Faecal incontinence

Kamm, Michael A.

doi:10.1136/bmj.327.7427.1299

Cited by 19 publications

(16 citation statements)

References 12 publications

(9 reference statements)

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“…Vaginal childbirth can impair the continence mechanism in several ways, 8,10,15,16,27 reflecting the combined symptoms (urge and passive faecal incontinence) and multiple pathophysiological abnormalities observed in the majority of parous females in this study. Although most of the parous women had experienced a complicated delivery, it is important to note that symptoms may develop after apparently uncomplicated parturition.…”

Section: Major Risk Factors In Femalesmentioning

confidence: 99%

“…Collection of both clinical and physiological data was standardized between different investigators within the department. Medical histories were scrutinized for the presence of four previously proposed risk factors 2,[8][9][10][11][12][13] (obstetric events, anal surgery, pelvic surgery, neurological factors), either individually or in combination, the age of onset of symptoms and their duration, and whether the patient ascribed the symptoms to a particular event.…”

Section: Methodsmentioning

confidence: 99%

“…2,[8][9][10][11][12][13] In some cases, the cause-effect relation is clear, in that a temporal relation is evident, the sufferer ascribes onset of symptoms to the event (e.g. 5-13% incidence of faecal incontinence after vaginal delivery in primiparous women 14,15 ), and the pathophysiology is demonstrable on anorectal function testing.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors in acquired faecal incontinence

Lunniss

Gladman

Hetzer

et al. 2004

JRSM

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SUMMARYAcquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing.Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple).These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.

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Section: Major Risk Factors In Femalesmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Risk factors in acquired faecal incontinence

Lunniss

Gladman

Hetzer

et al. 2004

JRSM

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“…It is known to be an under-reported problem, with many symptomatic patients suffering in silence. [5][6][7][8] FI has a significant impact on quality of life, causing social and psychological disability, 9,10 and often leads to people suffering from stigmatisation and social exclusion. 5,11,12 The attendant socioeconomic burden of FI is high not only because of the cost of health-care utilisation, but also because of job absenteeism.…”

Section: Introductionmentioning

confidence: 99%

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Horrocks

Bremner

Stevens

et al. 2015

Health Technol Assess

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BackgroundFaecal incontinence (FI) is a common condition which is often under-reported. It is distressing for those suffering from it, impacting heavily on their quality of life. When conservative strategies fail, treatment options are limited. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive outpatient treatment, shown in preliminary case series to have significant effectiveness; however, no randomised controlled trial has been conducted.ObjectivesTo assess the effectiveness of PTNS compared with sham electrical stimulation in the treatment of patients with FI in whom initial conservative strategies have failed.DesignMulticentre, parallel-arm, double-blind randomised (1 : 1) controlled trial.SettingEighteen UK centres providing specialist nurse-led (or equivalent) treatment for pelvic floor disorders.ParticipantsParticipants aged > 18 years with FI who have failed conservative treatments and whose symptoms are sufficiently severe to merit further intervention.InterventionsPTNS was delivered via the Urgent®PC device (Uroplasty Limited, Manchester, UK), a hand-held pulse generator unit, with single-use leads and fine-needle electrodes. The needle was inserted near the tibial nerve on the right leg adhering to the manufacturer’s protocol (and specialist training). Treatment was for 30 minutes weekly for a duration of 12 treatments. Validated sham stimulation involved insertion of the Urgent PC needle subcutaneously at the same site with electrical stimulation delivered to the distal foot using transcutaneous electrical nerve stimulation.Main outcome measuresOutcome measures were assessed at baseline and 2 weeks following treatment. Clinical outcomes were derived from bowel diaries and validated, investigator-administered questionnaires. The primary outcome classified patients as responders or non-responders, with a responder defined as someone having achieved ≥ 50% reduction in weekly faecal incontinence episodes (FIEs).ResultsIn total, 227 patients were randomised from 373 screened: 115 received PTNS and 112 received sham stimulation. There were 12 trial withdrawals: seven from the PTNS arm and five from the sham arm. Missing data were multiply imputed. For the primary outcome, the proportion of patients achieving a ≥ 50% reduction in weekly FIEs was similar in both arms: 39 in the PTNS arm (38%) compared with 32 in the sham arm (31%) [odds ratio 1.28, 95% confidence interval (CI) 0.72 to 2.28;p = 0.396]. For the secondary outcomes, significantly greater decreases in weekly FIEs were observed in the PTNS arm than in the sham arm (beta –2.3, 95% CI –4.2 to –0.3;p = 0.02), comprising a reduction in urge FIEs (p = 0.02) rather than passive FIEs (p = 0.23). No significant differences were found in the St Mark’s Continence Score or any quality-of-life measures. No serious adverse events related to treatment were reported.ConclusionsPTNS did not show significant clinical benefit over sham electrical stimulation in the treatment of FI based on number of patients who received at least a 50% reduction in weekly FIE. It would be difficult to recommend this therapy for the patient population studied. Further research will concentrate on particular subgroups of patients, for example those with pure urge FI.Trial registrationCurrent Controlled Trials ISRCTN88559475.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 77. See the NIHR Journals Library website for further project information.

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“…Almanya'da yapılan birçok çalışma inkontinanslı bireylerin sadece %50'sinin durumunu bir sağlık profesyoneline söylediği, Amerika ve İngiltere'de de bulguların benzer olduğu bildirilmiştir. Görülme sıklığı orantılı olmamakla birlikte kadınlarda, yaş-lılarda ve huzur evinde bulunanlarda daha yüksek oranda olduğu bilinmektedir (24)(25)(26). Özellikle obstetrik anal sfinkter yaralanmasının 40 yaş altı kadınlarda görülen fekal inkontinansın en önemli nedeni olduğu bilinmektedir.…”

Section: Fonksiyonal Fekal İnkontinansunclassified

Bowel Movement: The Sixth Vital Sign?

Dedeli¹,

Pakyüz²

2016

Clin Exp Health Sci

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Öz AbstractBowel movement is extremely important to assess body functions and constipation in all age groups, particularly in the geriatric population. Defecation function, which is the fifth status regarding to Daily Living Activity and the third place in Functional Health Patterns in which Nursing Process, is a concept that is dimension of functional as well as physical, social, and psychological. After the bowel movement of illness/health persons were assessed, health history, needs of training and support by nurses, and nursing care plan should be evaluated and prepared. The aim of this review is to provide nurses knowledge about assessing bowel movement and preparing a nursing care plan based on the current literature. Keywords: Nursing, bowel movement, constipation, fecal incontinence GİRİŞAnal kontinans, gaitanın, fiziksel, sosyal ve psikolojik olarak kabul edilebilir bir süre için geciktirilmesi ya da ertelenmesi olarak tanımlan-maktadır. Bu bağlamda, defekasyon fizyolojik olduğu kadar fiziksel, sosyal ve psikolojik boyutları olan bir fonksiyondur. Barsak hareketleri ve defekasyon, fonksiyonel yaşam örüntüleri ve günlük yaşam aktiviteleri içerisinde yer alan temel ihtiyaçlardandır. Kan basıncı, nabız, vü-cut sıcaklığı, solunum ve ağrının tanılanması gibi barsak hareketlerinin tanılanması vücut fonksiyonlarının değerlendirilmesini sağlayan yaşamsal bulgularından biri olarak kabul edilebilir. Normal barsak hareketleri olmadan feçesle atılan birçok toksik madde vücutta birikerek, barsakta retansiyona ve abdominal distansiyona neden olabilmektedir. Defekasyon sıklığı, günlük dışkı miktarı ve dışkının şeklindeki değişiklikler hemoroid, fissür, fekal impakşın (dışkı tıkacı), rektal kanama, perianal irritasyon ve enfeksiyonlar gibi birçok sağlık sorunlarına da neden olabilmektedir. Fonksiyonel barsak hastalıkları, toplumda oldukça sık görülmesine rağmen, lifli ve posalı beslenme, sıvı alımının arttırılması ve fiziksel aktivitenin arttırılması gibi yaşam tarzı değişiklikleri ile önlenmesi ve tedavisi mümkündür. Günlük barsak hareketleri barsak temizliği ve vücuttan sindirilemeyen atıklar, safra pigmentleri, sterkobilin gibi toksik maddelerin atılımı için gereklidir. Dolayısıyla vücut sistemlerinin sağlıklı bir şekilde çalışabilmesi için sağlıklı barsak hareketlerine ihtiyaç duyulmaktadır (1-3).Fonksiyonel alt gastrointestinal sistem hastalıkları içerisinde değerlendirilen fonksiyonel konstipasyon ve fonksiyonel fekal inkontinans her yaştaki bireyi etkileyebilen fiziksel, sosyal ve ruhsal rahatsızlıklara neden olabilen bir durumdur. Fonksiyonel konstipasyon bir hastalık olmaktan çok bir semptom olarak tanımlanabilmektedir. Toplumda yaygın olarak görüldüğü belirtilse de altta yatan nedenin belirlenmesi, tanılanması, önlenmesi ve tedavisi hastalarla az konuşulan bir durumdur (4). Amerika'da her yıl 2,5 milyon bireyin konstipasyon nedeni ile hekime başvurduğu, 800 milyon dolardan fazla paranın laksatiflere ödendiği belirtilmektedir (5). Yine, birçok yetişkin laksatif ve pürgatif ilaçları hekim kontrolü olmadan kulla...

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Faecal incontinence

Cited by 19 publications

References 12 publications

Risk factors in acquired faecal incontinence

Risk factors in acquired faecal incontinence

Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial)

Bowel Movement: The Sixth Vital Sign?

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