Fecal incontinence as consequence of anorectal surgeries and the physiotherapeutic approach

Abstract

Caused by sphincter injuries in various anorectal procedures, fecal incontinence (FI) is a common complication in some patients undergoing coloproctology surgeries. Objective: Demonstrate the occurrence of FI as a result of anorectal surgeries, present the physiotherapy resources for the treatment of this disorder and, based on that, propose the inclusion of physiotherapy as a routine postoperative practice for these types of interventions. Materials and Methods: An integrative review of databases from the virtual health library (VHL) and the Physiotherapy Evidence Database (PEDro) published between 2000 and 2010, in English and Portuguese. Results: Thirteen articles (one cross-section cohort, two uncontrolled clinical trials and ten retrospective cohorts), with evidence level between 2C and 4C and published between 2001 and 2009, were selected; review articles were excluded. The review demonstrated that FI is an important complication of anorectal surgeries, causing major impacts on the patients&#39; quality of life and that physiotherapy provides effective resources to treat this disorder. Conclusion: Further studies are recommended, in the form of systematic reviews, using a higher number of articles and better scientific evidences.<br>Causada por lesões esfincterianas em variados procedimentos anorretais, a incontinência fecal (IF) representa uma complicação presente em alguns indivíduos submetidos a cirurgias coloproctológicas. Objetivo: Evidenciar a ocorrência de IF como consequência de cirurgias anorretais e expor os recursos fisioterapêuticos no tratamento desta desordem e, com isso, propor a inclusão da fisioterapia como prática rotineira nos pós-operatórios desses tipos de intervenções. Materiais e Métodos: Revisão integrativa realizada a partir de pesquisas nos bancos de dados da biblioteca virtual em saúde - BVS - e do Physiotherapy Evidence Database - PEDro - publicados no período de 2000 a 2010, nos idiomas inglês e português. Resultados: Foram selecionados 13 artigos publicados entre os anos de 2001 e 2009, sendo um corte transversal, dois ensaios clínicos não controlados e dez coortes retrospectivos, com nível de evidência entre 2C e 4C, artigos de revisão foram excluídos. Foi evidenciado que a IF representa uma complicação importante de cirurgias anorretais, causando grande impacto sobre a qualidade de vida dos portadores e que a fisioterapia dispõe de recursos eficazes para o tratamento dessa disfunção. Considerações Finais: Recomenda-se a continuação do presente estudo, no formato de revisão sistemática, com um maior número de artigos e de melhores evidências científicas

Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women—Systematic Review of Methods

“…The main objectives of physiotherapeutic muscle training in FI are to increase the strength, tension, endurance, and co-ordination of anal sphincter and pelvic floor muscles [ 18 , 77 ]. Anal training is based on the co-ordination of anal sphincters as well as isolation of their contraction [ 77 ].…”

“…In turn, the puborectalis muscle, together with external anal sphincter muscle, are responsible for the conscious maintenance of the stool while sensing pressure before defecation. The above two muscles are striated muscles, mainly composed of slow twitch, type I fibers [ 18 ]. The rectum is supported by the levator ani muscle, which belongs to the pelvic floor muscles that support from below the rectum [ 13 ].…”