Clinical anatomy of fecal incontinence in women

Kadam-Halani, P.K.; Arya, Lily A.; Andy, Uduak U.

doi:10.1002/ca.22951

Cited by 10 publications

(8 citation statements)

References 45 publications

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“…Defecation requires both voluntary and involuntary reflexes, both of which are affected by aging, which may lead to the development of constipation and/or fecal incontinence. 31 Both conditions are prevalent in the geriatric population, particularly in frail, disabled adults and those with dementia, with over 50% of institutionalized adults experiencing fecal incontinence or constipation. 32,33 Previous research has also found that polypharmacy is a risk factor for fecal incontinence and constipation.…”

Section: Discussionmentioning

confidence: 99%

“…Polypharmacy, however, was associated with emptying symptoms, including straining with bowel movements and pain with passing stool. Defecation requires both voluntary and involuntary reflexes, both of which are affected by aging, which may lead to the development of constipation and/or fecal incontinence 31 . Both conditions are prevalent in the geriatric population, particularly in frail, disabled adults and those with dementia, with over 50% of institutionalized adults experiencing fecal incontinence or constipation 32,33 .…”

Section: Discussionmentioning

confidence: 99%

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Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms

Zuo

Tellechea

Kohn

et al. 2022

UROGC

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ImportancePolypharmacy and multimorbidity are common in older adults but has not been well studied in the urogynecologic patient population.ObjectivesThe objective of this study was to determine the prevalence of polypharmacy and multimorbidity in a diverse outpatient urogynecologic population and to examine whether polypharmacy and/or multimorbidity were associated with lower urinary tract symptoms, pelvic organ prolapse, defecatory distress, and/or female sexual dysfunction.Study DesignThis is a secondary analysis of a dual-center cross-sectional study of new patients presenting for evaluation of pelvic floor disorders at 2 urban academic outpatient urogynecology clinics. Baseline demographics and clinical characteristics were obtained from the electronic medical record. Validated surveys were administered to determine severity of lower urinary tract symptoms (Overactive Bladder Validated 8-Question Screener, Urogenital Distress Inventory-6), pelvic floor dysfunction (Pelvic Organ Prolapse Distress Inventory-6, Colorectal-Anal Distress Inventory-8), and sexual dysfunction (6-item Female Sexual Function Index). Standard statistical techniques were used.ResultsOne hundred ninety-seven women with mean age 58.8 years (SD, 13.4 years) were included, and most were of minority race/ethnicity (Black, 34.0%; Hispanic, 21.8%). The majority of participants met criteria for polypharmacy (58.4%) and multimorbidity (85.8%), with a mean prescription number of 6.5 (SD, ± 4.9) and mean number of medical comorbidities of 4.9 (SD, ± 3.3). Polypharmacy and multimorbidity were significantly associated with higher CRADI-8 scores. Specifically, polypharmacy was associated with straining with bowel movements and painful stools, whereas multimorbidity was associated with incomplete emptying and fecal urgency. There was no significant association between polypharmacy and multimorbidity with urinary symptoms, prolapse, or sexual dysfunction.ConclusionsPolypharmacy and multimorbidity are common in the urogynecologic population. There is a relationship between greater defecatory distress and polypharmacy and multimorbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms

Zuo

Tellechea

Kohn

et al. 2022

UROGC

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“…Additional insights into the pathophysiology of fecal incontinence come from the evaluation of patients with spinal cord injuries and other neurologic diseases. Loss of rectal sensation may contribute to deficits in RAIR, while exaggerated, unopposed stimulation during distention may induce involuntary sphincter relaxation, and impaired spinal reflex activity may reduce rectal compliance [82,93,94]. Incontinence in this setting may therefore derive from any combination of the following, depending on the level and completeness of injury: decreased anal sphincter resting tone, loss of voluntary control, or loss of anorectal reflexes.…”

Section: Fecal Incontinencementioning

confidence: 99%

Anorectal Physiology

Suwanabol

Regenbogen

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Maintenance of fecal continence and defecation are complex processes requiring both voluntary and involuntary reflexes that have yet to be fully characterized.• Normal continence is dependent on coordination between neuronal reflexes, sensory and motor pathways, the rectum, anal sphincters, and pelvic floor and requires adequate rectal compliance and competence of the anal sphincter.• During defecation, sensory mechanisms allow the rectum to stretch to accommodate feces, the pelvic floor muscles relax, and intraabdominal pressure increases. Simultaneously, the puborectalis relaxes and straightens the anorectal angle, the anal canal shortens, and the pelvic floor descends. Finally, the anal sphincters relax and evacuation is initiated. • Anatomy and physiology of the rectum and anus are intrinsically related, allowing physiologic testing to be exceedingly useful for diagnosis and management of anorectal pathologies. • Disorders of continence can derive from deficits of mental, anatomic, and physiologic functions, including reflexes, sensory and motor nerves, and the muscles of the rectum, sphincters, and pelvic floor. • Functional defecatory disorders frequently coexist with urogynecologic conditions likely due to the shared musculature of the pelvic floor and urogenital diaphragm, as well as from the overlap in peripheral innervation and spinal nerve roots.

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“…3,4 Anal continence control physiology is complex, and relies on the integrated action of several events, such as the action of the sphincter muscles and pelvic floor muscles, presence of the rectal-anal inhibitory reflex, rectal-anal angle, rectal capacity, sensory-motor function of the anorectal anatomical region, patient's neurologic status, stool consistency, and intestinal transit time. 5,6 Several factors contribute to the appearance of female fecal incontinence, with predominance of obstetric trauma; a sphincteric lesion may occur in 35% of women who had normal deliveries, which can progress to incontinence or not, along with diabetes mellitus, multiple sclerosis and dementia. 7 Inflammatory bowel diseases, postoperative hemorrhoidal disease, and resection of colon and rectum are also conditions associated with AI.…”

Section: Introductionmentioning

confidence: 99%

Effects of biofeedback in the treatment of female fecal incontinence

Santos

Cavenaghi

Folchine

et al. 2018

Journal of Coloproctology

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Introduction Fecal incontinence is the involuntary loss of stools and gases, characterized by the inability to keep physiological control of bowel contents. It can negatively affect patients’ quality of life. Biofeedback is a therapeutic tool used in the treatment, through the training of the pelvic floor muscles from visual and sound stimuli. Objective To evaluate the effects of biofeedback in the treatment of female fecal incontinence. Methods Twenty-three patients with fecal incontinence, diagnosed by clinical evaluation and manometry, and referred for biofeedback treatment, participated responding to the Cleveland Clinic Incontinence Assessment scale, and the Fecal Incontinence Quality of Life Questionnaire to obtain personal data, clinical complaints and incontinence characteristics. Four biofeedback sessions were held once a week. After the protocol, they were reevaluated with anorectal manometry and questionnaires, and they were instructed to daily perform the sphincteric contraction exercises at home. Results The comparison of the Cleveland Clinic Florida Scoring System and FIQL scores before and after the biofeedback protocol showed a significant decrease ( p = 0.0001) in fecal incontinence. The mean anal pressure at rest was 33.3 mmHg before and 49.65 mmHg after biofeedback, while the mean anal pressure of maximal voluntary contraction was 85 mmHg before treatment and 136.65 mmHg after it. Conclusion Biofeedback is an effective method for the treatment of fecal incontinence, with increased sphincter strength and improved quality of life.

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Clinical anatomy of fecal incontinence in women

Cited by 10 publications

References 45 publications

Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms

Polypharmacy and Multimorbidity in the Urogynecology Population and Their Effect on Pelvic Floor Symptoms

Anorectal Physiology

Effects of biofeedback in the treatment of female fecal incontinence

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