Are special investigations of value in the management of patients with fecal incontinence?

Keating, John P.; Stewart, Peter; Eyers, A. A.; Warner, Daniel A.; Bokey, E. L.

doi:10.1007/bf02051195

Cited by 71 publications

(49 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As stated, most studies that included more than one examiner have been in accordance with our findings (3,7,14,17,18,25) .…”

Section: This Study Has Some Limitationssupporting

confidence: 78%

“…The same authors found some correlation between anal resting and squeeze tone to resting and incremental pressures (7) . Conversely, other studies have shown that DRE tone was either not related or related only to squeeze pressures (3,9,18,25) . In this study, despite its inaccuracy in assessing anatomical defects, DRE tone was correlated to sphincter function, since women with abnormal resting tone had lower resting pressures whereas women with abnormal squeeze tone also had lower incremental anal pressures than those with normal DRE.…”

Section: Resting Tone Dre Resting Pressurementioning

confidence: 92%

See 1 more Smart Citation

Is Digital Rectal Exam Reliable in Grading Anal Sphincter Defects?

Coura

Silva

Almeida

et al. 2016

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Background -Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective -In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures. Methods -Women with fecal incontinence were divided into two groups: small or extensive defects according to the ultrasound scoring system. Sensitivity, specificity, positive and negative predictive values of digital rectal examination in grading global and external sphincter defects were calculated. Anal tone at digital rectal examination was compared to resting and incremental pressures. Results -A cohort of 76 consecutive incontinent women were enrolled. The median Wexner score was 9. Sixty-eight showed sphincter defects on 3D endoanal ultrasound. Anal tone at digital rectal examination was considered abnormal in 62 cases. Abnormal digital rectal examination showed a sensitivity of 90%, specificity of 27.78% in distinguishing small from extensive defects of both sphincters. Five out of eight women with no sphincter defects had only abnormal squeeze tone at digital rectal examination. Abnormal squeeze tone at digital rectal examination had a sensitivity of 65.31% in distinguishing small from extensive external anal sphincter defects. Digital rectal examination sensitivity increased linearly from small to extensive external anal sphincter defects (P=0.001). Women with abnormal resting tone had lower resting pressures than women with normal tone at digital rectal examination (P=0.0001). Women with abnormal squeeze tone had lower incremental pressures than women with normal tone at digital rectal examination (P=0.017). Conclusion -Digital rectal examination had good sensitivity and poor specificity in discerning small from severe global anal sphincter defects. Moreover, digital rectal examination had fair sensitivity and poor specificity in grading external anal sphincter defects, and its best accuracy was on complete external anal sphincter lesions. Anal resting and squeeze tone were correlated to anal pressures.

show abstract

“…As stated, most studies that included more than one examiner have been in accordance with our findings (3,7,14,17,18,25) .…”

Section: This Study Has Some Limitationssupporting

confidence: 78%

Section: Resting Tone Dre Resting Pressurementioning

confidence: 92%

Is Digital Rectal Exam Reliable in Grading Anal Sphincter Defects?

Coura

Silva

Almeida

et al. 2016

Arq. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…It shows electric changes during rest, contraction of muscle and during voluntary squeeze. 9 If the curve of the manometric study was flat during contraction this means there is incontinence as shown in (Figure 1) between the two vertical red lines from the second 20 to the second 90 during applying the test.…”

Section: Special Physiological Studiesmentioning

confidence: 99%

Use of gatekeeper in obese patients with fecal incontinence before bariatric surgery, is it improving the results?

Ibrahim

2017

Int Surg J

View full text Add to dashboard Cite

Background: Fecal incontinence or bowel incontinence is a lack of defecation control with loss of bowel continent for gas, liquid, or solid content. Causes of incontinence are so different and might occur as apart of diarrhea or constipation. After following up patients with gastric bypass surgery for bariatric purpose we observe that most of them develop incontinence by different grades after bariatric surgery. Also, some of them complaining from soiling by different degrees before any operative procedure. Gatekeeper is a bulking agent recently introduced for treatment of fecal incontinence, implants of polyacrylonitrile (4-6) implants are inserted in inter-sphincteric space (Gatekeeper, THD) is used as a bulking agent to increase the volume in the inter-sphincteric space in cases of fecal incontinence follow-up was at 2, 4, 8 months. Aim is to evaluate efficacy of gatekeeper application in obese patient with fecal incontinence after bypass bariatric surgery.Methods: Thirty obese patients (19 females) and (11 males) undergoing bariatric surgery at Alsalama Hospital Abu Dhabi from the period between July 2015 to July 2017, are classified into two groups (group I) 15 patients (9 females and 6 males) are subjected to gatekeeper before gastric bypass surgeries and (group II) 15 patients (10 females and 5 males) not subjected to the use of gatekeeper and both groups were followed at 2, 4 and 8 months postoperative.Results: This randomized controlled study was conducted on 30 patients between July 2015 to July 2017 at Alsalama hospital Abu Dhabi. The use of gatekeeper in obese patients undergo bypass surgery is un effective technique to improve liquid stool incontinence.Conclusions: The use of gatekeeper in obese patients with fecal incontinence before gastric bypass surgery has improved the incontinence postoperative signs and symptoms.

show abstract

“…The causes of fecal incontinence were: sphincter defect (14), neurogenic (37), combined incontinence (10), incontinence due to diarrhea (5) and incontinence due to small rectal capacity (< 100 mL) (5). Within these groups, the largest improvement was seen in the combined incontinence group (1.8 point) (P = 0.01).…”

Section: Effect Of Treatmentmentioning

confidence: 99%

“…Most studies that mention anorectal function tests in relation to anorectal pathology limit themselves to pre-and post-treatment results. Therefore, it often remains unclear whether AFE leads to relevant findings or subsequent change of therapy [1][2][3][4][5][6][7][8][9][10] . A large multi-centre Dutch study referred to the value of AFE for outcome of physiotherapy in patients with fecal incontinence [1] .…”

Section: Introductionmentioning

confidence: 99%

Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients

Szojda

Tanis²,

Mulder³

et al. 2008

WJG

View full text Add to dashboard Cite

AIM:To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests. METHODS:In a retrospective study, patients referred for anorectal function evaluation (AFE) between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence (fecal incontinence without diarrhea, 3 rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation). Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration. RESULTS:From the 216 patients referred, 167 (78%) returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice. Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale (1 to 10) symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE. CONCLUSION:Referral for AFE was indicated in 65%. Beneficial effect was seen in 92%: 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.

show abstract

Are special investigations of value in the management of patients with fecal incontinence?

Abstract: Even experienced colorectal surgeons will misdiagnose up to one-fifth of patients presenting with fecal incontinence if assessment is based on the history and physical examination alone. However surgically correctable causes of incontinence are rarely missed on clinical assessment.

Cited by 71 publications

References 14 publications

Is Digital Rectal Exam Reliable in Grading Anal Sphincter Defects?

Is Digital Rectal Exam Reliable in Grading Anal Sphincter Defects?

Use of gatekeeper in obese patients with fecal incontinence before bariatric surgery, is it improving the results?

Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients

Contact Info

Product

Resources

About