Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence

Sun, Wei; Katsinelos, P.; Horowitz, M.; Read, N W

doi:10.1097/00042737-199610000-00014

Cited by 43 publications

(44 citation statements)

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“…It has been suggested that internal anal sphincter dysfunction causes fecal incontinence in diabetic patients 7,8). In contrast, Rogers et al 9) reported that external anal sphincter dysfunction may A schematic representation of the innervation of the distal colon and anal canal is taken from Caviezel's et a113 (Fig.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology in Diabetic Patients with Fecal Incontinence

Watanabe

Tsunoda

Kamiyama

et al. 2003

The Showa University Journal of Medical Sciences

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Section: Discussionmentioning

confidence: 99%

Pathophysiology in Diabetic Patients with Fecal Incontinence

Watanabe

Tsunoda

Kamiyama

et al. 2003

The Showa University Journal of Medical Sciences

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“…In the central nervous system, multiple sclerosis, dementia, stroke, brain tumors, sedation, dorsal and spinal cord lesion may each cause incontinence (40)(41)(42)(43). In the peripheral nervous system, cauda equina lesions, diabetic neuropathy (41,44,45), toxic neuropathy from alcohol, or traumatic neuropathy in the post partum setting may all lead to fecal incontinence. Up to 30% of patients with multiple sclerosis are incontinent (41).…”

Section: Pathogenic Mechanisms and Etiologymentioning

confidence: 99%

“…Rectal compliance can be calculated by assessing the changes in rectal pressure during balloon distention with air or fluid (41,44,52,67,68). The ratio dv/dp describes the relationship.…”

Section: Sensory Testingmentioning

confidence: 99%

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Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

281

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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“…Fecal continence depends on the physical properties of fecal content and on the integrity and functional characteristics of the anatomical structures that propel, maintain, and expel the fecal bolus [4]. A number of techniques have been used alone or in association to evaluate anorectal function and the anatomy of the pelvic floor [4,5]. Anorectal manometry, anal electromyography, anal endosonography, and defecography provide extremely useful information on the pelvic floor, are reproducible, and can be of great help in evaluating patients with anal incontinence.…”

Section: Introductionmentioning

confidence: 99%