Incontinencia fecal del adulto

Abstract

Fecal incontinence in adultsThe aim of this paper is to review the knowledge of this pathology by highlighting the clinical evolution, study and treatment. These different aspects need a multidisciplinary approach, because of their complex physiopathology, possible association with urinary incontinence and prolapse of the three compartments of the pelvis. The fecal incontinence (FI) constitutes a highly prevalent pathology that affects at least 2% of the population and up to 45% of the patients in nursing homes. This pathology can cause serious problems in physical, psychological, social, and economical levels. The clinical evaluation may identify or suspect the cause, and guide the study of FI. The initial treatment of the FI should always be medical one, often associated to biofeedback and the surgical treatment should be only reserved for refractory FI. Sphincteroplasty is indicated by defi ned defaults of the external sphincter, with good initial results (at least 70%) that fall to 50% in 5 years. The artifi cial neosphincter and the dynamic graciloplasty represent an option for patient without suffi cient sphincter mass for a plasty. In the last few years new techniques have appear with promising results, as the neuromodulation that uses electrodes in the sacral plexus or applied to the posterior tibial nerve. In conclusion the IF is a problem of large prevalence but kept in shadows because the patients tend to have reticence to declare it, and the doctors to inquire about. The focus should be multidisciplinary and the initial treatment must be medical one. The surgical treatment should be reserved for refractory FI.Key words: Fecal incontinence, endosonography, anal manometry, biofeedback, sphincteroplasty. ResumenEl propósito de esta revisión es actualizar los conocimientos sobre esta patología, destacando su evolución clínica, estudio y tratamiento, aspectos que ameritan un enfoque multidisciplinario, ya que, además de su compleja fi siopatología, puede asociarse a incontinencia urinaria y prolapso de los tres compartimentos de la pelvis. La incontinencia fecal (IF) constituye una patología altamente prevalente que afecta al menos un 2% de la población y hasta el 45% de los pacientes en casas de reposo; cuyas consecuencias pueden ocasionar al paciente serios problemas físicos, psicológicos, sociales y económicos. La evaluación clínica puede identifi car o sospechar la causa de la IF, y guiar el estudio de la misma. El tratamiento inicial de la IF debe ser siempre médico, a menudo asociado a biofeedback, y el tratamiento quirúrgico reservarse para la IF refractaria a estas

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Physiotherapeutic Approaches to Treat Anal Incontinence in Women after Obstetric Trauma

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