Fecal incontinence is a devastating disability, and although this condition is widely accepted as a problem in the elderly, it is now becoming apparent that much younger age groups are also frequently affected. Thorough assessment of anorectal incontinence is very important to choosing the most appropriate treatment. Careful history-taking and physical examination can identify the cause of most cases of incontinence and are essential in every patient. Several incontinence scoring systems have been proposed to provide an objective measure of a subject's degree of fecal incontinence, but only one acknowledges the important contribution of the severity of symptoms to quality of life. The investigations used to evaluate anorectal physiology include anorectal manometry, anal endosonography, nerve stimulation techniques, electromyography, defecography, endoluminal magnetic resonance imaging, the saline continence test, and the balloon-retaining test. Although all of these tests are important, the most useful for patients with incontinence are anal manometry, anal endosonography, and the pudendal nerve terminal motor latency test, because they can identify anatomic or physiologic abnormalities for which there may be effective treatments.
Faecal incontinence is a complex problem, often of multifactorial origin. Although the condition is widely accepted as a problem in the elderly, it is now becoming apparent that much younger age groups are frequently affected. Its exact incidence is about 2% of the general population, while in other individuals, the prevalence has been reported to approach 60%. Despite the considerable advances that have been made the past decades in the evaluation of anorectal incontinence, our understanding of it remains limited. A thorough history, good physical examination, and detailed anorectal physiological investigations can help the therapeutic decision-making algorithm. Complete functional and anatomical assessments of the anorectum, anal sphincters, and pelvic floor are mandatory in all patients with faecal incontinence to correctly identify the cause and type of incontinence and allow correct treatment. Anorectal manometry is used to establish the presence and extent of the weakness degree of the pelvic floor sphincter muscles, allowing an objective measure of resting and squeeze pressure. Anal endosonography is a very valuable tool in planning restorative surgery or in assessing results after sphincter repair. Because electromyography may detect functional abnormalities, the two techniques are complementary and not mutually exclusive. Determining the most appropriate tests will largely depend on the patient's history and symptoms and can vary for each patient.
We report the case of a patient with lower gastrointestinal haemorrhage. The cause of the haemorrhage was a lipoma of the terminal ileum that protruded into the caecum. The diagnosis was made endoscopically and radiologically. It was surgically treated with local excision.
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