Treatment Of Anal Incontinence Research Articles

Novel Nonablative Radiofrequency Approach for the Treatment of Anal Incontinence: A Phase 1 Clinical Trial.

We aimed to describe the action, impact on quality of life, and side effects of perianal nonablative radiofrequency (RF) application in the treatment of anal incontinence (AI) in women. This was a pilot, randomized clinical trial conducted between January and October 2016. We enrolled women who consecutively attended the Attention Center of the Pelvic Floor (CAAP)with complaints of AI for more than six months. Nonablative RF was applied to the perianal region of the participantsusing Spectra G2 (Tonederm®, Rio Grande do Sul, Brazil). The reduced or complete elimination of the need for protective undergarments (diapers and absorbents) was considered a partial therapeutic response. Nine participants reported treatment satisfaction, while one reported dissatisfaction with the nonablative RF treatment of AI based on the Likert scale. No patientinterrupted treatment sessions because of adverse effects, although adverse effects occurred in six participants. However, the clinical and physical examination of the participants with burning sensations showed no hyperemia or mucosal lesions. This study showed a promising reduction of fecal loss, participant satisfaction with treatment, and improved lifestyle, behavior, and depression symptoms with minimal adverse effects.

Possibility of osteopathic correction inclusion in the complex treatment of anal incontinence in teenagers

Introduction. Anal incontinence (insufficiency of the anal sphincter) is a disease in which there is an uncontrolled discharge of intestinal contents through the anal canal when it is impossible to keep the episode of defecation to an acceptable place, which is a socially significant problem. Patients suffering from anal incontinence experience a feeling of psychoemotional inferiority and are often socially maladjusted. Insufficiency of the anal sphincter is a widespread pathology. The course of therapy is, as a rule, complex, and usually includes the use of medications, cleansing enemas, as well as non-drug methods of treatment (exercise therapy, massage, physiotherapy). At the same time, information on the possibility of including such a method of non-drug treatment as osteopathic correction in the complex therapy of anal incontinence in the available literature has not been found.The aim of the research was to study the possibility of including osteopathic correction in the complex treatment of anal sphincter insufficiency in teenagers.Materials and methods. The study involved 32 teenagers with functional anal sphincter incontinence, aged 14–17 years, undergoing treatment in the department of surgery. The patients were divided into 2 groups by the method of simple randomization — the main group (16 people, they received osteopathic correction in addition to the standard treatment) and the control group (16 people, they received only the standard treatment). At the beginning and at the end of the study there were assessed the osteopathic status and the disease severity using the Wexner scale and the Browning–Parks scale. The obtained results were analyzed by methods of nonparametric statistics. Results. It was found that the inclusion of osteopathic correction in the complex treatment of teenagers with anal sphincter insufficiency is accompanied by a statistically significant (p<0,05) decrease in the severity of the disease. It was revealed that children suffering from anal sphincter insufficiency are characterized by a high frequency of detection of regional (pelvic region, lumbar region) and local (some skull sutures, rectum, ascending and descending colon) somatic dysfunctions. After osteopathic correction, the frequency of detecting regional and local dysfunctions in teenagers is statistically significantly lower (p<0,05) compared with children who did not receive osteopathic correction.Conclusion. The obtained results demonstrated the ability to include the osteopathic correction in the complex treatment of teenagers with anal sphincter insufficiency.

Obstetric anal sphincter injury and anal incontinence.

The aim of our study is to clarify the problems of OASI (obstetric anal sphincter injuries) and anal incontinence and prevention of this injury. Review of articles in peer reviewed journals with the usage of Google Scholar function and PubMed. OASI is asevere injury which is more commonly associated with assisted vaginal delivery. This injury cannot be fully prevented, but its incidence can be averted by the usage of selective mediolateral episiotomy, or by other precautionary moves in high risk patients. The treatment of anal incontinence after OASI requires acomplex approach and thorough examination. At first delivery, OASI is not astern indication for caesarean section in accordance with current state of knowledge.

Postpartum anal incontinence

Postpartum anal incontinence is a complex disorder that develops mainly in young women and negatively affects their social and professional activity. The aim of this review is to summarize the available literature and current concepts on the etiology, pathogenesis, diagnosis and treatment of postpartum anal incontinence. The prevalence of postpartum anal incontinence varies from 13 to 39 %. The risk factors include vaginal delivery, the use of instrumental methods, age, body mass index > 30, delivery-associated perineal tears, incontinence during pregnancy and smoking. The role of episiotomy in anal incontinence is not clear, some authors note a high risk of median episiotomy compared with mid-lateral one. Diagnosis of anal incontinence is mainly based on clinical examination and history data. The most informative imaging modality is endoanal ultrasound. Treatment of anal incontinence should begin with diet correction and medications for stool control. The efficacy of various treatment programs directed to strengthening the pelvic floor and anal sphincter muscles is controversial and needs further study. Surgical treatment is indicated if the conservative therapy is unsuccessful; the most common methods are sphincteroplasty and electroneuromodulation of the sacral plexus branches. Primary prevention measures for postpartum anal incontinence should focus on eliminating or reducing the risk factors. Special training programs for obstetricians can significantly reduce the number of perineal tears and their severity, as well as reduce the need in obstetric forceps. Secondary prevention steps include the correct choice of the first and subsequent deliveries in women with an increased risk.

Interview-based versus self-reported anal incontinence using St Mark's incontinence score.

St Mark's incontinence score (SMIS) was originally designed and validated for use in an interview setting (iSMIS), and there is conflicting evidence for the validity of the self-administered SMIS (sSMIS). Our objective was to compare self-administered and interview-based reports of anal incontinence (AI) symptoms. A total of 147 women reported symptoms of AI on a sSMIS before inclusion in a clinical study investigating the effect of conservative treatment for AI 1year after delivery. After clinical investigations, an iSMIS was completed by one of two consultant surgeons blinded to the sSMIS results. The correlation and agreement among the individual items of the iSMIS and the sSMIS were assessed using Spearman's rho and weighted kappa statistics, respectively. The mean iSMIS and sSMIS reported was 4.0 (SD: 3.6) and 4.3 (SD: 4.0), respectively. Spearman's rho showed a strong relationship between the two total SMIS scores (r=0.769, n=147, p<0.001), and explained variance was 59% (r2=0.591). Except for the individual item about gas incontinence, women reported more frequent AI symptoms on the sSMIS than on the iSMIS. The assessment of consistency among the individual items of the iSMIS and sSMIS showed substantial agreement (κ≥0.60) for all items except for fair agreement for the item about formed stool incontinence (κ=0.22), and moderate for the item about any change in lifestyle (κ=0.5). The level of consistency between the two methods of reporting anal incontinence symptoms suggests that theSt Mark's score may be used as both an interview-based and a self-administered incontinence score.

INDICATIONS FOR INJECTION OF BULKING AGENTS FOR THE TREATMENT OF ANAL INCONTINENCE

Despite of lots conservative and surgical methods of treatment, the problem of anal incontinence is relevant today and remains unresolved. Since the beginning of the 1990s attempts ofimplantation of bulking agents in order to increase the basal pressure in the anal canal were begun. Domestic product “ДАМ+” used in the study. OBJECTIVE. To determine the indications for injection of bulking agents for the treatment of anal incontinence. Research the possibility of using the drug “ДАМ+,” with assessment of treatment outcomes. During a period of 2014 to 2016 there were 30 patients with anal incontinence of various etiologies involved in research. The mean age was 47,5 ± 6,5 years. Injection of bulking agent “ДАМ+” were performed by the punction of submucosa of the anal canal in 3 points, andfollowed by a comparative analysis of the survey after treatment. Average follow-up was 12,1 ± 0,97 months. The study we have identified indications for the implementation of bulking agents for correction of anal incontinence, and the estimation results.

Regenerative medicine provides alternative strategies for the treatment of anal incontinence

Anal incontinence is a common disorder but current treatment modalities are not ideal and the development of new treatments is needed. The aim of this review was to identify the existing knowledge of regenerative medicine strategies in the form of cellular therapies or bioengineering as a treatment for anal incontinence caused by anal sphincter defects. PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016. Animal studies have demonstrated that cellular therapy in the form of local injections of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2-4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. Cellular therapies with myogenic cells and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most intensively investigated and several clinical trials were ongoing at the time of this report. The cost-effectiveness of such a therapy is an issue and muscle fragmentation is suggested as a simple alternative.

Does regenerative medicine have a potential role in the treatment of anal incontinence?

Does regenerative medicine have a potential role in the treatment of anal incontinence?

Obstetrics and fecal incontinence.

Anal incontinence (AI) can be a debilitating condition for women following vaginal delivery. Operative vaginal delivery and anal sphincter laceration are important risk factors for the development of postpartum AI. Obtaining a comprehensive delivery history, along with a thorough physical examination of the perineum, vagina and rectum may aid the clinician in the diagnosis of an anal sphincter defect. Sonographic imaging can also assist in identifying sphincter defects. The treatment of AI may include a combination of dietary modification, medications that promote constipation, pelvic floor physical therapy, biofeedback, anal sphincteroplasty, and/or sacral neuromodulation.

Modern methods of conservative treatment of anal incontinence

Modern methods of conservative treatment of anal incontinence

Temperature-controlled radiofrequency energy in patients with anal incontinence: an interim analysis of worldwide data.

Background: Controlled delivery of radiofrequency energy (SECCA procedure) as treatment for anal incontinence (AI) was introduced 15 years ago. Since then, several clinical studies have emerged. This article evaluates the clinical response and sustainability of SECCA for patients with AI.Methods: Only original clinical studies retrieved from PubMed and Medline were included. The outcome measures, faecal incontinence scores, definition of response, clinical results and anorectal evaluation were analysed.Results: Ten studies were included, which involved 150 original patients. Three studies reported a long-term follow-up. The one-year follow-up shows a moderate effect, which declines somewhat over time. Only minor temporary side-effects are reported and none of the patients declined treatment.Conclusion: SECCA is a safe and well-tolerated procedure that is easy to perform without any serious short- or long-term complications, but with only a moderate clinical effect that declines over time. Results of randomized, sham-controlled controlled trials are awaited.

Obésité et urogynécologie : revue de la littérature

To determine the specificity of the management of urogynecologic disorders in obese women. obesity, genital prolapse, pelvic organ prolapse, urinary incontinence, anal incontinence. The relative risk of urinary incontinence (UI) for morbidly obese women (BMI>40 kg/m(2)) is five times greater than a normal weight woman. A 10% weight loss reduced the frequency of urinary leakage by 50%. Beyond a BMI of 35 kg/m(2), the success rate of suburethral sling decreased to 50% with an increased risk of de novo urgenturies. Within this population of morbidly obese women, bariatric surgery was as successful as or more than surgery for incontinence. Patients with morbid obesity are three times as likely to experience anal incontinence, with a prevalence reaching 32%. The treatment of anal incontinence in obese patients is not clearly codified. The association between obesity and prolapse is very controversial according to the methodology used in the studies. Treatment of genital prolapse in obese women is little studied in the literature. Only sacrocolpopexy by laparotomy was studied. No more complications were found in this population. Now we have specific data concerning urogynecology in obese women to better manage these patients.

Nutzen von Medizinprodukten: Lösungsansätze bei der Planung und Durchführung von Studien

Medicines and medical devices do not only differ in the approval process, but also in the aim and conduct of clinical trials. We first discuss important differences between medicinal products and medical devices. Emphasis is put on the differences in the framework for clinical trials. We point out that a different analysis set should be used in clinical trials of medical devices when compared with medicinal products and medical devices in the USA. Specifically, regulators generally ask for the full analysis set based on the intention-to-treat principle as proof of efficacy of medicines. A central aspect of clinical trials of medical devices is that they have to be tested under normal conditions of use according to the performance data. As a result, all data acquired while the medical device was not during normal conditions of use should be excluded from statistical analyses. We discuss statistical methodological particularities of medical devices, such as blinding and the control of placebo effects. Using the conservative treatment of anal incontinence as an example, we show that comprehensive technical and physical knowledge is required for assessing the utility of medical devices. Finally, we consider reporting of severe adverse events and of severe adverse device effects of medical devices.

Long-term outcome after free autogenous muscle transplantation for anal incontinence in children with anorectal malformations

PurposePatients with high anorectal anomalies are often incontinent after reconstruction, particularly with the older forms of surgical treatment, that is, anorectal pull-through or Stephen's operations. In 1974, a new treatment for anal incontinence in children was introduced at the Akademiska Hospital: free autogenous muscle transplantation (FAMT) to the perirectal area. All the patients receiving FAMT were totally incontinent before the procedure and had no rectal sensitivity. The aim of this study was to evaluate the long-term functional outcome of this procedure. MethodsTwenty-two patients (17 males) operated on with FAMT below the age of 15 years were identified through records. One of the patients had died, and 2 were not available for follow-up. The remaining 19 were sent a validated bowel function questionnaire, and 15 (78.9%) of 19 patients responded (12 males). These 15 patients were compared with 15 patients with the same sex, age, and a similar malformation from our patient database. ResultsAt follow-up, after an average of 30 years postoperatively, 2 of 15 patients with FAMT had a stoma compared with 3 of 15 in the control group. The Miller incontinence score had a mean of 6.2 (median, 6; range, 0-15) in the FAMT group and 3.7 (median, 4; range, 0-12) in the control group. All patients in both groups could sense stool, and 11 of 13 patients in the FAMT group could distinguish between feces and flatus. ConclusionsThe patients with FAMT had a slightly inferior anorectal function compared with the controls. Considering they were all totally incontinent before FAMT, we conclude that FAMT has an acceptable effect 30 years postoperatively. Therefore, we find that FAMT could be an alternative for anorectal malformation patients who are totally incontinent.

Measure of the Voluntary Contraction of the Puborectal Sling as a Predictor of Successful Sphincter Repair in the Treatment of Anal Incontinence

Overlapping sphincteroplasty is the surgery of choice for incontinent patients with an anterior defect after childbirth. Numerous predictive factors have been proposed, but no preoperative variables have been successfully shown to be reproducible. The purpose of this study was to assess the prognostic value of voluntary contraction of the puborectal sling before sphincter repair for anal incontinence. This prospective study evaluated 109 consecutive women who underwent surgery for postobstetric anal incontinence. Voluntary contraction of the puborectal sling was measured by perineal ultrasound before the surgery. Severity of anal incontinence was evaluated preoperatively and postoperatively with the Miller Incontinence Score (total incontinence = 18, complete continence = 0). The proportion of patients with scores <or=3 was 16.7 percent when the preoperative voluntary contraction of the puborectal sling was <or=4 mm, 48.1 percent when it was 4.1 to 8 mm, and 98.7 percent when it was >8 mm (P < 0.001). Using <or=8 mm to define abnormal shortening, the sensitivity of the test was 0.95 (95 percent confidence interval, 0.75-1.00) and specificity was 0.84 (95 percent confidence interval, 0.75-0.91). A preoperative voluntary contraction of the puborectal sling >8 mm convincingly discriminates between patients with a good functional outcome and those with an unsatisfactory outcome after sphincter repair for postobstetric anal incontinence.

Therapie anorektaler Erkrankungen

HAEMORRHOIDAL DISEASE: Stage orientated treatment of haemorrhoidal disease using conservative and operative measures provides high healing rates with low complication- and recurrence rates. ANAL FISSURE: Muscle relaxing ointments (Nitrates, Ca-channel-blocker) are the treatment of choice for chronic anal fissure. In cases of insufficiency fissurectomy provides high healing rates. ABSCESS AND ANAL FISTULA: Anal fistulae are treated with respect of their involvement of the anal sphincters. Distal fistulae are completely excised reaching high healing rates, proximal fistulae are treated using local flap procedures with healing rates reaching 50 to 80%. ANAL INCONTINENCE: Treatment of anal incontinence is depending on the severity and on the etiology of the disease. The following procedures are used: conservative: improving consistency, physical exercises, electrostimulation Biofeedback-Training surgical: Sphincterreconstruction, Pre-anal Repair, Post-anal Repair, Total Pelvic Floor Repair, Dynamic Graciloplasty, Artificial Anal Sphincter, Sacralnervestimulation, Stoma

Surgical treatment of anal incontinence. 2nd ed. C. V. Mann and R. E. Glass. 197 × 275 mm. Pp. 195. Illustrated. 1997. London: Springer. Price not supplied

Surgical treatment of anal incontinence. 2nd ed. C. V. Mann and R. E. Glass. 197 × 275 mm. Pp. 195. Illustrated. 1997. London: Springer. Price not supplied

Modern surgical treatment of anal incontinence

New surgical treatment modalities have been developed for patients with anal incontinence resulting from extensive sphincter destruction and in whom standard sphincter repair has failed. These new modalities include the transposition of striated skeletal muscles combined with implantation of neurostimulators, artificial sphincters based on the same principle as artificial urinary sphincters, and direct sacral nerve stimulation. In a few reported series muscle transposition in combination with neurostimulation has given a satisfactory continence in 50–70% of the patients. The same is true for the smaller series published on artificial anal sphincters, whereas the results of sacral nerve stimulation have thus far been reported in only a few patients. The selection of patients and the performance of these procedures should be limited to few specialist centres.

The electrically stimulated gracilis neo-anal sphincter.

Many patients with incontinence gain no relief from their symptoms following traditional surgical treatment and by necessity resort to a stoma. A number of attempts have been made to replace damaged or excised sphincters using the gracilis muscle to fashion a neo-anal sphincter. The results of the published series using the technique of unstimulated graciloplasty for the treatment of anal incontinence and in total anorectal reconstruction are reviewed. The results of these series are conflicting. In an effort to improve on these results the electrically stimulated neo-anal sphincter has been developed. The rationale behind its development and its evolution are discussed. The efficacy of the procedure in treating patients with incontinence or as part of total anorectal reconstruction is assessed.

Treatment of anal incontinence by an implantable prosthetic anal sphincter.

Twelve patients with anal incontinence due to neurologic disease or failure of previous incontinence surgery underwent implantation of an artificial anal sphincter. The system used was a modification of the AMS 800 artificial urinary sphincter. In two patients, infection necessitated removal of the system, and in four patients, eight revisional procedures had to be performed because of mechanical failure. After various modifications of the system, especially reinforcement of the closing mechanism of the cuff, only one case of mechanical failure has occurred. Erosion through the anal canal did not occur. Among 10 patients with the system in function for more than 6 months, the result was considered excellent in 5, with only occasional leakage of flatus, good in 3, who occasionally leaked liquid feces and flatus, and acceptable in 2, in whom the cuff obstructed defecation. It is concluded that implantation of an artificial anal sphincter is a valid alternative to permanant colostomy in patients with anal incontinence due to neurologic disorders and in patients in whom other types of incontinence surgery have failed.