Symptoms Of Fecal Incontinence Research Articles

S0458 Does Fecal Incontinence Symptom Severity Evaluated by Symptom Summation and Individual Fecal Incontinence Components Predict Rectal Hypersensitivity in a Large Fecal Incontinence Cohort?

INTRODUCTION: Rectal sensation contributes significantly to the process of continence. Rectal hypersensitivity (RH) has been associated with a greater perception to defecate, increase lifestyle restrictions, and decrease quality of life domains in patients with fecal incontinence (FI). RH to rectal sensation measurements during an anorectal manometry (ARM) are often reported by patients with FI. Our hypothesis is that higher self-reported FI symptom severity will be associated with RH. METHODS: Retrospective cross-sectional study was conducted on 955 FI patients ≥18 years of age who were referred for ARM at a single tertiary medical center from 6/11 to 3/20. All patients completed the Fecal Incontinence Severity Index (FISI) questionnaire (0–61 scale: higher scores representing greater symptom severity). FISI components, gas (0–12), mucous (0–12), liquid (0–19), and stool (0–18) were scored using the patient validated metrics instead of physician values. RH was defined as balloon distention volume documented in the FI literature: First Sensation (FS) as ≤38 ml and Urge-to-Defecate (UD) as ≤80 ml. Independent t-tests were performed to assess the mean difference of FISI summation (FISI-Sum) and FISI components (FISI-C) between FI patients categorized as RH vs. normal rectal sensation (NRS) and sex (male vs. female). A P-value of ≤0.05 was considered statistically significant. RESULTS: Demographics (N = 955) were as follows: mean age 60.4 ± 14.1 years (19–91), mean BMI 29.3 ± 6.6, 73.6% female, and 90.7% Caucasian. No demographics differences between genders. The mean FISI-Sum and FISI-C scores for entire sample were 35.8 ± 12.5: Gas (10.2 ± 2.7), Mucous (7.9 ± 3.4), Liquid (13.5 ± 4.3), and Stool (12.8 ± 3.6). RH measured by FS and UD criteria for the sample were 29.1% and 49.1%. No significant differences in FISI-Sum and FISI-C related to RH using FS besides Liquid incontinence reported greater severity by NRS (P = 0.001) (Table 1). No significant differences in FISI-Sum and FISI-C between the RH and NRS groups in males. Females in the NSR group self-reported greater Liquid incontinence (P = 0.003) vs. the RH group measured by FS and no differences between RH and NRS groups using UD. CONCLUSION: Rectal hypersensitivity did not predict FI severity and may reduce the amount of liquid FI in patients. Therefore, the use of anorectal rectal function testing including rectal sensation metrics and rectal sensory re-training are necessary for evaluating and improving defecatory sensations.Table 1

Association of Copper and Zinc Intake with Inflammatory Bowel Disease and Fecal Incontinence Symptoms: Evidence from the National Health and Nutrition Examination Survey.

The associations between copper and zinc intake with the risk of inflammatory bowel disease (IBD) and fecal incontinence symptoms in the general population are not well understood. This study aims to evaluate the associations of zinc and copper intake with the risk of IBD and fecal incontinence symptoms in adults aged ≥ 20 years using data from the 2009-2010 National Health and Nutritional Examination Surveys (NHANES) (N = 5593). The presence of IBD was analyzed from the NHANES data, directly querying the presence or absence of ulcerative colitis (UC) and Crohn's disease (CD). Fecal incontinence symptoms including accidental bowel leakage of gas, mucus, liquid, or solid stool were determined by using the bowel health questionnaire. Multivariable logistic regressions models were performed controlling for confounding factors (dietary, lifestyle, psychological, and health conditions). No associations between either zinc or copper intake with IBD were found. However, zinc intake was independently associated with increased risk of bowel leakage of gas or liquid. Compared with quartile 1, the multivariate-adjusted ORs (95%CI) of bowel leakage of gas across quartiles 2-4 of zinc intake were 1.41 (1.15-1.71), 1.30 (1.00-1.68), and 1.61 (1.16-2.23). Likewise, there was a trend for higher odds of bowel leakage of liquid among participants in the higher zinc intake. Compared with quartile 1, the multivariate-adjusted ORs (95%CI) of bowel leakage of liquid across quartiles 2-4 of zinc intake were 3.55 (0.94-13.41), 3.65 (1.27-10.47), and 5.06 (1.25-20.50). Future prospective studies are warranted to confirm these findings.

Management of Fecal Incontinence.

Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician-gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.

Prevalence of anal sphincter defects and association with anal incontinence in women scheduled for pelvic organ prolapse surgery.

Some women with pelvic organ prolapse (POP) have concomitant symptoms of anal incontinence. Our aim was to assess the prevalence of anal sphincter defects and the association with incontinence in women undergoing POP surgery. Cross-sectional study of 200 women scheduled for POP surgery. They answered yes/no and graded any symptoms of fecal and flatal incontinence on a visual analog scale (0-100). 3D/4D transperineal ultrasound was used to assess internal (IAS) and external anal sphincter (EAS) defects. A defect of ≥30° in ≥4 of 6 slices on tomographic imaging was regarded significant. The association between incontinence and sphincter defects was tested with multivariable logistic regression analysis. The prevalence of any sphincter defect was 50/200 (25%). Combined IAS/EAS defect was found in 19/200 (9.5%) women, 8/200 (4.0%) had isolated IAS, and 23/200 (11.5%) had isolated EAS defects. In women with defect and intact IAS, 37% and 11% reported fecal incontinence, respectively, adjusted odds ratio (aOR) 2.3 (95% confidence interval [CI], 0.7-7.0), p = .147 and in women with defect versus intact EAS, 36% and 9% had fecal incontinence, aOR 4.0 (95% CI, 1.5-10.8), p = .005. In women with defect and intact IAS, 85% versus 43% reported flatal incontinence, aOR 5.2 (95% CI, 1.6-17.2), p = .007 and in women with defect versus intact EAS, 71% versus 43% had flatal incontinence, aOR 1.9 (95% CI, 0.8-4.5), p = .131. One of four women scheduled for POP surgery had an anal sphincter defect. EAS defects were associated with fecal incontinence and IAS defects were strongly associated with flatal incontinence.

Biofeedback for Pelvic Floor Disorders.

Defecatory disorders can include structural, neurological, and functional disorders in addition to concomitant symptoms of fecal incontinence, functional anorectal pain, and pelvic floor dyssynergia. These disorders greatly affect quality of life and healthcare costs. Treatment for pelvic floor disorders can include medications, botulinum toxin, surgery, physical therapy, and biofeedback. Pelvic floor muscle training for pelvic floor disorders aims to enhance strength, speed, and/or endurance or coordination of voluntary anal sphincter and pelvic floor muscle contractions. Biofeedback therapy builds on physical therapy by incorporating the use of equipment to record or amplify activities of the body and feed the information back to the patients. Biofeedback has demonstrated efficacy in the treatment of chronic constipation with dyssynergic defecation, fecal incontinence, and low anterior resection syndrome. Evidence for the use of biofeedback in levator ani syndrome is conflicting. In comparing biofeedback to pelvic floor muscle training alone, studies suggest that biofeedback is superior therapy.

Symptoms of fecal incontinence two decades after no, one, or two obstetrical anal sphincter injuries

The long-term effects of 1 or 2 consecutive obstetrical anal sphincter injuries on bowel continence are still inadequately investigated, and published results remain contradictory. This study aimed to present detailed descriptive measures of the current bowel incontinence 20 years after the first birth in women who had 2 vaginal deliveries with and without sphincter injuries. Birth register data were used prospectively and linked to information from a questionnaire survey about current symptoms. Women with 2 singleton vaginal births, from 1992 to 1998, and no further births were retrieved and surveyed by the Swedish Medical Birth Register and Statistics Sweden in 2015. A simple random sample of 11,000 women was drawn from a source cohort of 64,687 women. The cumulative effect was studied in all women with a repeat sphincter injury from 1987 to 2000. Postal and web-based questionnaires were used. The study population consisted of 6760 women with no sphincter injury, 357 with 1 sphincter injury, and 324 women with 2 sphincter injuries. Women with 2 deliveries without sphincter injuries aged 40 to 60 years as reference, were compared with those of women that sustained 1 or 2 consecutive sphincter injuries. Here, third- and fourth-degree perineal tears were presented as 1 group. Fecal incontinence was defined as current involuntary leakage of solid or liquid stool, with and without concomitant leakage of gas. The Fisher exact test and the Mann-Whitney U test were used to compare the results of the 2 groups. The trend was analyzed using the Mantel-Haenszel statistics. Logistic regression models obtained the estimated age-related probability of fecal incontinence components. The risk of sphincter injury at first delivery was 3.9%, and the risk of a repeat sphincter injury was 10.0% (odds ratio, 2.70; 95% confidence interval, 1.80-4.07). The overall prevalence of fecal incontinence in women without sphincter injuries was 11.7%, which doubled to 23.8% (odds ratio, 2.27; 95% confidence interval, 1.75-2.94) in those with 1 sphincter injury and more than tripled to 36.1% (odds ratio, 3.97; 95% confidence interval, 3.11-5.07) after 2 sphincter injuries (trend P<.0001). The proportion of women with severe fecal incontinence increased 3-fold and 5-fold from 1.8% after no obstetrical anal sphincter injury to 5.4% (95% confidence interval, 3.3-8.2) and 9.0% (95% confidence interval, 6.1-12.6) after 1 or 2 obstetrical anal sphincter injuries, respectively (trend P<.0001). In women without sphincter injuries, the estimated probability of fecal incontinence increased from 7.0% at the age of 40 years to 19.8% at the age of 60 years. In contrast, in women with 1 or 2 sphincter injuries, the estimated probability of fecal incontinence increased from 26.1% and 33.3%, respectively, at the age of 40 years to 36.8% and 48.8% at the age of 60 years. The prevalence of fecal incontinence increased after 52 years of age in women with 1 or 2 sphincter injuries. The dominant types of leakage in women with fecal incontinence were the combination of liquid stool and gas, and the triple combination consisting of solid and liquid stools and gas. The triple combination increased from 18.9% in those without sphincter injury to 28.2% in women with 2 injuries (trend P=.0204). The risk of sustaining a repeat sphincter injury at the second delivery was almost tripled compared with the risk at the first delivery. Furthermore, 1 or 2 sphincter injuries brought severe long-term consequences for bowel continence. Accidental leakage of stool and gas increased with each sphincter injury, and the effect was proportionally cumulative. After the age of 52 years, the prevalence of fecal incontinence seemed to accelerate.

The impact of sacrospinous ligament fixation on pre-existing nocturia and co-existing pelvic floor dysfunction symptoms

Introduction and hypothesisTo evaluate whether nocturia and coexisting pelvic floor symptoms in women with pelvic organ prolapse (POP) can be improved by ligamentous fixation of apical vaginal prolapse to the sacrospinous ligament.MethodsWe evaluated the PROPEL study data from 281 women with pelvic organ prolapse stage > 2. Bothersome nocturia and coexisting pelvic floor symptoms were assessed with the Pelvic Floor Disorder Inventory (PFDI) questionnaire preoperatively and at 6, 12 and 24 months after successful vaginal prolapse repair. Women with successful reconstruction (POP-Q stage < 1 at all compartments throughout the 2-year follow-up), defined as anatomical “responders,” were compared to the anatomical “non-responders.”ResultsAmong the patients completing all PFDI questions (N = 277), anatomical responders and non-responders were the groups of interest for our analysis. We found the occurrence rates of “moderate” or “quite a bit” of nocturia was significantly reduced after surgery in all subgroups (48.7% at baseline vs. 19.5% after 24 months). The occurrence of nocturia was halved for responders compared to non-responders (45.4% and 48.3% at baseline vs. 14% and 29.5% after 24 months). Anatomical non-responders still had a relevant improvement of POP-Q stages, especially in the apical compartment. Prevalence rates of co-existing over- and underactive bladder, fecal incontinence, defecation disorders and pain symptoms were also significantly reduced postoperatively.ConclusionNocturia can be associated with symptomatic POP, with improvements seen following vaginal ligamentous prolapse repair. We caution providers, however, when advising patients of the possible resolution of nocturia following POP reconstruction, that all other traditional etiologies of nocturia must first be ruled out.

Assessing the effectiveness of laser fistulectomy for anal fistula: a retrospective cohort study

Laser fistulectomy is a minimally invasive, sphincter-sparing procedure for treatment of anal fistula. In several studies, this method has been shown to be safe and effective, with reported success rates ranging from 40 to 88%. We hypothesized that with longer follow-up, these rates would decrease. A retrospective case analysis assessing the effectiveness of laser fistulectomy in curing fistula-in-ano tracts within a cohort of patients at a single academic institution was conducted. All patients having laser ablation between March 2016 and July 2018 were analyzed. Cure of the fistula was determined by history and postoperative physical exam, and was defined as complete closure of fistula tract with resolution of symptoms. Secondary symptoms of fecal incontinence, infection, and pain were evaluated. Eighteen patients (10 males, mean age 41 ± 13years) were analyzed. Transphincteric fistula was the most common type (67%, N = 12). The mean number of previous fistula procedures was 1.33 ± 1.64. There was a 22% (N = 4) success rate at an average postoperative follow-up period of 29 ± 8months (range 18-46months). Of those who failed, 64% (N = 9) had a subsequent fistula procedure. There were no cases of fecal incontinence, but 3 cases (17%) of postoperative infection were reported and 8 patients (44%) had a subjective increase in pain at first follow-up appointment. Our data showed a much higher failure rate of laser fistulectomy compared to those reported in the literature. However, the small sample size, a large amount of heterogeneity in our patient population with a mixture of fistula types present, and various laser techniques applied decreased the power of this study.

Outcome following local excision of T1 anal cancers—a systematic review

In most cases, squamous cell carcinoma of the anus (SCCA) is treated with chemo-radiotherapy preserving sphincter function and offering good long-term survival and low recurrence rates. However, chemo-radiotherapy has several side effects: dyspareunia, impotence, fecal incontinence, pain, and skin symptoms. Small/T1 tumors, without metastatic disease, can be treated with local excision alone. We aimed to systematically review the literature regarding outcome following local excision of T1 SCCA. PubMed and Embase databases were searched for studies that investigated outcome following local excision of SCCA. Twenty-three studies were included. Twenty of the studies were retrospective, and three studies included more than 100 patients. Most of the studies were published before the 1980s. Overall there was great heterogeneity and missing data across the included studies when comparing patient demographics, resection margins, definitions on tumor location, and outcome. Overall 5-year survival was 69% (95% CI 66-72) following local excision. Overall 5-year recurrence was 37% (95% CI 30-45) following local excision. No complications were reported following local excision. The current literature on outcome following local excision of T1 anal cancers consists predominantly of smaller, retrospective, and heterogenous studies. Overall 5-year survival is acceptable, but worse than following chemo-radiation therapy. However, local excision seems to have no or only few minor complications. Recurrence rates are high. Therefore, a thorough follow-up program is needed when performing local excision as primary treatment for T1 SCCA. There is an evident need for further studies.

Effect of darifenacin on fecal incontinence in women with double incontinence.

To evaluate change in fecal incontinence symptom severity after 8weeks of darifenacin therapy in patients with double incontinence-urgency urinary incontinence (UUI) and fecal incontinence. Important secondary outcomes included fecal incontinence symptom distress and impact on quality of life, fecal incontinence episodes, global impression of improvement and overactive bladder symptom distress and impact. Prospective open-label cohort study of women presenting primarily with UUI, diagnosed with double incontinence and electing antimuscarinic therapy for UUI. Women ≥ 18years with moderate or greater bothersome UUI and fecal incontinence of liquid/solid stool with St. Marks (Vaizey) score ≥ 12 were included. Subjects were treated with darifenacin 15mg daily for 8weeks. The primary outcome was change in fecal incontinence symptom severity using the St. Marks (Vaizey) score after 8weeks. Sample size was based on the minimally important difference of the St. Marks, -5, and standard deviation, ± 8.5; 30 subjects provided 80% power and type I error of 0.05, including a 15% attrition rate. Thirty-two women were consented with mean baseline St. Marks (Vaizey) score of 18.0 ± 3.0. Mean age was 66.5 ± 10.3 years. Twenty-eight subjects (29/32, 87.5%) completed assessments. St. Marks (Vaizey) score significantly improved from 18.0 to 11.0 [mean difference - 7.0, 95% confidence interval (CI): -8.7, -5.3], and 19 subjects (19/32,67.9%) met the minimally important difference. Statistically significant improvements were also noted in fecal incontinence frequency, quality of life, and overactive bladder symptom bother and quality of life (all p< 0.01). Darifenacin can be considered a highly effective early intervention in women suffering from double incontinence. Bladder Antimuscarinic Medication and Accidental Bowel Leakage (BAMA), https://clinicaltrials.gov/ct2/show/NCT03543566 , NCT03543566.

Impact of Transanal Irrigation Device in the Management of Children With Fecal Incontinence and Constipation.

Children with fecal incontinence and constipation can be classified into 3 groups: neurogenic bowel dysfunction (NBD) related to spinal cord defects (NBD), refractory constipation (RC), or anorectal malformations (ARMs). The transanal irrigation (TAI) device (Peristeen) was approved in 2012 by the Food and Drug Administration. This system uses a pump rather than gravity to instill water as a colonic irrigant and uses balloon occlusion of the rectum. Our aim was to evaluate the effectiveness of TAI (Peristeen) in children who failed to respond to conservative measures for stool incontinence and constipation. Retrospective study of 147 patients prescribed TAI between January 2014 and January 2020. Data collected included demographics, prior bowel regimen, symptoms before and after, patient satisfaction scores, and NBD scores. Of the 147 patients initiated, 114 remain active users (13 lost to follow-up and 20 discontinued use). Multiple bowel regimens including laxatives (n = 139), cone enema (n = 40), and cecostomy (n = 7) were tried previously. The majority of our patients (n = 85) have NBD, primarily spina bifida, followed by RC (n = 43), and ARM (n = 19). For all patient groups, there was significant improvement in symptoms of fecal incontinence and constipation (P ≤ 0.001). Abdominal pain was improved in the NBD and RC group, but not significantly in the ARM group. We provide a single-center review of a large pediatric cohort using TAI (Peristeen) for management of fecal incontinence and constipation. Peristeen offered significant improvement in patients with NBD, RC, and ARM.

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy-a multicentre randomised controlled trial (LAVA trial).

To investigate whether laparoscopic sacrohysteropexy (LSH) is non-inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse. Multicentre randomised controlled, non-blinded non-inferiority trial. Five non-university teaching hospitals in the Netherlands, one university hospital in Belgium. 126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery. Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%. Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP-Q≥2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life. Laparoscopic sacrohysteropexy was non-inferior for surgical failure (n=1, 1.6%) compared with SSHP (n=2, 3.3%, difference -1.7%, 95% CI: -7.1 to 3.7) 12months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP. Laparoscopic sacrohysteropexy was non-inferior to SSHP for surgical failure of the apical compartment at 12months' follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent. Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short-term outcomes.

Transanal irrigation: is it the magic intervention for bowel management in individuals with bowel dysfunction?

Historically, the use of colonic irrigation or transanal irrigation (TAI) has been viewed as an alternative therapy for the treatment of a wide variety of conditions not relating to bowel dysfunction, including nausea, fatigue, depression, headache, anxiety and rheumatism. However, these days it is viewed as an effective treatment in individuals who may present with bowel dysfunction and related symptoms of constipation and faecal incontinence. Such individuals would include people with neuropathic bowel disorders, conditions that affect sphincter control or bowel motility disorders. injury to the rectum, sphincter or bowel, slow transit times, evacuation difficulties or prolapse due to a weak/damaged pelvic floor, and chronic faecal incontinence. TAI may be performed by the person with bowel dysfunction, or by a carer or health professional. An individual's ability to use a device to undertake the procedure will be influenced by a range of factors, which are explored in this article.

Long-term outcomes and quality of life of patients with Hirschsprung disease: a systematic review and meta-analysis

BackgroundAdvances in surgical techniques and perioperative care have improved the short- and mid-term postoperative outcomes of patients with Hirschsprung disease (HD). However, the long-term outcomes of these patients (older than 10 years) have not been fully investigated. The aim of this systematic review is to clarify the prevalence of long-term outcomes and the quality of life of these patients.MethodsPubMed, AMED, Cochrane Library, CINAHL and PsycINFO databases were searched from inception to October 2018, following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. Original studies reporting the outcomes of patients older than ten years with HD were selected and reviewed. The overall prevalence of fecal incontinence, constipation, bowel function score, bladder dysfunction symptoms, and patients’ quality of life were extracted from the included studies and pooled through the random-effects meta-analysis model. The heterogeneity and variation in the pooled estimations were evaluated by Cochrane’s Q test and the I2 test. The sensitivity analysis was conducted by the sequential omission of individual studies. Publication bias was evaluated by Egger’s linear regression test. The whole procedure was conducted with Stata (version 14).ResultsIn total, 3406 articles were identified from the literature search, among which twelve studies, including 625 patients, were included for analysis. The pooled prevalences of fecal incontinence, constipation, and bladder dysfunction symptoms and good to excellent bowel function scores were 0.20 (95% CI 0.13–0.28), 0.14 (95% CI 0.06–0.25), 0.07 (95% CI 0.04–0.12), and 0.95 (95% CI: 0.91–0.97), respectively; the pooled mean score of gastrointestinal-related quality of life was 118 (95% CI: 112.56–123.44).ConclusionsHD patients older than ten years old have an overall high prevalence of fecal incontinence and a low quality of life. Targeted and evidence-based follow-up procedures and transitional care are essential to meet these patients’ long-term care needs. Prospective and multicenter research that focuses on the attributes and predictors of the long-term prognosis of patients with HD are necessary.

LONG-TERM OUTCOMES OF SPINKTER-SPARING SURGERIES IN MID- AND LOWER AMPULLARY RECTAL CANCER: QUALITY OF LIFE AND SURVIVAL OF PATIENTS

The purpose of the study was to comparatively analyze surgical outcomes in patients with histologically proven rectal cancer. Material and methods. From 1999 to 2012, 174 patients with histologically proven rectal cancer underwent abdominal-anal resection of the rectum with bringing down the sigmoid colon into the anal canal and sphincter-preserving low intra-abdominal resection of the rectum with coloanal anastomosis. Results. Two groups of patients were studied: the main group (sphincter-preserving low intra-abdominal rectal resection) and the control group (abdominal-anal resection of the rectum) . The 5-year survival rates and quality of life of the patients (Wexner scale) were compared. Improvement in fecal retention function was observed in both groups a year after surgery. However, 17 patients in the control group (25 %) had unsatisfactory function of the closure apparatus (11–20 points on the Wexner scale), sharply limiting their social activity and requiring the use of anal tampons. Fecal incontinence was observed in 95% of the control group patients 1 year after surgery. A significant improvement in the quality of life associated with adequate sphincter function was found in the main group of patients. In 40 out of 88 patients who had survived 1 year (45 %), no significant violations of the closure function were revealed. The remaining patients had symptoms of fecal incontinence or inability to control bowel movements for a long time (less than 10 points on the Wexner scale). Conclusion. The use of low anterior rectal resection with coloanal anastomosis in the surgical treatment of cancer, significantly improves the patient’s quality of life without compromising the radicality and safety of treatment.

Device-assisted pelvic floor muscle postpartum exercise programme for the management of pelvic floor dysfunction after delivery

Background Pelvic floor dysfunction (PFD) is a multifactorial condition that clinically manifests as the pelvic prolapse, urinary and/or rectal incontinence, and sexual dysfunction. Aim We aimed to evaluate the efficacy of two pelvic floor trainers for the prevention of PFD in women during the postpartum period. Materials and methods This was a prospective, randomized, open-label study in 70 women in the postpartum period. Participants were randomized to complete a daily, 20-min set of pelvic floor muscle exercises using the EmbaGYN (UK; Group 1, n = 40) or the Magic Kegel Master device (China; Group 2, n = 40) for 4 weeks. All participants anonymously completed the PFDI-20 questionnaire and FSFI form at baseline and last visit. Pelvic floor muscle strength was measured using the XFT-0010 device. Results After the completion of the 4-week pelvic floor muscle exercise program, there was a significant decrease in the rates of all PFD symptoms including pelvic organ prolapse and urinary and/or fecal incontinence in both groups. The rates of sexual dysfunction after the exercise program decreased significantly only in Group II (69.4 versus 25.0%; р =.001). After the program, Group I showed a significant reduction in the number of women with symptoms of urgent urinary incontinence versus baseline (35.3 versus 8.8% p = .009). Similarly, the rates of urine loss associated with coughing, sneezing or laughing in Group I decreased from 41.2% at baseline to 11.8% after the program (р =.006) and the rates of urine leakage independent of physical activity from 23.5 to 5.9% (p = .040), respectively. Conclusion The 4-week postpartum pelvic floor muscle exercise program utilizing the EmbaGYN or Magic Kegel Master device has significantly increased the pelvic floor muscle strength and decreased the symptoms of pelvic organ prolapse, urinary and fecal incontinence. The use of the Magic Kegel Master device significantly reduced the symptoms of sexual dysfunction. The use of the EmbaGYN device was effective in addressing the individual symptoms of urinary incontinence.

Is Fluid Intake Associated With Fecal Incontinence in Women?

The primary aim of this study was to determine if fecal incontinence (FI) is associated with self-reported fluid intake in women seeking care for pelvic floor disorders. The secondary aim was to determine the association between bowel symptoms and fluids associated with FI. We conducted a retrospective cross-sectional study of women presenting for evaluation of pelvic floor disorders from 2009 to 2015. The presence of FI was defined as an affirmative response of any frequency to the question, "During the last 4 weeks, how often have you leaked or soiled yourself with stool?" Data on fluid intake and bowel symptoms were collected using the Questionnaire-based Voiding Diary and Colorectal-Anal Distress Inventory short form, respectively. The relationship between FI and quartiles of fluid intake, as well as the relationship between bowel symptoms and fluids associated with FI, was analyzed. Nine hundred twenty-four women were included: 379 (41%) with and 545 (59%) without FI. There was an association between FI and increasing total carbonated fluid intake (P = 0.009) and decreasing water intake (P = 0.009). The associations between FI and carbonated fluid intake and FI and water intake remained significant after controlling for patient characteristics (P < 0.05). There was a significant association between the symptom of straining to defecate and carbonated beverage intake (P = 0.046), which remained significant after controlling for patient characteristics (P < 0.001). Consumption of carbonated beverages is associated with FI in women. Intake of carbonated fluids is associated with bowel symptoms that may exacerbate FI symptoms.

Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy

PurposeTo compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP).MethodsA randomized, parallel-group, double-blinded, single-center prospective study.PatientsSymptomatic 2nd- or 3rd-degree hemorrhoids patients.InterventionsComputer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year.Outcome measuresRecurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients’ quality of life, fecal incontinence, and patients’ evaluation of treatment.ResultsA total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001. Patients after LHP returned to regular activity after 15 days, after MP after 22 days, and after EH after 30 days, p < 0.001. SF-36 scores were better after EH. Symptoms of fecal incontinence improved in all the groups. Patients evaluate LHP better than EH and MP.LimitationsSingle-center study.ConclusionsLaser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.

7: Impact of second stage pushing timing on maternal pelvic floor morbidity: Multicenter randomized controlled trial

Childbirth is the most significant risk factor for pelvic floor disorders in women, yet the impact of labor management such as timing of pushing in the second stage is unknown. We sought to determine whether immediate or delayed pushing results in higher measures of pelvic floor morbidity. Multicenter randomized trial in which nulliparous women at term with neuraxial analgesia were randomly assigned at complete cervical dilation to immediate pushing or delay for 1 hour. Participants were assessed at baseline (for questionnaire), 6 weeks and 6 months postpartum. Outcome measures were rates and extent of pelvic organ prolapse (POP) based on the Pelvic Organ Prolapse Quantification (POP-Q) system, and patient-reported symptoms of urinary incontinence (UI), fecal incontinence (FI), and POP using validated symptom-specific distress and quality-of-life pelvic floor questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Fecal Incontinence Severity Index (FISI). Rates and severity of POP, and changes in questionnaire scores from baseline at 6 weeks and 6 months were compared between the 2 groups. Of the 2414 subjects randomized, 941 (39.0%) participated in the pelvic floor assessments; 452 immediate and 489 delayed pushing. Baseline characteristics were comparable in the 2 groups. There were no differences in overt perineal lacerations and objective measures of POP at 6 weeks and 6 months (Figure). None of the changes from baseline in the total and subscale scores for the PFDI and PFIQ were significantly different at 6 weeks and 6 months postpartum (Table). The change in FISI score from baseline was statistically higher with immediate pushing at 6 months (0-61 points: 2.91 ± 5.7 vs 1.99 ± 4.5, P=0.01), but this difference was less than the minimal important difference of 4 for this instrument. Among nulliparous women at term with neuraxial analgesia, neither immediate nor delayed pushing in the second stage resulted in significant differences in POP, and patient-reported symptoms of UI and FI at 6 weeks and 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women.

To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.