Fecal Incontinence Severity Index Research Articles

Prevalence and Severity of Fecal Incontinence in Veterans.

Background/AimsFecal incontinence (FI) is a common complaint that increases in prevalence with age. Our aim was to determine the prevalence of FI and assess its severity by self-report in a male-predominant Veteran outpatient clinic setting.MethodsAn anonymous 28 item questionnaire was administered to a convenience sample of veterans awaiting appointments. FI was defined as a loss of liquid or solid stool at least monthly. Multivariable logistic and linear models were used to identify predictors of FI prevalence and severity.ResultsOne hundred thirty-three gastroenterology (GI) participants and 126 primary care (PC) participants completed the survey. Ninety-four of 259 participants (36.3%, 95% confidence interval [CI]: 30.4–42.5) reported an episode of FI (41.4% GI participants vs 31.0% PC participants; P = 0.078) with 33.6% having FI within the last 30 days (36.8% GI participants vs 30.2% PC participants; P = 0.122). Participants with more bowel movements per week (P = 0.005) and per day (P < 0.001) and with a higher Bristol Stool Scale form (P = 0.010) were more likely to have FI. Of participants with FI, mean Fecal Incontinence Severity Index score was 23.0 ± 9.5 with a significantly higher symptom score in GI participants compared to PC participants (25.2 ± 10.0 vs 20.1 ± 8.2; P = 0.011). Few participants had ever been asked by (35.0%) or evaluated by (18.0%) a doctor for FI symptoms.ConclusionsFI is a common complaint and under-recognized problem in the male-dominant Veteran population. Despite its prevalence, relatively few participants were asked about FI, with even less being treated. Due to the possible effects and implications on quality of life, more should be done to recognize this condition and arrange treatment.

Pelvic floor dysfunctions in female cheerleaders: a cross-sectional study.

Cheerleaders perform high-impact maneuvers that can be associated with pelvic floor dysfunction. We hypothesized that female cheerleaders would report more symptoms of pelvic floor dysfunction and fewer symptoms of premenstrual syndrome than nonathletic women. This cross-sectional study included high-performance female cheerleaders and young nonathletic, nulliparous, and normal-weight females. Demographics, sports practices, and pelvic floor dysfunction data were collected through an electronic questionnaire. Urinary symptoms were collected through the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and King's Health Questionnaire. Intestinal symptoms were collected through the use of Criterion F of item C3, referring to functional constipation of Rome III and Fecal Incontinence Severity Index. Data on sexual function were collected through the Female Sexual Function Index. Data on pelvic organ prolapse were obtained through the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). In addition, questions about premenstrual syndrome-dysmenorrhea, irritability, headache, tiredness, fluid retention, and constipation-were collected through the Menstrual Symptom Questionnaire. The comparison between groups of the quantitative variables was performed using the Mann-Whitney U test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for comparison between groups on the occurrence of pelvic floor muscle dysfunction symptoms. A significance level of 5% was adopted. A total of 156 women (78 cheerleaders and 76 nonathletes) completed the electronic questionnaire. Anal incontinence was the most prevalent symptom of pelvic floor muscle dysfunction. Cheerleaders were 2.3 times more likely to report symptoms regarding anal incontinence than nonathletic women. For the other symptoms of pelvic floor dysfunction, no statistical differences between the groups were found. Cheerleaders reported fewer symptoms of tiredness and constipation during the premenstrual period than did nonathletic women. Pelvic floor dysfunction, particularly anal incontinence, appears to be more prevalent among cheerleaders than among nonathletic women. In addition, cheerleaders demonstrated fewer symptoms of tiredness and constipation during the premenstrual period.

Comparison of Transanal Minimally Invasive Surgery (TAMIS) and Transanal Endoscopic Operations (TEO)

Rectal lesions, benign or malignant, are one of the most encountered clinical entities in general surgery departments. Technological breakthroughs in local excision techniques have been occurring such as transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS), and transanal endoscopic operations (TEO) during the last two decades. We compared the results between TAMIS and TEO for removing rectal lesions. The study was conducted on patients who underwent TAMIS and TEO interventions due to rectal lesions between 2010 and 2015 in the Department of General Surgery of Gulhane Military Medical Academy and the University of Ankara. The data for these patients relating to their age, gender, distance from the anal verge, operation time, occurrence of first bowel movement after surgery, initiation of oral intake after surgery, length of hospital stay, tumor size, follow-up, complications, free resection margin, recurrence, postoperative Fecal Incontinence Severity Index (FISI) and visual analog scale (VAS) scores, and pathologic specimen examination were taken from the hospital’s electronic database. All data were enrolled and analyzed statistically. The TAMIS group had 23 (54.8%) patients, and the TEO group had 19 (45.2%) patients. The TAMIS operation time was significantly longer than that of TEO (Z = 3.188; P < 0.001). Median time to first bowel movement in the TAMIS group was 36.0 h (interquartile range (IQR) = 12.0) vs. 24.0 h (IQR = 18.0) in the TEO group; the difference was significant (Z = 3.358; P = 0.001). No significant differences were found between the two groups in complication rate, recurrence, visual analog scale, or Fecal Incontinence Severity Index. TAMIS and TEO techniques have been found to produce almost similar results. These two techniques are considered to be good alternatives to conservative treatment methods with their reliability and feasibility in experienced hands for selected patients. For TAMIS and TEO techniques to qualify as “treatment of choice,” prospective randomized clinical trials are needed.

Fecal Incontinence Symptoms and Impact in Older Versus Younger Women Seeking Care.

The differential impact of aging on fecal incontinence symptom severity and condition-specific quality of life remains unclear. The purpose of this study was to characterize differences in symptom distress, quality of life, and anorectal physiology assessments in older versus younger women with fecal incontinence. This was a cross-sectional study. This study was conducted at a tertiary genitorectal disorder clinic. Women presenting for fecal incontinence evaluation between 2003 and 2016 were classified as older or younger based on age ≥65 or <65 years. The main outcomes were symptom-specific quality of life and distress measured by validated questionnaires (the Modified Manchester Health Questionnaire containing the Fecal Incontinence Severity Index); anorectal physiology and anatomy were assessed by manometry and endoanal ultrasound. Of 879 subjects, 286 and 593 were classified as older and younger (mean ages, 71.4 ± 5.3 y and 51.3 ± 10.5 y). Solid stool leakage was more frequent in older women (83.2% vs 76.7%; p = 0.03), whereas liquid stool leakage (83.2% vs 82.8%; p = 0.88) and fecal urgency (76.9% vs 78.8%; p = 0.54) did not differ between groups. Mean symptom severity scores were similar between groups (28.0 ± 11.9 and 27.6 ± 13.5; p = 0.69); however, there was greater negative impact on quality of life among younger women (46.3 ± 22.0 vs 51.8 ± 21.8; p < 0.01). Multivariable linear regression controlling for pertinent covariates revealed younger age as an independent predictor for worse condition-specific quality-of-life scores (p < 0.01). Squeeze pressures were similar between groups, whereas younger women had greater resting pressures and higher rates of sphincter defects (external, 7.7% vs 20.2%; internal, 12.2% vs 26.8%; both p < 0.01). This study was limited by its lack of patient obstetric history and the duration of their incontinence symptoms. Characteristics differ between older and younger women seeking care for fecal incontinence. The differential impact and age-related phenotypes may provide useful information for patient counseling and developing management algorithms for women with fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A910.

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.

Midterm functional outcome after laparoscopic ventral rectopexy for external rectal prolapse.

IntroductionAlthough long‐term crude outcomes of laparoscopic ventral rectopexy for external rectal prolapse (ERP) have been documented, repetitive functional and quality of life (QOL) assessments are scarce. This study assessed midterm annual functional results and QOL after laparoscopic ventral rectopexy for ERP.MethodsThis study consisted of 58 patients and was a retrospective analysis of prospectively collected data. The Fecal Incontinence Severity Index, the Constipation Scoring System, and QOL instruments (ie 36‐item Short‐Form Health Survey and Fecal Incontinence Quality of Life scale) were administered before and after operation.ResultsThere was no mortality or major morbidity. After a median follow‐up of 49 months (6‐92 months), recurrence of ERP was noted in one patient (2%). There were no mesh‐related complications. The median Fecal Incontinence Severity Index score was significantly reduced at 3 months (34 [10‐61] vs 12 [0‐50], P < 0.0001) and remained significantly reduced for 5 years. The median Constipation Scoring System score was significantly reduced at 3 months (14 [9‐20] vs 7 [0‐16], P < 0.0001) and remained significantly reduced for 4 years. No patients developed new‐onset constipation. All of the Fecal Incontinence Quality of Life scales significantly improved overtime for 4 years. All of the 36‐item Short‐Form Health Survey scales were significantly improved at 3 and 6 months, but none of the scales significantly improved after 2 years.ConclusionLaparoscopic ventral rectopexy for ERP was associated with low morbidity, low recurrence, and a midterm improvement in function and fecal incontinence‐specific QOL.

Efficacy of Supervised Pelvic Floor Muscle Training and Biofeedback vs Attention-Control Treatment in Adults With Fecal Incontinence

Pelvic floor muscle training (PFMT) in combination with conservative treatment is recommended as first-line treatment for patients with fecal incontinence, although its efficacy is unclear. We investigated whether supervised PFMT in combination with conservative treatment is superior to attention-control massage treatment and conservative treatment in adults with fecal incontinence. We performed a randomized, controlled, superiority trial of patients with fecal incontinence at a tertiary care center at a public hospital in Denmark. Ninety-eight adults with fecal incontinence were randomly assigned to groups that received supervised PFMT and biofeedback plus conservative treatment or attention-control treatment plus conservative treatment. The primary outcome was rating of symptom changes, after 16 weeks, based on scores from the Patient Global Impression of Improvement scale. Secondary outcomes were changes in the Vaizey incontinence score (Vaizey Score), Fecal Incontinence Severity Index, and Fecal Incontinence Quality of Life Scale. In the intention-to-treat analysis, participants in the PFMT group were significantly more likely to report improvement in incontinence symptoms based on Patient Global Impression of Improvement scale scores (unadjusted odds ratio, 5.16; 95% CI, 2.18-12.19; P= .0002). The PFMT group had a larger reduction in the mean Vaizey Score (reduction, -1.83 points; 95% CI, -3.57 to -0.08; P= .04). There were no significant differences in condition-specific quality of life. In the per-protocol analyses, the superiority of PFMT was increased. No adverse events were reported. This randomized controlled trial of adults with fecal incontinence provides support for a superior effect of supervised PFMT in combination with conservative treatment compared with attention-control massage treatment and conservative treatment. We found that participants who received supervised PFMT had 5-fold higher odds of reporting improvements in fecal incontinence symptoms and had a larger mean reduction of incontinence severity based on the Vaizey Score compared with attention control massage treatment. Clinicaltrials.gov no: NCT01705535.

Effect of laser acupuncture on fecal incontinence after anorectal surgery

Fecal incontinence (FI) is considered a common complication after anorectal surgeries because of sphincter injury. Application of laser acupuncture (LA) on acupoints is a noninvasive modality that may assist in the treatment of FI and in decreasing the frequency of incontinence. This study investigated the effect of laser stimulation to acupoints on anal pressure during rest and squeeze, and the frequency and consistency of defecation in FI after anorectal surgery. This study was carried out as a randomized-controlled trial of 40 patients (17 men and 23 women) diagnosed with moderate FI after anorectal surgery. The ages of the patients ranged from 40 to 70 years. They were assigned randomly to two equal groups: the experimental (LA) group, which received 60 s laser stimulation for acupuncture points plus pelvic floor exercises three sessions per week for 4 weeks, and the control (placebo) group, who received sham LA plus pelvic floor exercises three sessions per week for 4 weeks. Anorectal manometry was used to measure resting anal pressure and squeeze anal pressure. The frequency of FI was measured using the FI severity index. Assessment was carried out before and after 1 month of treatment. The results showed that there was a significant increase in resting anal pressure and squeeze anal pressure of the study group compared with that of the control group after treatment (P> 0.001). Also, there was a significant decrease in the fecal incontinence severity index of the study group after treatment compared with that of the control group (P>0.001). It was concluded that stimulation of laser to acupuncture points for 4 weeks is an effective approach for FI after anorectal surgery.

Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12years.

Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy. All the patients who hadstapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score. One hundred and ninety four patients were identified and171 completed the questionnaire.The mean follow-up was 12 ± 0.8years (range 11-13years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 ona scale of 1 to 5) in 81.2% (n = 139) of cases. The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future.

Obstetric Risk Factors and Anal Incontinence among Women with Previous History of Vaginal Delivery

Objective: To investigate the obstetric risk factors of the analincontinence in mothers with previous history of vaginaldelivery.Methods: The was a case-control study conducted in the Obstetricsand Gynecology Department of Dr.Wahidin Sudirohusodo Hospital,Faculty of Medicine, Universitas Hasanuddin, Makassar, during theperiod of February 2015 through January 2016. The researchinstruments were used to evaluate obstetric risk factors and theanal incontinence was the self-administered questionnaire and FecalIncontinence Severity Index. The data were analyzed statisticallyusing the Chi-square test with the significant value of p&lt;0.05.Results: A total of 300 subjects were recruited in this study. Theresearch results indicated that the parity of  3, the assisted vaginaldelivery history (vacuum extraction), and the prolong secondstage of labor had a significant correlation with the anal incontinencewith p value=0.026, OR (95% CI) = 1.8 (1.07-3.03), p=0.018with OR (95% CI) =3.65 (1.2-10.7) and p=0.006 with OR (95% CI)= 2.9 (1.2-6.7).The history of episiotomy and the delivery of thebaby  4000 gram had no correlation with the anal incontinence.Conclusion: Parity, vacuum delivery and prolong second stage oflabor have an association with anal incontinence among womenwho has history of vaginal delivery.Keywords: anal incontinence, obstetric risk factors, vaginal delivery

Permacol™ Collagen Paste Injection in Anal Fistula Treatment: A Retrospective Study with One-Year Follow-Up.

This study aimed to evaluate the applicability, safety, results, and functional performance of Permacol™ collagen paste injection in patients with an anal fistula. Thirty-one patients with anal fistula underwent Permacol™ collagen paste injection between February 2015 and February 2017. The patients were followed up for a total of 12months with recovery conditions monitored at intervals of 3, 6, and 12months. Preoperative insertion of seton was performed in 15 patients for a period of 6-8weeks and 2 patients for a period of 12weeks. A trans-sphincteric anal fistula was present in 20 patients and an intersphincteric fistula was present in 11 patients. There was a recurrence in 7 patients (22.5%): 1 patient (3.2%) after 1-month follow-up, 3 patients (9.7%) after 3-month follow-up, 2 patients (6.5%) after 6-month follow-up, and 1 patient (3.2%) after 12-month follow-up. A complete recovery was observed in 24 (77.5%) patients after a 12-month follow-up. The mean Fecal Incontinence Severity Index score was 0.29 ± 0.64 preoperatively and 0.55 ± 1.03 after 12months. In this study, we show that treatment of patients with an anal fistula by injection of Permacol™ is a safe and successful method that does not compromise continence.

Long-term outcome of anorectal biofeedback for treatment of fecal incontinence.

Long-term outcome data for anorectal biofeedback (BF) for fecal incontinence (FI) is scarce. Our aims were to describe the long-term symptom profile, quality of life, and need for surgery in FI patients following BF. One hundred and eight consecutive female patients with FI who completed an instrumented BF course were identified for long-term follow-up. In 61 of 89 contactable patients, outcome measures were assessed at short-term (end of BF), mid-term (9months median), and long-term (7years median) follow-up after treatment. Long-term response rate (50% or more reduction in FI episodes/wk compared to before BF and not requiring surgical intervention) was seen in 33/61 (54%) patients. Thirteen of these had complete continence. Improvement was seen at short, mid, and long-term follow-up for patients' satisfaction and control of bowel function. In contrast, fecal incontinence severity index and quality of life measures, which improved in short and mid-term, were no different from baseline by long-term follow-up. Patients classified as short-term responders were far more likely to display a long-term response compared to short-term non-responders (68% vs 18%, P<.001). Long-term symptom improvement was observed in more than half of FI patients at 7year post BF follow-up. Quality of life improvements, however, were not maintained. Patients improving during the initial BF program have a high chance of long-term improvement, while patients who do not respond to BF should be considered early for other therapies.

Anal Penetrative Intercourse as a Risk Factor for Fecal Incontinence.

The aim of the study is to investigate the relationship between anal penetrative intercourse (API) and pelvic floor symptoms, specifically, anal incontinence (AI). This was an institutional review board-approved, cross-sectional, e-mail survey of women enrolled in the Illinois Women's Health Registry. Participants were anonymously queried about their sexual practices and the effects of these on bowel and bladder symptoms. Urinary symptoms were assessed using the urogenital distress inventory-6 and bowel symptoms with the fecal incontinence severity index (FISI). One thousand three women (mean age of 46 ± 15 years) completed the survey. Eighty percent were white, 56% were married, and 99% reported ever being sexually active. Thirty-two percent had API at least once, and 12% considered it "part of their sexual practice." Sixty percent of the cohort reported a bothersome urinary symptom on the urogenital distress inventory-6, 70% reported AI on the FISI, and 15% reported fecal incontinence. Of women who engaged in API, 18% reported it changed their stool consistency, and 10% reported it caused AI. Having engaged in API within the last month was correlated with higher FISI scores (P = 0.05) and with fecal incontinence on the FISI (28.3% vs 14.4%; P = 0.01; odds ratio, 2.48). In addition, API was more commonly practiced among women who reported that vaginal intercourse caused dyspareunia (17% vs 12%, P = 0.05) or changes in bladder symptoms such as urgency or dysuria (44% vs 30%, P < 0.001). Self-reported AI and FI (as measured by the FISI scores) are higher in women who have had API, and frequency of API may be important in determining the risk of bowel symptoms.

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 ...

Comparative Quality of Life in Patients Following Transanal Minimally Invasive Surgery and Healthy Control Subjects

BackgroundTransanal minimally invasive surgery (TAMIS) is considered the successor of transanal endoscopic microsurgery (TEMS). It makes use of more readily available laparoscopic instruments and single-port access platforms with similar perioperative, clinical and oncological outcomes. Little is known about quality of life (QoL) outcomes after the use of TAMIS. The aim of this study was to assess QoL after TAMIS in our patients and compare this with QoL in the healthy Dutch population. MethodsAll patients undergoing TAMIS for selected rectal neoplasms between October 2011 and March 2014 were included in this analysis. Patients were studied for a minimal period of 24 months. QoL outcomes were measured using the Short-Form 36 Health Survey (SF-36) questionnaire; faecal continence was measured using the Faecal Incontinence Severity Index questionnaire. Patient reported outcomes were compared to case-matched healthy Dutch control subjects. We hypothesise that undergoing TAMIS will subsequently result in a decreased quality of life in patients compared to healthy individuals. ResultsThirty-seven patients (m:f = 17:20, median 67 years) were included in the current analysis. In four patients (10.8%), postoperative complications occurred. The median follow-up was 36 (range 21–47) months. Postoperative QoL scores are similar comparable to those reported by Dutch healthy controls. Patients reported a statistically significant better QoL score in the ‘bodily pain’ domain when compared to the controls (81.8 vs. 74.1 points) (p = 0.01). Significant worse QoL scores for the ‘social functioning’ domain were reported by patients after TAMIS (84.4 vs. 100 points) (p = 0.03). ConclusionTAMIS seems to be a safe technique with postoperative QoL scores similar to that of healthy case matched controls in 3-year follow-up. There seems to be no association between faecal incontinence and reported QoL. Negative effects of TAMIS on social functioning of patients should not be underestimated and should be discussed during preoperative counselling.

Post-surgical fecal incontinence.

The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9±6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7months. The mean number of bowel movements/week was 18.2±7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0±6.6. Operated patients had significantly lower anal resting pressure (P<0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P<0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρs = 73; IAS: ρs=81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.

Relationship between symptoms and quality of life in fecal incontinence.

Most measures of fecal incontinence (FI) severity assess the frequency of solid and liquid FI, but may incorporate other features. We compared two scales-the Fecal Incontinence Severity Score (FISS) and Fecal Incontinence Severity Index (FISI)-to determine which questionnaire and which individual questions predict FI Quality of Life (FIQOL). A national sample of American adults completed a health questionnaire, and 234 with monthly FI were selected. Participants completed assessments of FI severity, FIQOL, and somatization. Stepwise linear regression models evaluated whether FISS and FISI total scores, or individual items on the FISS and FISI predicted FIQOL after adjusting for gender, age, income, and somatization (Brief Symptom Inventory-18). Reliable responses were provided by 186. Age was 49years, and 52% were women. The mean FISS score was 8.4 (95% confidence interval [CI] 8.0-8.9, 13 questions) and mean FISI was 29.9 (95% CI 27.4-32.4, 62 questions), indicating moderate FI severity. The mean FIQOL was 2.6 (95% CI 2.4-2.7, 5 questions). Lower income, greater somatization, and total FISS and FISI scores explained 69% of FIQOL; and total FISS and FISI scores were independent predictors. On the FISS, frequency, amount, and urgency to defecate were independently associated with FIQOL. After adding somatization, all but amount remained significant. For the FISI scale, solid and liquid FI and gas were significant predictors, but adjusting for somatization excluded solid FI. Five variables independently explained FIQOL: overall frequency of FI, frequency of liquid and gas leakage, urgency, and somatization.

Laparoscopic ventral rectopexy with sacrocolpopexy for coexisting pelvic organ prolapse and external rectal prolapse.

Objectives: Pelvic organ prolapse (POP) POP is defined as the protrusion of pelvic organs from the vaginal canal. POP often coexists with internal rectal prolapse or external rectal prolapse (ERP). A series of patients with coexisting POP and ERP who underwent laparoscopic ventral rectopexy (LVR) combined with laparoscopic sacrocolpopexy (LSC) are reported here. Methods: Seven patients underwent LVR and LSC together. Fecal incontinence was assessed by the Fecal Incontinence Severity Index (FISI), constipation was assessed by the Constipation Scoring System (CSS), and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Anatomical disorders were assessed by Pelvic Organ Prolapse Quantification (POP-Q) and defecography. Results: The patients' median age was 81 (60-88) years. The median operative time was 380 (282-430) minutes. The median postoperative hospital stay was 3 (1-5) days. There were no postoperative complications. The FISI, CSS, POP-Q, and defecography findings improved postoperatively; however, the ICIQ-SF deteriorated in 2 of 5 patients. Conclusions: LVR combined with LSC for coexisting POP and ERP is feasible.

Proctographic findings and symptoms in patients with anterior rectoanal intussusception.

Objectives: Rectoanal intussusception (RAI) is a common finding on defecography in patients with defecation disorders. This study aimed to compare the proctographic findings and symptoms between patients with anterior RAI and those with circular RAI. Methods: We included 208 patients who were diagnosed as having RAI on defecography. Anorectal function was evaluated using Constipation Scoring System (CSS) and Fecal Incontinence Severity Index (FISI). Results: Twenty-four patients had anterior RAI and 184 had circular RAI. While the anterior intussusception descent or pelvic floor descent was significantly smaller in patients with anterior RAI than those with circular RAI [14.3 vs. 18.5 mm, p=0.004; 12.4 vs. 21.6 mm, p=0.005], there were no significant differences in incidences of obstructed defecation (OD) and fecal incontinence (FI) between the groups. Sixteen patients with anterior RAI and 137 patients with circular RAI had OD. There was no significant difference in the CSS scores between the groups. Twelve patients with anterior RAI and 108 patients with circular RAI had FI. No significant difference in the FISI scores between the groups. Conclusions: Approximately one tenth of the whole RAI was anterior in location, and symptoms in patients with anterior RAI were similar to those with circular RAI.

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

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