7 (range 22.5–69.8) months. Good fecal continence was observed in 91.3% of patients with low type compared to 72.8% of patients with high type of anorectal malformation; however, the difference was not significant (P=0.13). Conclusion Posterior sagittal anorectoplasty surgery in patients with anorectal malformation may result in acceptable fecal continence.

Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations.

Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5-17). Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

MP27-06 RISK FACTORS ASSOCIATED WITH FECAL INCONTINENCE IN PATIENTS WITH OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2018MP27-06 RISK FACTORS ASSOCIATED WITH FECAL INCONTINENCE IN PATIENTS WITH OVERACTIVE BLADDER Caitlin Lim, Joshua Cohn, Casey Kowalik, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Caitlin LimCaitlin Lim More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Casey KowalikCasey Kowalik More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.885AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overactive bladder (OAB) and bowel conditions often occur together, and both can have profound effects on a woman′s quality of life. Treatment of OAB can impact bowel function as well, either negatively (e.g. constipation and antimuscarinics), or positively (e.g. reduced fecal incontinence, FI, with sacral neuromodulation). We sought to identify factors associated with FI in a community-based sample of women with OAB. METHODS Adult women with symptoms of OAB were identified via clinical practice and email-based advertisements. In all subjects, OAB was confirmed by a score of 4 on the OABv3 screening questionnaire. Standardized questionnaires assessed clinical characteristics, OAB severity (OAB-q8), quality of life (OAB-q SF HRQoL), and FI (Fecal Incontinence Severity Index, FISI). These data were compared between subjects with and without FI, defined as any leakage of mucus, liquid or solid stool at least monthly, and the association between OAB and FI severity assessed. RESULTS 101 (53%) participants reported having FI and 91 (47%) did not. Mean FISI scores were 27.9 ± 8.6 in those reporting FI and 5.5 ± 5.2 in those reporting no FI (p<0.001). Women reporting FI had more severe OAB (mean OABq8 SS: 47.5 ± 25.6 vs. 39.3 ± 21.2, p=0.017) and worse OAB-HRQL (59.6 ± 29.5 vs 69.3 ± 23.0, p=0.012). OAB severity (OABq8) (β 0.29, 95% 0.04-0.55) and OAB-related quality of life (OABq-SF HRQL) (β -0.33, 95% CI -0.61, -0.05) were significantly correlated with FISI scores. In addition to suffering from more severe OAB, women reporting any FI were older (mean age 46.8 ± 15.2 vs. 41.6 ± 14.0 years, p=0.015) and more likely to report suffering from neuropathy (p=0.013), spine or degenerative disc disease (p=0.003), irritable bowel syndrome (p=0.013), fibromyalgia (p=0.035), and chronic fatigue syndrome (p=0.044). CONCLUSIONS Over half of women with OAB reported at least monthly FI, which was associated with increased age and the presence of neuropathy, degenerative spinal disease, irritable bowel syndrome, and chronic pain syndromes. Furthermore, FI was associated with increased OAB symptom severity and decreased OAB condition-specific quality of life. In many patients, FI and OAB may be unique symptoms resulting from common pathophysiology, either due to pelvic organ or more global dysfunction. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e348 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Caitlin Lim More articles by this author Joshua Cohn More articles by this author Casey Kowalik More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Diagnosis and Management of Fecal Incontinence.

The purpose of this review is to highlight current and newer therapeutic approaches to treat fecal incontinence in patients who do not respond to conservative measures. Neurostimulation techniques, injection of bulking agents, and radiofrequency energy delivery to the anal canal have been proposed and tested for fecal incontinence over the last decade. Sacral stimulation is both effective and durable and is now the most popular of the invasive techniques whereas percutaneous tibial stimulation, radiofrequency energy, and bulking agents are either less effective or their evaluation has been handicapped by suboptimal study designs. The precise indications for the new vaginal control device and anal plugs remain to be established. The magnetic anal sphincter is disappointing. Stem cell therapy is a potentially exciting approach, which is in its infancy. There continues to be an unmet need for innovative approaches to patients with fecal incontinence who do not respond to conservative measures. The efficacy of current and future therapies should be assessed using criteria more stringent than has been used in the past to provide a more realistic assessment of meaningful efficacy.

Application of a structured skin care regimen on the patients with fecal incontinence in ICU

Objective To explore the nursing effects ofstructured skin-care regimenon the incontinence-associated dermatitis of ICU patients with fecal incontinence. Methods A total of 144 patients with fecal incontinence in ICU were chosen as the research objects and were divided into the control group and the intervention group, 72 cases of each group.The control group received routine care of incontinence-associated dermatitis, and the intervention group were given thestructured skin-intervention program for patients with fecal incontinence. Rate of incontinence-associated dermatitis and its severity, nursing duration and care cost were compared between the control group and the intervention group. Results The incidence rate of IAD of the intervention group was significantly lower than that of the control group, and the difference was statistically significant(P 0.05). There was no significant difference in the nursing time between patients with fecal incontinence and IAD in the intervention group compared with the control group(P>0.05). Conclusion Structured skin-care regimen can obviously reduce the occurance rate of incontinence-associated dermatitis and its severity, decrease care cost of fecal incontinence patients with incontinence-associated dermatitis and reduce the burden of patients and the society. Key words: Fecal incontinence; Incontinence-associated dermatitis; Structured skin-care regimen

Evaluation of outcomes in fissurectomy and V–Y advancement flap for the treatment of chronic anal fissure

Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V–Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V–Y advancement flap in both groups of patients with low and high anal sphincter tones.