Fecal Incontinence Severity Index Research Articles

Predicting the patients who will struggle with anal incontinence: sensitivity to disgust matters.

Quality of life varies in patients with anal incontinence. The severity of symptoms is a surprisingly modest predictor, but they reliably elicit disgust. The current work assessed prospectively whether dispositional sensitivity to disgust predicted the quality of life in patients with anal incontinence. Seventy-five patients with anal incontinence identified from the waiting list for the pelvic floor clinic at the Greenlane Clinical Centre, Auckland, New Zealand, completed questionnaires assessing symptom severity (Fecal Incontinence Severity Index) and disgust sensitivity (Disgust Sensitivity-Revised scale) prior to a first appointment. Three months later incontinence-specific (Fecal Incontinence Quality of Life Scale, FI QLS) and general quality of life (World Health Organization Quality of Life-BREF, WHOQOL-BREF) were assessed. Greater severity of symptoms prospectively predicted lower incontinence-specific quality of life (FI QLS lifestyle domain) and lower general quality of life (WHOQOL-BREF environmental domain). Greater disgust sensitivity predicted poorer psychological and environmental well-being, and moderated the link between symptom severity and outcome. Persons low in disgust sensitivity reported a higher quality of life when symptom severity was low, but those with a high disgust sensitivity had a low quality of life regardless of symptom severity. The functional status of patients with anal incontinence explains some but not all of the variation in quality of life. Emotional factors such as disgust appear to have a role. Disgust sensitivity warrants further attention.

Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse?

High-grade internal rectal prolapse appears to be one of the contributing factors in the multifactorial origin of faecal incontinence. Whether it affects the outcome of sacral neuromodulation is unknown. We compared the functional results of sacral neuromodulation for faecal incontinence in patients with and without a high-grade internal rectal prolapse. One hundred six consecutive patients suffering from faecal incontinence, who were eligible for sacral neuromodulation between 2009 and 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 12 months after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI range = 0-61) and the Gastrointestinal Quality of Life Index (GIQLI). Success was defined as a decrease in the FISI score of 50 % or more. High-grade internal rectal prolapse (HIRP) was found in 36 patients (34%). The patient characteristics were similar in both groups. Temporary test stimulation was successful in 60 patients without HIRP (86%) and in 25 patients with HIRP (69 %) (p = 0.03). A permanent pulse generator was then implanted on these patients. After 1-year follow-up, the median FISI was reduced in patients without HIRP from 37 to 23 (p < 0.01). No significant change in FISI score was observed in patients with a HIRP (FISI, 38 to 34; p = 0.16). Quality of life (GIQLI) was only improved in patients without HIRP. A successful outcome per protocol was achieved in 31 patients without HIRP (52%) versus 4 patients with HIRP (16%) (p < 0.01). The presence of a high-grade internal rectal prolapse has a detrimental effect on sacral neuromodulation for faecal incontinence.

Laparoscopic Ventral Rectopexy for Faecal Incontinence: Equivalent Benefit is seen in Internal and External Rectal Prolapse

AimAn external rectal prolapse (ERP) is often associated with faecal incontinence, and surgery is the recommended therapy. It has been suggested that correction of a high grade internal rectal prolapse (HIRP) is also worthwhile for patients with faecal incontinence. The aim of the present study is to compare the results of laparoscopic ventral rectopexy (LVR) in patients with faecal incontinence associated with either an ERP or a HIRP. MethodConsecutive patients suffering from faecal incontinence, who underwent a LVR between June 2010 and October 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 1 year after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI; range 0–61) and the Gastrointestinal Quality of Life Index (GIQLI). ResultsLVR was performed in 50 incontinent patients with a HIRP, and in 41 patients with an ERP. Preoperatively, the FISI was higher in patients with HIRP (HIRP 42 versus ERP 30, P < 0.01). The recurrence rate at 1 year was similar in both groups (HIRP 6 % versus ERP 2 %, P = 0.156). The FISI scores were significantly reduced in both groups (HIRP 48 % versus ERP 50 %, both P < 0.01). GIQLI was equally improved in both groups (HIRP 17 % versus ERP 18 %, both P < 0.01). ConclusionLaparoscopic ventral rectopexy for the treatment of faecal incontinence achieves equivalent outcomes in both patients with an external rectal prolapse or high grade internal rectal prolapse.

272. Immunohistochemistry as a measurement tool for various aspects of the tumour response to radiotherapy in rectal cancer

272. Immunohistochemistry as a measurement tool for various aspects of the tumour response to radiotherapy in rectal cancer

Factors That Affect Consultation and Screening for Fecal Incontinence

Fecal incontinence (FI) affects 15% of people age 70 years and older, but only 10% to 30% discuss FI with their physicians. We aimed to identify barriers that prevent people from consulting with their physicians, and that prevent physicians from screening for FI. We performed structured interviews of 124 individuals with FI (mean age, 56 y; 87.9% women) recruited from 6 medical offices at the University of North Carolina Hospitals from June 2012 through March 2013. The subjects completed the Fecal Incontinence Severity Index and the Fecal Incontinence Quality of Life Scale questionnaires. Interview questions aimed to determine which patients had consulted physicians for FI. Eleven of the 56 physicians with patients included in the study responded to the survey. Eighty-eight of the 124 participants consulted with their physicians about FI (consulters). These individuals had a higher incidence of depression than the 36 subjects who did not consult with their physicians about FI (nonconsulters; P = .04), but similar Fecal Incontinence Severity Index scores. A smaller proportion of nonconsulters were aware of available treatments than consulters (P < .01). Fifty-six percent of nonconsulters said their FI was not serious enough to consult a physician. There was no difference between consulters and nonconsulters in embarrassment in talking about FI. Among consulters, 88% initiated the conversation about FI with their physician. Seven of the 11 responding physicians screened for FI, but only screened high-risk patients. The 4 physicians who did not screen for FI were unaware of its prevalence, viewed FI as a low priority, or stated that patients were responsible for reporting their own symptoms. Based on surveys of physicians and patients, many patients have insufficient knowledge about the availability and effectiveness of treatments for FI. Some people with FI do not discuss it with their physician because their symptoms are mild, and most prefer physicians to ask them directly about FI. Educating patients and physicians about the prevalence of FI and management strategies may improve consultation rates.

Fecal Incontinence

Fecal incontinence, defined as the involuntary loss of gas, liquid, or solid stool through the anal canal, occurs in an estimated 18 million adults in the United States. Fecal incontinence causes social isolation and confines patients to their homes; additionally, it contributes to medical morbidity, including urinary tract infections, perianal skin breakdown, and decubitus ulcers. Causes for fecal incontinence can be broken down into three broad categories: neurologic disease; functional gastrointestinal diseases or abnormalities; and structural injuries or abnormalities in the pelvic floor, rectum, or anal sphincter. This review describes the clinical evaluation of, investigative studies related to, and management of fecal incontinence. Tables review common causes of sphincter injury, the Fecal Incontinence Severity Index, and daily life factors measured by the Fecal Incontinence Quality of Life questionnaire. Figures show an obstetric sphincter injury, an algorithm outlining the workup and management of fecal incontinence, ultrasonograms of a normal anal sphincter and a sphincter defect, the steps involved in sphincteroplasty, sacral nerve stimulation, and an artificial anal sphincter. This review contains 6 figures, 3 tables, and 54 references.

Evaluation of anal function and quality of life after transanal endoscopic microsurgery

To evaluate the impact of transanal endoscopic microsurgery (TEM) on postoperative anal function and quality of life in patients with benign rectal tumor and early rectal cancer. Clinical data of 50 patients with rectal adenoma and early rectal cancer undergoing transanal endoscopic microsurgery in our hospital from October 2008 to June 2013 were retrospectively analyzed. Anorectal manometry, endorectal ultrasonography (ERUS), the fecal incontinence severity index (FISI), and the physical and mental health status scores (SF-36) were used to evaluate preoperative and postoperative anorectal function and quality of life. Anorectal manometry indicated anal resting pressure (ARP), maximum squeeze pressure (MSP), rectal volume at sensory threshold(RVST), maximum tolerable volume(MTV) decreased significantly at the first month after surgery (P<0.05). MSP returned to preoperative level at the 3rd month (P>0.05). ARP and MTV returned to normal values at the 6th month (P>0.05). RVST returned to normal values at the 9th month (P>0.05). Recto-anal inhibitory reflex(RAIR) was absent in 1 (2%) patient preoperatively and in 30(60%), 18(36%), 7(14%), 2(4%) at the 1st, 3rd, 6th, 9th months after surgery respectively. ERUS showed similar width and thickness of internal sphincter at 1st and 6th month after surgery compared with preoperative measures (P>0.05). Six months after surgery, the mean FISI score decreased(preoperative vs postoperative:8.5 vs 5.8, P<0.05), suggesting an improvement in fecal continence. However, the overall quality of life did not danger significantly after surgery(P>0.05). TEM has little impact on anorectal anatomic structure. Anal function may be compromised in the short-term, however the vast majority of patients recover completely after 6-9 months. TEM is a safe, effective and minimally invasive surgery.

Transanal minimally invasive surgery: initial experience and short-term functional results.

Currently, the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery, avoiding rectal resection. Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments. This method is less expensive as compared with transanal endoscopic microsurgery, relatively easy to learn, and available. Despite wide adoption of transanal minimally invasive surgery, to date only a few series on the implementation and use of this technique are reported, and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available. The purpose of this work was to prospectively assess the functional outcome after transanal minimally invasive surgery using the Fecal Incontinence Severity Index preoperatively and postoperatively. This was a prospective cohort study. The study was conducted at a large teaching hospital. Patients included those who underwent transanal minimally invasive surgery between October 2011 and September 2013. Transanal minimally invasive surgery was studied. We measured postoperative surgical and functional results. A total of 37 patients underwent transanal minimally invasive surgery during our study period. Short-term morbidity rate was 14%, and positive resection margins were reported in 6 cases (16%); in 1 of these patients, a local recurrence was observed. Overall, there was a significant decline in preoperative and postoperative Fecal Incontinence Severity Index scores (p = 0.02), indicating an improvement in anorectal function after transanal minimally invasive surgery for patients with impaired preoperative continence. Seventeen patients (49%) had impaired continence before transanal minimally invasive surgery (mean Fecal Incontinence Severity Index score = 21). Continence improved in 15 (88%) of these patients after surgery; no change was observed in 1 patient (6%), and continence further decreased in another. In addition, 18 patients (51%) had normal preoperative continence (Fecal Incontinence Severity Index score = 0), of which 83% had no change in functionality, and continence decreased in 3. No quality of life was measured. Short-term functional results of transanal minimally invasive surgery for rectal polyps are excellent and comparable to functional results using the dedicated transanal endoscopic microsurgery equipment. More research on outcome after transanal minimally invasive surgery is needed to assess morbidity rates and oncologic clearance.

Does intramesorectal excision for ulcerative colitis impact bowel and sexual function when compared with total mesorectal excision?

BackgroundProctectomy for ulcerative colitis (UC) can be performed via intramesorectal (IME) or total mesorectal excision (TME). MethodsWe compared patient-reported bowel and sexual function among IME versus TME UC patients (September 2000 to March 2011) using the Memorial Sloan-Kettering Cancer Center Bowel Function scale, Fecal Incontinence Quality of Life, Fecal Incontinence Severity Index, Female Sexual Function Instrument, and International Index of Erectile Dysfunction surveys. ResultsEighty-nine IME versus TME patients (35 ± 2 years, 57% male, 62% IME) had similar baseline characteristics, although IME patients had more open procedures (P ≤ .03). IME patients reported better fecal continence (P = .009) but similar fecal incontinence-related quality of life (P ≥ .44). For sexual function, there were no differences for either women (Female Sexual Function Instrument; P ≥ .20) or men (International Index of Erectile Dysfunction; P ≥ .22). ConclusionsIME appears to be associated with better fecal continence but no difference in overall bowel or sexual function compared with TME in patients with UC.

Vitamin D deficiency is associated with increased fecal incontinence symptoms.

Vitamin D is an important micronutrient in muscle function. We hypothesize that vitamin D deficiency may contribute to fecal incontinence (FI) symptoms by affecting the anal continence mechanism. Our goal was to characterize the association of vitamin D deficiency as a variable affecting FI symptoms and its impact on health-related quality of life (HR-QoL). This case-control study assessed women seen at a tertiary-care referral center. Participants were identified as having had a serum vitamin D level obtained within a year of their visit: cases were women presenting for care for FI symptoms; controls were women without any pelvic floor symptoms presenting to the same clinical site for general gynecologic care. Cases completed the Modified Manchester Health Questionnaire (MMHQ) and the Fecal Incontinence Severity Index to measure symptom severity and burden on QoL. Among the 31 cases and 81 controls, no demographic or medical differences existed. Women with FI had lower vitamin D levels (mean 29.2 ± 12.3 cases vs. 35 ± 14.1 ng/ml controls p = 0.04). The odds of vitamin D deficiency were higher in women with FI compared with controls [odds ratio (OR) 2.77, 95 % confidence interval (CI) 1.08-7.09]. Among cases, women with vitamin D deficiency (35 %) had higher MMHQ scores, indicating greater FI symptom burden [51.3 ± 29.3 (vitamin D deficient) vs. 30 ± 19.5 (vitamin D sufficiency), p = 0.02]. No differences were noted for FI severity, p = 0.07. Vitamin D deficiency is prevalent in women with fecal incontinence and may contribute to patient symptom burden.

Su1787 Lubiprostone (Amitiza) Activates Cellular Prostanoid Signaling to Enhance Intestinal Motility in Human Colon

Background: Laparoscopic Ventral Mesh Rectopexy (LVR) corrects both, internal and external rectal prolapse, improving obstructed defaecation symptoms (ODS) and faecal incontinence. Similarly, Stapled Trans-Anal Rectal Resection (STARR) allows resolution of ODS. However data from retrospective series or prospective trials comparing the two procedures for internal rectal prolapse (IRP, defined as recto-rectal or recto-anal intussusception) are absent. In this matched cohorts study we compared outcomes in terms of surgical complications and functional results of LVR and STARR in order to better understand the ideal surgical approach for IRP. Patients and Methods: All patients underwent preoperative evaluation with defaecating proctography or pelvic dynamic MRI. Only patients with recto-rectal or recto-anal intussusception, rectocoele with or without enterocoele or sigmoidocoele were considered from our prospectively kept database. Patients with concomitant middle and anterior pelvic compartment prolapses, were excluded. Two groups of patients were considered according to the surgical technique (LVR or STARR) and matched for demographics, symptoms and characteristics of the prolapse. Only patients with a minimum of 1 year follow-up were considerd. End-points were surgical complications and functional results expressed as Wexner Constipation Score (WCS) and Faecal Incontinence Severity Index (FISI). Results: Twenty-seven patients who underwent LVR were compared to 27 patients who underwent STARR. After LVR, overall complications rate was 15% similar to STARR (11%), all minor. After LVR, WCS significantly improved to 5+/-3 from preoperative 15+/5 (p 0.03). Constipation improved in 89% and was cured in 81%. Similarly, after STARR, WCS score significantly improved to 6+/-5 from preoperative 16+/-11(p 0.03). Recurrence rate was 22%. Constipation improved in 85% and was cured in 78%. No significative differences were observed between the two groups. Considering incontinence, after LVR the FISI score significantly improved to 2+/-2 from preoperative 7+/-3 (p 0.03). Incontinence improved in 90% and was completely cured in 90%. After STARR, the FISI score improved to 4+/-2 from preoperative 8+/-5(p 0.06). Incontinence improved in 54% and was completely cured in 45%. These percentages were significantly lower compared to those observed after LVR. Conclusions: LVR and STARR seems to be equally valid to treat constipation associated to IRP, but LVR has greater chances to cure incontinence.

Su1786 Laparoscopic Ventral Mesh Rectopexy Compared to Stapled Trans-Anal Rectal Resection (STARR) to Treat Internal Rectal Prolapse: A Matched Cohorts Study

Background: Laparoscopic Ventral Mesh Rectopexy (LVR) corrects both, internal and external rectal prolapse, improving obstructed defaecation symptoms (ODS) and faecal incontinence. Similarly, Stapled Trans-Anal Rectal Resection (STARR) allows resolution of ODS. However data from retrospective series or prospective trials comparing the two procedures for internal rectal prolapse (IRP, defined as recto-rectal or recto-anal intussusception) are absent. In this matched cohorts study we compared outcomes in terms of surgical complications and functional results of LVR and STARR in order to better understand the ideal surgical approach for IRP. Patients and Methods: All patients underwent preoperative evaluation with defaecating proctography or pelvic dynamic MRI. Only patients with recto-rectal or recto-anal intussusception, rectocoele with or without enterocoele or sigmoidocoele were considered from our prospectively kept database. Patients with concomitant middle and anterior pelvic compartment prolapses, were excluded. Two groups of patients were considered according to the surgical technique (LVR or STARR) and matched for demographics, symptoms and characteristics of the prolapse. Only patients with a minimum of 1 year follow-up were considerd. End-points were surgical complications and functional results expressed as Wexner Constipation Score (WCS) and Faecal Incontinence Severity Index (FISI). Results: Twenty-seven patients who underwent LVR were compared to 27 patients who underwent STARR. After LVR, overall complications rate was 15% similar to STARR (11%), all minor. After LVR, WCS significantly improved to 5+/-3 from preoperative 15+/5 (p 0.03). Constipation improved in 89% and was cured in 81%. Similarly, after STARR, WCS score significantly improved to 6+/-5 from preoperative 16+/-11(p 0.03). Recurrence rate was 22%. Constipation improved in 85% and was cured in 78%. No significative differences were observed between the two groups. Considering incontinence, after LVR the FISI score significantly improved to 2+/-2 from preoperative 7+/-3 (p 0.03). Incontinence improved in 90% and was completely cured in 90%. After STARR, the FISI score improved to 4+/-2 from preoperative 8+/-5(p 0.06). Incontinence improved in 54% and was completely cured in 45%. These percentages were significantly lower compared to those observed after LVR. Conclusions: LVR and STARR seems to be equally valid to treat constipation associated to IRP, but LVR has greater chances to cure incontinence.

Mo2025 Patient Preference for Defining Success in Fecal Incontinence Treatment Trials

Background: Fecal incontinence (FI) affects 9% of non-institutionalized U.S. adults and may severely impact quality of life. In recent clinical trials evaluating new treatments for regulatory approval, the primary outcome is often the proportion of responders, defined as anyone with least a 50% reduction in FI frequency. However, some patients have objected that a 50% reduction is not enough to restore quality of life and would not be regarded by them as a Aim: To identify patient preferences for the best way to identify what constitutes success in the treatment of FI. Methods: 23 individuals with FI participated in one of six 2-hour online moderated chatroom discussions in groups of 2-7 patients. Participation was anonymous only arbitrarily assigned IDs were used to identify patients in the focus groups. Topics covered included patient preferences for the terminology used to refer to FI, what should be included in the definition of FI (reported separately), and patient views on how to define a successful outcome of treatment. Participants were recruited via online advertisements, mass e-mails to the students and staff of the university, and our Center's research participant registry. Volunteers first logged onto a website where they gave informed consent to the research and answered standardized questionnaires on FI severity (Fecal Incontinence Severity Index, Constipation and Incontinence Questionnaire) and quality of life impact (Fecal Incontinence Quality of Life scale). They also signed up for one of several scheduled chatroom sessions. The sessions were moderated by the study investigators who combined open-ended questions (e.g., How would you define success in a clinical trial?) with questions about whether specific responder definitions (e.g., at least a 50% reduction) were acceptable to them. Results: There were 23 participants, 22 were females. Only 41% of subjects felt that a 50% reduction in FI symptoms reflected a meaningful treatment success. When asked how much reduction would be necessary to regard the treatment as successful, the average was a 75% reduction. Only 4 out of 23 subjects reported that a cure (100% reduction in FI frequency) was necessary to count a treatment as successful. Adequate relief was endorsed by 52% of subjects as a good way to measure results, although several commented that they did not know what adequate relief means. Conclusions: The primary outcome that has been accepted by regulatory agencies for approval of new treatments 50% reduction in treatment is not considered to be sufficient for treatment to be successful by the majority of patients, but neither would they require a complete cure. On average, these FI patients felt that a 75% reduction in frequency would be required for a successful treatment outcome. [Supported by Salix Pharmaceuticals and AHRQ grant R01 HS018695]

Developing a new electromyography-based algorithm to diagnose the etiology of fecal incontinence.

PurposeFor surface electromyography (sEMG) to become widely used in fecal incontinence (FI) etiology assessment, one would have to create a simple, step-by-step, computer-aided, electromyography-based algorithm that would become the basis for a computer-aided diagnosis (CAD) system. Thus, the aim of this work was to develop such an algorithm.MethodsEach patient included in the study underwent a structured medical interview, a general physical examination, and a proctological examination. Patients that scored more than 10 points on the fecal incontinence severity index (FISI) underwent further tests that included rectoscopy, anorectal manometry, transanal ultrasonography, multichannel sEMG, and assessment of anal reflexes. Patients with fully diagnosed FI were included into the study group. The control group consisted of healthy volunteers that scored five or less points on the FISI and had no known anal sphincters dysfunction.ResultsForty-nine patients were qualified to the study group (age ± SD 58.9 ± 13.8). The control group was number- and gender-matched (age ± SD 45.4 ± 15.1). The sensitivity and specificity of classification tree number I, to diagnose neurogenic FI, were 89.5 and 86 %, respectively. For patients with idiopathic FI, these values were 82 and 91 %, respectively. The sensitivity and specificity of classification tree number III, to diagnose neurogenic FI, were 84 and 78 %, respectively. For patients with idiopathic FI, these values were 78 and 87 %, respectively.ConclusionsThe relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology CAD system.

Laparoscopic ventral rectopexy is effective for solitary rectal ulcer syndrome when associated with rectal prolapse

Solitary rectal ulcer syndrome (SRUS) is uncommon and its management is controversial. The aim of this study was to evaluate the outcome of patients with SRUS who underwent laparoscopic ventral rectopexy (LVR). A review was performed of a prospective database at the Oxford Pelvic Floor Centre to identify patients between 2004 and 2012 with a histological diagnosis of SRUS. All were initially treated conservatively and surgical treatment was indicated only for patients with significant symptoms after failed conservative management. The primary end-point was healing of the ulcer. Secondary end-points included changes in the Wexner Constipation Score and Faecal Incontinence Severity Index (FISI). Thirty-six patients with SRUS were identified (31 women), with a median age of 44 (15–81) years. The commonest symptoms were rectal bleeding (75%) and obstructed defaecation (64%). The underlying anatomical diagnosis was internal rectal prolapse (n = 20), external rectal prolapse (n = 14) or anismus (n = 2). Twenty-nine patients underwent LVR and one a stapled transanal rectal resection (STARR) procedure. Nine (30%) required a further operation, six required posterior STARR for persistent SRUS and two a per-anal stricturoplasty for a narrowing at the healed SRUS site. Healing of the SRU was seen in 27 (90%) of the 30 patients and was associated with significant improvements in Wexner and FISI scores at a 3-year follow-up. Almost all cases of SRUS in the present series were associated with rectal prolapse. LVR resulted in successful healing of the SRUS with good function in almost all patients, but a significant number will require further surgery such as STARR for persistent obstructed defaecation.

Transanal endoscopic microsurgery combined with endoscopic posterior mesorectum resection in the treatment of patients with T1 rectal cancer - 3-year results.

IntroductionRectum-sparing transanal endoscopic microsurgery (TEM) is a well-established treatment for T1 rectal cancer (RC). However, it is associated with an increased rate of local recurrence in comparison with extended resection. In most cases this failure is linked to inappropriate case selection and the presence of clinically non-detectable metastases in the regional lymph nodes. Endoscopic posterior mesorectal resection (EPMR) makes it possible to remove the relevant lymphatic drainage of the lower third of the rectum in a minimally invasive way, which in turn can help in adequate tumor staging.AimTo evaluate the long-term clinical results and influence of combined TEM and EPMR treatment on the anorectal functions.Material and methodsTen consecutive patients with T1 RC were operated on using TEM and EPMR as a two-stage procedure between 2007 and 2009.ResultsAfter a median follow-up of 42.6 (range: 36–80) months, none of our patients complained of symptoms of incontinence apart from one female patient with gas incontinence diagnosed preoperatively. There was no statistically significant difference in basal anal pressure, squeeze anal pressure, high pressure zone length or fecal continence assessed using the Fecal Incontinence Severity Index before and in follow-up months after the procedure. Postoperative morbidity consisted of one hematoma formation and one male patient complaining about sexual dysfunction until 6 months postoperatively. There was no evidence of locoregional recurrence.ConclusionsEndoscopic posterior mesorectal resection in combination with TEM appears to be safe, feasible and with no impact on the basic anorectal functions in the 3-year follow-up.

Association between fecal incontinence and objectively measured physical activity in u.s. Adults.

Background:Brisk physical activity may facilitate fecal incontinence due to physical activity-induced colonic motility. However, there currently are no studies that have examined the relationship between fecal incontinence and free-living physical activity behavior.Aim:Therefore, the purpose of this study was to examine the association between fecal incontinence and objectively measured physical activity among adults.Materials and Methods:A national sample of adults in the United States (n = 2565, 20-85 years) completed the Fecal Incontinence Severity Index questionnaire and wore an accelerometer for a week to objectively measure physical activity behavior.Results:After adjustments, fecal incontinence was positively associated with moderate-to-vigorous physical activity (β = 0.85, P = 0.04), suggesting that lower perceived severity of fecal incontinence was associated with greater engagement in moderate-to-vigorous physical activity. Fecal incontinence was not significantly associated with light-intensity physical activity (P = 0.27).Conclusion:Our results suggest that adults in the United States with greater perceived severity of fecal incontinence engage in less moderate-to-vigorous physical activity; however, those with greater severity of fecal incontinence do not appear to have different levels of light-intensity physical activity behavior. Given the emerging research showing beneficial effects of light-intensity physical activity, health care professionals should encourage light-intensity physical activity to their patients with fecal incontinence.

Sacrocolpopexy With Rectopexy for Pelvic Floor Prolapse Improves Bowel Function and Quality of Life

Sacrocolpopexy with rectopexy is advocated for combined rectal and vaginal prolapse, but limited outcome data have been reported. The purpose of this study was to evaluate the indications and outcomes of sacrocolpopexy and rectopexy by comparing pre- and postoperative function and quality of life. A retrospective review of prospectively collected data was performed of all patients undergoing sacrocolpopexy and rectopexy at our institution from 2004 to 2011. Preoperatively, all patients underwent physiology testing and completed 4 validated questionnaires assessing bowel symptom severity and associated quality of life. Patients completed the same questionnaires in 2012. A total of 110 women (median age, 55 years; range, 28-88) underwent a sacrocolpopexy and rectopexy, 33 with concomitant hysterectomy. All patients had rectal prolapse (n = 96) or rectal intussusception (n = 14), and each also had either enterocele (n = 86) or vaginal prolapse (n = 48). Rectal prolapse with enterocele was the most common presentation (n = 75). Previous surgery included rectal prolapse repair (21%) and hysterectomy (57%). Complications included presacral bleeding (n = 2), ureteral injury (n = 2), wound infection (n = 8), and pulmonary embolism (n = 2). There were no mortalities. Fifty-two patients completed the follow-up questionnaires, with a median follow-up of 29 (range, 4-90) months, and preoperative surveys were available in 30 of these patients. Preoperatively, 93% reported constipation; 82% reported resolution or improvement postoperatively. Constipation severity, measured with the Patient Assessment of Constipation Symptom Questionnaire, demonstrated improvement (1.86-1.17; p < 0.001). Fecal incontinence severity scores (Fecal Incontinence Severity Index) improved (39-24; p < 0.01), and 82% of incontinent patients reported cure or improvement. Quality-of-life scores also improved significantly. No patient developed recurrent rectal prolapse. This was a retrospective review, and the response rate to questionnaires was limited. Sacrocolpopexy and rectopexy for combined middle and posterior compartment prolapse is a safe procedure, with low risk for recurrence, and improves bowel function and quality of life in most patients.

Laparoscopic Ventral Rectopexy for Fecal Incontinence Associated with High-Grade Internal Rectal Prolapse

The role of internal rectal prolapse in the origin of fecal incontinence remains to be defined. In our institution, laparoscopic ventral rectopexy is offered to patients with high-grade internal prolapse and fecal incontinence. The present study was designed to evaluate the functional outcome after laparoscopic ventral rectopexy in patients with fecal incontinence associated with high-grade internal rectal prolapse. This study was designed as a prospective observational study. The study took place in a university hospital. Between 2009 and 2011, 72 patients with fecal incontinence not responding to maximum medical treatment (including biofeedback) were included. All patients had a grade III or grade IV rectal prolapse. Laparoscopic ventral rectopexy was performed. Preoperative endoanal ultrasonography and anorectal manometry were performed. Fecal continence was evaluated by using the Rockwood Fecal Incontinence Severity Index score before and 1 year after surgery. The median fecal incontinence severity index score 1 year after surgery was lower than the median score before surgery (15 versus 31; p < 0.01), representing an improvement in fecal continence. This was a preliminary observational study with no control group, no postoperative proctography, and no postoperative anal physiology. Laparoscopic ventral rectopexy can improve symptoms of fecal incontinence in patients with a high-grade internal rectal prolapse. Internal rectal prolapse contributes to the multifactorial origin of fecal incontinence.

Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse

Limited literature exists on whether slow colonic transit adversely influences the results of outlet obstruction surgery. We compared the functional results of laparoscopic ventral rectopexy (LVR) for obstructed defaecation secondary to high grade internal rectal prolapse in patients with normal and slow colonic transit. Consecutive patients suffering from obstructed defaecation associated with an internal rectal prolapse, who underwent an LVR between 2007 and 2011, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and colonic transit studies. Symptoms were assessed preoperatively and at 12months after operation using a standardized questionnaire incorporating the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire, the Fecal Incontinence Severity Index (FISI), the Patient Assessment of Constipation Quality of Life (PAC-QOL) scale and the Gastrointestinal Quality of Life Index (GIQLI). In all, 151 patients underwent LVR, 109 with normal and 42 with slow colonic transit. Preoperatively there was no significant difference between the two groups in age, sex, PAC-SYM score or FISI score. The PAC-SYM and FISI scores were significantly reduced in both groups at 12months (P<0.001). When comparing the change from baseline of PAC-SYM between patients with and without slow transit constipation, a significant difference was observed (P=0.030) with changes of 58% and 40%. Quality of life (GIQLI and PAC-QOL) was equally improved in both groups. Quality of life improvement was less in patients with right colonic stasis. Slow colonic transit has no adverse impact on function and quality of life after LVR for obstructed defaecation due to high grade internal rectal prolapse.