Fecal Incontinence: The Importance of a Structured Pathophysiological Model

Knol, M E; Snijders, H.S.; Heyden, Johannes TM van der; Baeten, Coen I.M.

doi:10.23922/jarc.2021-040

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…The fact that these patients more often had a birth trauma without physical damage to the anal sphincters could imply that the damage after delivery is more neurological in nature. This could be an explanation why SNM is equally effective in patients with FI with and without a sphincter defect and after sphincter repair [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of phenotypes of fecal incontinence

et al. 2023

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Purpose Fecal incontinence (FI) is common, but its etiology is complex with large knowledge gaps. Several phenotypes of FI are known, but the phenotype is often not decisive in the chosen therapy. In this study we aimed to assess the association of the clinical characteristics of patients with FI and the various phenotypes, in order to establish a targeted clinical treatment decision tree. Methods We retrospectively studied the charts of patients with FI, who visited our institute from January 2018 until December 2020. Patients were divided into the following groups: passive fecal loss, urge incontinence, combined fecal incontinence with predominantly passive fecal loss, and combined fecal incontinence with predominantly urge incontinence. We compared the characteristics between the passive and urge incontinence groups, the passive and combined mainly passive groups, and the urge and combined mainly urge groups. Results Patients with passive incintinence were older, more often had a flaccid anus with presence of a mucosal prolapse, and had a lower resting pressure on anorectal manometry. Patients with urge incontinence were younger and more often had a history of birth trauma. The combined groups showed characteristics of both of the main types of FI. Conclusion Differentiating into phenotypes of FI can be clinically meaningful. The patient history and clinical judgement of the consulting specialist, rather than the physical characteristics, seem to be decisive in the categorization. Additional diagnostic testing can be helpful in complicated cases, but should not be used routinely.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics of phenotypes of fecal incontinence

et al. 2023

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“…Fecal incontinence (FI) is defined as the involuntary or uncontrolled loss of liquid/solid stool [1]. The prevalence of FI increases with increasing age and has a devastating effect on the quality of life (QOL) [2,3]. Similarly, urinary inconti-nence (UI) also increases with advancing age and negatively affects patients' mental health and social activities [4].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Double Incontinence and Lower Urinary Tract Symptoms in Patients with Fecal Incontinence: A Single-center Observational Study

Abe,

Matsumoto,

Kunimoto

et al. 2024

J Anus Rectum Colon

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Objectives: Double incontinence (DI), which is the co-occurrence of fecal incontinence (FI) and urinary incontinence (UI), increases with age and has a greater negative impact on the quality of life (QOL) than either incontinence alone. We aimed to assess lower urinary tract symptoms (LUTS) in patients with FI to elucidate the prevalence and characteristics of DI. Methods: This study enrolled consecutive patients who visited our hospital with FI symptoms. FI was evaluated using the Cleveland Clinic Florida Fecal Incontinence Score (CCFIS). LUTS were assessed using the International Prostate Symptom Score (IPSS), QOL score (IPSS-QOL) and Overactive Bladder Symptom Score (OABSS). Results: This study evaluated 140 patients (96 women [mean age: 70.7 years] and 44 men [mean age: 74.4 years]). The mean IPSS was significantly higher in men than in women (12.0 vs. 7.5, p = 0.003). A positive correlation was found between IPSS and CCFIS in women (r = 0.256, p = 0.012) but not in men. For both sexes, the older group (aged ≥70 years) had higher OABSS scores and more urge UI instances than the younger group (aged ≤69 years). Of the 140 patients with FI, 78 (55.7%) had DI, and DI was more common in women than in men (63.5% vs. 38.6%, p = 0.006). Conclusions: The characteristics of LUTS and UI in patients with FI were comparable to those in the general population for both sexes; however, the prevalence of DI was much higher among patients with FI than that in the general population.

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“…Current studies show that pelvic floor muscle (PFM) weakness is one of the main pathophysiological causes of UI 8 . Injury of the internal and external anal sphincters, combined with injury of the puborectalis muscle, is an important risk factor for FI 9 . Therefore, we considered that normal functioning of the PFM was the basis for maintaining control of urination and defecation.…”

Section: Introductionmentioning

confidence: 99%

Association between low handgrip strength and incontinence among Chinese middle‐aged and older people: A cross‐sectional study

Li,

Chen,

et al. 2024

Aging Medicine

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ObjectiveIncontinence seriously affects the lives of middle‐aged and older people. Pelvic floor muscle assessment is very important for incontinence, and handgrip strength can be used as an auxiliary diagnostic tool. Our study aims to find new cutoff points of handgrip strength as early indicators of incontinence and analyze the association between low handgrip strength and incontinence among Chinese middle‐aged and older people.MethodsParticipants were recruited from the 2015 China Health and Retirement Longevity Study. Receiver operating characteristic (ROC) curves were used to find the handgrip strength cutoff point. Logistic regression analysis was performed to explore other incontinence‐related risk factors.ResultsThe study included 10,229 middle‐aged and older people. Compared with normal handgrip strength participants, medium strength participants had 1.510 [men, 95% confidence interval (CI) = 1.017–2.243] and 1.792 (women, 95% CI = 1.294–2.480) times greater risk of incontinence, and low strength participants had 2.420 (men, 95% CI = 1.787–3.277) and 1.516 (women, 95% CI = 1.130–2.032) times greater risk of incontinence. Trend test results showed that the risk of incontinence increased with decreasing handgrip strength in middle‐aged and older people.ConclusionsOur study suggests that handgrip strength < 31 kg in men and < 20.5 kg in women is significantly associated with higher risk of incontinence in Chinese middle‐aged and older people. The risk of incontinence increases with decreasing handgrip strength. Handgrip strength should be measured in routine physical examinations in middle‐aged and older people for timely assessment and intervention in incontinence.

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Fecal Incontinence: The Importance of a Structured Pathophysiological Model

Cited by 6 publications

References 28 publications

Clinical characteristics of phenotypes of fecal incontinence

Clinical characteristics of phenotypes of fecal incontinence

Prevalence of Double Incontinence and Lower Urinary Tract Symptoms in Patients with Fecal Incontinence: A Single-center Observational Study

Association between low handgrip strength and incontinence among Chinese middle‐aged and older people: A cross‐sectional study

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