Rehabilitation of fecal incontinence: What is the influence of anal sphincter lesions?

Abstract

These data suggest that rehabilitation may be less effective in patients affected by sphincter defects.

Novel insights into fecal incontinence in men

“…Anorectal ultrasound was not performed on all patients. Although some data have suggested the presence of sphincter defects to be correlated with long-term outcomes following BF (27), recent guidelines and consensus statements do not advocate performing imaging before treatment (29,32). Sensory testing was performed using a compliant latex balloon and not a barostat with an infinitely compliant balloon, which arguably would have given more accurate sensory assessment.…”

Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists

“…Manometric findings of severely reduced anal resting pressure and/or squeezing pressure, supported by images of external anal sphincter defects, suggest the need for surgical repair [81,82]. Manometry can guide the rehabilitation approach [81][82][83][84]. In particular, reduced anal resting pressure suggests the need for biofeedback, sometimes combined with electrostimulation.…”

“…In particular, reduced anal resting pressure suggests the need for biofeedback, sometimes combined with electrostimulation. Reduced rectal sensation can be restored by sensory retraining with biofeedback or volumetric rehabilitation [81,[84][85][86]. On the other hand, multimodal rehabilitation can be ineffective in the presence of significant sphincter lesions [84].…”

“…Reduced rectal sensation can be restored by sensory retraining with biofeedback or volumetric rehabilitation [81,[84][85][86]. On the other hand, multimodal rehabilitation can be ineffective in the presence of significant sphincter lesions [84].…”

“…Functional FI [120] is an indication for RT: uncontrolled studies report improved continence in about 70% of patients after biofeedback therapy (BFB) [121]. Similar percentages are reported when rehabilitative is used in FI secondary to organic diseases such as post-partum incontinence [122][123][124][125], post-surgical incontinence [84,126,127], descending perineum syndrome, rectocele, and rectoanal intussusception [128,129]. Patients with rectal prolapse and neurological diseases are fairly unresponsive [83].…”