Function and dysfunction of the colon and anorectum in adults: Working team report of the Swedish Motility Group (SMoG)

Abstract

Symptoms of fecal incontinence and constipation are common in the general population. These can, however, be unreliably reported and are poorly discriminatory for underlying pathophysiology. Furthermore, both symptoms may coexist. In the elderly, fecal impaction always must be excluded. For patients with constipation, colon transit studies, anorectal manometry and defecography may help to identify patients with slow-transit constipation and/or pelvic floor dysfunction. The best documented medical treatments for constipation are the macrogols, lactulose and isphagula. Evolving drugs include lubiprostone, which enhances colonic secretion by activating chloride channels. Surgery is restricted for a highly selected group of patients with severe slow-transit constipation and for those with large rectoceles that demonstrably cause rectal evacuatory impairment. For patients with fecal incontinence that does not resolve on antidiarrheal treatment, functional and structural evaluation with anorectal manometry and endoanal ultrasound or magnetic resonance (MR) of the anal canal may help to guide management. Sacral nerve stimulation is a rapidly evolving alternative when other treatments such as biofeedback and direct sphincter repair have failed. Advances in understanding the pathophysiology as a guide to treatment of patients with constipation and fecal incontinence is a continuing important goal for translational research. The content of this article is a summary of presentations given by the authors at the Fourth Meeting of the Swedish Motility Group, held in Gothenburg in April 2007.

Defecation disturbances after cystectomy for urinary bladder cancer

“…Intuitively, there is no problem understanding that rectal problems might arise after major urological pelvic surgery such as cystectomy with urinary tract reconstruction, as they do after other pelvic surgical procedures [23–25]. The colorectal physiology is complex and includes many different stages of the stool evacuation process [26]. More systematic research is needed for this to be discussed and handled during urological postoperative controls.…”

Association between bowel symptoms, symptom severity, and quality of life in Swedish patients with fecal incontinence

“…FI is a multifactorial disorder associated with decreased quality of life (QoL) [5][6][7][8][9][10][11]. However, Bordeianou et al recently found that the severity of FI was only moderately correlated with a disease-specific QoL measurement [12].…”

Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women – a randomized controlled trial

“…The prevalence increases with age [5], and after 50 years of age, prevalence rates up to 22% in women have been reported [2]. In elderly living in institutions, the prevalence has been found to range between 10% and 50% [4]. Whitehead et al reported that most participants with FI suffered from 1 to 3 leakages per month [3].…”

“…Fecal incontinence (FI) affects 2.2-15.3% of an adult general population [1][2][3][4]. The prevalence increases with age [5], and after 50 years of age, prevalence rates up to 22% in women have been reported [2].…”