Loperamide improves anal sphincter function and continence after restorative proctocolectomy

Hallgren, Thomas; Fasth, S.; Delbro, Dick; Nordgren, Svante; Øresland, Tom; Hultén, L.

doi:10.1007/bf02087698

Cited by 107 publications

(44 citation statements)

References 23 publications

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“…A placebocontrolled study of loperamide 4 mg tid has been shown to reduce the frequency of incontinence, improve stool urgency and increase colonic transit time (84), as well as increase anal resting sphincter pressure (137) and reduce stool weight (138). Clinical improvement was also reported with diphenoxylate/atropine (Lomotil ® ) (139) but, objective testing showed no improvement in their ability to retain saline or spheres.…”

Section: Specific Treatmentmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

284

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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Section: Specific Treatmentmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

284

295

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“…Results demonstrated that the administration of antidiarrheal agents resulted in more patients achieving full continence compared with placebo. 29,31,32 Decreased episodes of fecal incontinence, fecal urgency, and occurrence of unformed stools have been noted as well. 26,27 With an overall decrease in incontinent symptoms, patients treated with constipating agents also were noted to have decreased fecal weight and water contents.…”

Section: C: Constipating Agentsmentioning

confidence: 91%

“…Loperamide inhibits small and large intestinal peristalsis, increases oralcecal transit time, and increases the mucosal exposure to intestinal effluent. 29,33 In addition, loperamide has been shown to improve anorectal physiology in normal volunteers and patients with diarrhea and to decrease stool frequency. Loperamide increases resting anal sphincter tone, improves rectal perception, increases the threshold of the rectoanal inhibitory reflex (RAIR), and increases fluid load retention in the rectum.…”

Section: C: Constipating Agentsmentioning

confidence: 99%

“…Loperamide increases resting anal sphincter tone, improves rectal perception, increases the threshold of the rectoanal inhibitory reflex (RAIR), and increases fluid load retention in the rectum. 29,31 In clinical studies of loperamide, this drug has been shown to decrease urgency and stool frequency in patients with chronic diarrhea. 29,31,32 At present, one study has been conducted comparing the efficacy of loperamide and other constipating agents.…”

Section: C: Constipating Agentsmentioning

confidence: 99%

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Pharmacotherapy for Fecal Incontinence: A Review

Ehrenpreis¹,

Chang²,

Eichenwald³

2007

Diseases of the Colon &Amp; Rectum

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Fecal incontinence is a common clinical problem that often is frustrating to the patient and treating physician. Nonsurgical management for fecal incontinence includes dietary manipulation, Kegel exercises, perianal skin care, and biofeedback therapy. Pharmacotherapies often are used to assist in management of fecal incontinence. A variety of pharmacotherapies have been utilized for the management of fecal incontinence; limited data from randomized, placebo-controlled trials are available. This is a review of the existing literature on clinical trials of several classes of drugs and other medical therapies that may be beneficial for patients with fecal incontinence. The information in this article was obtained by a MEDLINE search for all clinical trials of drug therapy for fecal incontinence. These treatments and the existing data on their use are summarized. Treatments reviewed include stool bulking agents, with an emphasis on the most promising effect obtained with calcium polycarbophil, constipating agents, including loperamide, codeine, amitriptyline, atropine, and diphenoxylate agents injected into the anal sphincter, drugs to enhance anal sphincter function, including topical phenylepherine and oral sodium valproate, and trials of fecal disimpaction. A new classification to easily remember the treatment categories for this condition, based on the "ABCs of treatment for fecal incontinence," has been introduced into the structure of this review.

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“…O uso de agentes formadores de massa, anticolinérgicos, opióides, antidepressivos, e outras drogas, são eficazes apenas na minoria dos casos de incontinência leve, ou como medidas adicionais a outros tipos de tratamento 41,42 . Outras medidas terapêuticas que surtem algum efeito para casos menos graves são o uso plugs e o biofeedback, sendo este último muito aplicado também como medida complementar ao tratamento cirúrgico [43][44][45] .…”

Section: Tratamentounclassified

Transplante anorretal como proposta terapêutica para o tratamento de incontinência fecal e colostomia definitiva

Hirano

Seid

Galvão

et al. 2013

Rev. Med. (São Paulo)

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RESUMO:A incontinência fecal é um problema de enorme impacto social e econômico. Com semelhante semblante encontrase a colostomia definitiva, outra situação de igual gravidade e impacto sobre a vida dos pacientes. Neste trabalho, reuniram-se artigos retirados das bases de dados Cochrane Library, Medline e Embase para tratar das atuais situações desses problemas. A abordagem é realizada através dos tópicos Prevalência e impacto, Etiologia e Tratamento, sendo nesse último descrito e comentado o procedimento do transplante anorretal. A análise realizada revela a atual situação ruim para o tratamento da incontinência fecal e colostomia definitiva, mas coloca o transplante anorretal como proposta futura capaz de alterar essa realidade. DESCRITORES:Transplante heterotópico; Transplante autólogo; Transplante isogênico; Incontinência fecal; Colostomia.ABSTRACT: Fecal incontinence is a problem of great social and economic impact. With similar aspects, there is the definitive colostomy, another situation of equal gravity and impact over the patient's lives. In this work, articles from Cochrane Library, Medline and Embase were revised using these problems as parameters. The approach is systematically accomplished through the topics Prevalence and impact, Etiology and Treatment, with the description of anorectal transplantation in this last topic. The analysis reveals the bad situation of treatment for fecal incontinence and definitive colostomy nowadays, but settles the anorectal transplantation as a future proposal capable of changing this reality. KEYWORDS:

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Loperamide improves anal sphincter function and continence after restorative proctocolectomy

Cited by 107 publications

References 23 publications

Diagnosis and Management of Fecal Incontinence

Diagnosis and Management of Fecal Incontinence

Pharmacotherapy for Fecal Incontinence: A Review

Transplante anorretal como proposta terapêutica para o tratamento de incontinência fecal e colostomia definitiva

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