Fecal incontinence and rectal prolapse

Abstract

Fecal incontinence is the involuntary loss of flatus, liquid, or solid stool from the anus. It is more common in women than men. The prevalence of fecal incontinence increases with advancing age. It is either idiopathic or due to injury to the sphincter complex. In women, obstetric trauma is the commonest cause of anal sphincter injury leading to incontinence. Other causes include iatrogenic sphincter injury during hemorrhoidectomy and fistula surgery and acute trauma to the perineum. Overt sphincter damage due to third-or fourth-degree vaginal tears during childbirth has been reported in up to 0.7% of all vaginal deliveries resulting in symptomatic fecal incontinence [1, 2]. The pudendal nerve can also be damaged during childbirth trauma resulting in late development of fecal incontinence [3]. Some patients sustain both mechanical and neurological trauma to the sphincter complex [4]. Risk factors associated with sphincter injury include forceps delivery, primiparous mother, birth weight of the baby > 4 kg, and occipito-posterior presentation. A posterolateral episiotomy does not protect against a sphincter tear [5]. Anal endosonography has enabled accurate imaging of the sphincter complex resulting in accurate recognition of occult anal sphincter defects [6-8]. In one study of 62 women with a history of obstetric trauma, endoanal ultrasonography revealed an external anal sphincter defect in 90% and an internal sphincter defect in 65% of patients [9]. In 8 of the 10 women who had a forceps-assisted delivery, there was evidence of sphincter damage. In another study [10], 127 women who had a vaginal delivery underwent endoanal ultrasonography postpartum. Of the 79 primiparous mothers who had intact sphincters before childbirth, 28 showed damage to one or both sphincter muscles following delivery. The extent of the damage to the sphincter complex was

Comment on “Diagnostic approach to faecal incontinence: What test and when to perform?”

“…For example, a study from the United States reported that the prevalence of FI is 2.2%, with 63% in females and 37% in males, and approximately 30% of patients are over 65 years of age[ 4 ]. Consequently, we conclude that females are more likely to develop FI owing to their physiology and childbearing experiences[ 5 ]. In addition, the factors that cause FI are different in women and men, with women being more susceptible to anal sphincter disorders due to obstetric trauma and reduced pelvic floor muscle training (PFMT), whereas men are more likely to suffer from anorectal sensory disturbances[ 6 ].…”

Interaction and main effects of physical and depressive symptoms on quality of life in Korean women seeking care for rectal prolapse: a cross-sectional observational study

“…Nearly 90% of the patients diagnosed with rectal prolapse were aged above 50 years, 34.7% were in their 70s, and 26.8% were in their 80s [2]. The relationship between pelvic floor disorders and age is thought to be due to aging changes in connective tissue integrity and neuromuscular degeneration [1,3]. Thus, age impacts the bothersome nature of rectal prolapse symptoms, especially as associated with functionality and quality of life (QOL) [1].…”

“…Rectal prolapse is a protrusion of part or all of the layers of the rectal wall toward or outside the anus [3]. It should not be confused with hemorrhoids, which are enlarged cushions of vascular tissue found within the anal canal in the submucosal space [4].…”

A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases

“…Occasionally, the symptoms of FTRP may occur spontaneously while coughing or weight-bearing. FTRP is a debilitating condition with a complex etiology, with obstetric trauma as the most common, iatrogenic sphincter injury during hemorrhoidectomy and fistula surgery, and external injury to the perineum [ 2 ].…”