Pub Date : 2020-04-06DOI: 10.5772/intechopen.91952
J. Camilleri-Brennan
Faecal incontinence (FI) is a common condition, the prevalence of which increases with age. It is associated with a negative impact on the quality of one’s life. The aetiology is multifactorial; hence, both the diagnosis and the treatment of faecal incontinence may be challenging. A variety of surgical treatments for faecal incontinence have emerged over the years. One of these is the use of anal bulking agents. Anal bulking agents have been available for over 25 years, with various studies being published. Initial results were disappointing, mainly due to lack of efficacy and reliability as well as concerns about safety. Great strides have been made recently with the introduction of the anal implants Gatekeeper (GK) and Sphinkeeper (SK). This chapter explores the evolution of anal injectables and implants, discusses operative techniques and provides a critical analysis of the results of the various studies to date.
{"title":"Anal Injectable and Implantable Bulking Agents for Faecal Incontinence","authors":"J. Camilleri-Brennan","doi":"10.5772/intechopen.91952","DOIUrl":"https://doi.org/10.5772/intechopen.91952","url":null,"abstract":"Faecal incontinence (FI) is a common condition, the prevalence of which increases with age. It is associated with a negative impact on the quality of one’s life. The aetiology is multifactorial; hence, both the diagnosis and the treatment of faecal incontinence may be challenging. A variety of surgical treatments for faecal incontinence have emerged over the years. One of these is the use of anal bulking agents. Anal bulking agents have been available for over 25 years, with various studies being published. Initial results were disappointing, mainly due to lack of efficacy and reliability as well as concerns about safety. Great strides have been made recently with the introduction of the anal implants Gatekeeper (GK) and Sphinkeeper (SK). This chapter explores the evolution of anal injectables and implants, discusses operative techniques and provides a critical analysis of the results of the various studies to date.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126926896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-19DOI: 10.5772/intechopen.90101
A. M. Duyos, Y. Ribas
Traditionally, it has been assumed that tests like anorectal manometry and endoanal ultrasound are essential in the evaluation of fecal incontinence (FI). However, in daily practice, this testing rarely helps in the decision-making, as are mainly based on the patient’s symptoms. Moreover, indications and outcome evaluation should not be decided by only considering the symptom severity but the impact on QoL and patient satisfaction. Nowadays, patients tend to be active consumers of health care, so they may participate on the medical decision-making. On the other hand, monitoring treatment results are mandatory in current practice. Finally, considering the cost of some of the current treatments for FI, changes in QoL should be demonstrated before implementing some procedures. For all these reasons, the QoL scales should be used, and readers encouraged to become familiar with QoL instruments and their limitations. The following chapter will cover almost all areas on existing knowledge about QoL in patients with FI: from how many types of QOL scales have been described, to the different ways to measure our patients’ satisfaction, passing through the difference between severity and QOL, going deep on if the improvement of patients treated for FI is reflected enough in the current used QOL scales.
{"title":"Quality of Life Considerations on Fecal Incontinence","authors":"A. M. Duyos, Y. Ribas","doi":"10.5772/intechopen.90101","DOIUrl":"https://doi.org/10.5772/intechopen.90101","url":null,"abstract":"Traditionally, it has been assumed that tests like anorectal manometry and endoanal ultrasound are essential in the evaluation of fecal incontinence (FI). However, in daily practice, this testing rarely helps in the decision-making, as are mainly based on the patient’s symptoms. Moreover, indications and outcome evaluation should not be decided by only considering the symptom severity but the impact on QoL and patient satisfaction. Nowadays, patients tend to be active consumers of health care, so they may participate on the medical decision-making. On the other hand, monitoring treatment results are mandatory in current practice. Finally, considering the cost of some of the current treatments for FI, changes in QoL should be demonstrated before implementing some procedures. For all these reasons, the QoL scales should be used, and readers encouraged to become familiar with QoL instruments and their limitations. The following chapter will cover almost all areas on existing knowledge about QoL in patients with FI: from how many types of QOL scales have been described, to the different ways to measure our patients’ satisfaction, passing through the difference between severity and QOL, going deep on if the improvement of patients treated for FI is reflected enough in the current used QOL scales.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127365376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.5772/intechopen.89290
B. Mahdi
Fecal incontinence is an embarrassing social problem to the patients affecting patients’ work and social ordinary life. It affects both sexes characterized by inability to control bowel motions causing leaking stool or flatus unexpectedly from the rectum and anus, and in severe cases, it causes a complete loss of bowel control. The causes are severe diarrhea, constipation, muscle and nerve damage that is caused by aging, vaginal delivery, episiotomy or forceps delivery. Anal and rectal continence depends on many aspects like consistency of stool, neuromuscular sphincter complex, rectal capacity, sensation of defecation and ability to move and reach a toilet. Another cause is immunological disorders that cause muscle damage due to formation of autoantibodies in autoimmune diseases or in association with gastrointestinal manifestation of autoimmune diseases like multiple scleroses and other autoimmune diseases. Simply, it can be diagnosed by routine digital rectal examination that has good sensitivity and poor specificity in discriminating small from severe anal sphincter defects.
{"title":"Effect of Autoimmunity in Fecal Incompetence","authors":"B. Mahdi","doi":"10.5772/intechopen.89290","DOIUrl":"https://doi.org/10.5772/intechopen.89290","url":null,"abstract":"Fecal incontinence is an embarrassing social problem to the patients affecting patients’ work and social ordinary life. It affects both sexes characterized by inability to control bowel motions causing leaking stool or flatus unexpectedly from the rectum and anus, and in severe cases, it causes a complete loss of bowel control. The causes are severe diarrhea, constipation, muscle and nerve damage that is caused by aging, vaginal delivery, episiotomy or forceps delivery. Anal and rectal continence depends on many aspects like consistency of stool, neuromuscular sphincter complex, rectal capacity, sensation of defecation and ability to move and reach a toilet. Another cause is immunological disorders that cause muscle damage due to formation of autoantibodies in autoimmune diseases or in association with gastrointestinal manifestation of autoimmune diseases like multiple scleroses and other autoimmune diseases. Simply, it can be diagnosed by routine digital rectal examination that has good sensitivity and poor specificity in discriminating small from severe anal sphincter defects.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126072375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-25DOI: 10.5772/intechopen.86345
Prabhash Dadhich, K. Bitar
A healthy sphincter physiology is a complex interplay between neural and muscle population, responsible for relaxation and contraction, which allow feces to pass and reestablishment of closure. The loss of integrity of neuromuscular functionality or cellular component results in fecal incontinence (FI). The current available treatments have been disappointing in long-term relief. This chapter represents a regenerative medicine approach to this debilitating disease, wherein a new internal anal sphincter (IAS) BioSphincter ™ is bioengineered from the patient ’ s own cells and implanted. It results in long-term restoration of the cellular integrity and reinstatement of the physiological function of the IAS. Following implantation in rodents, the engineered sphincters became vascularized and maintained their phenotype and functionality. The developed IAS BioSphincter ™ were validated to treat the FI in large animals and successfully restored anorectal functionality. According to NIH/NIDDK, one out of seven people report to health care providers complaining of fecal incontinence. This chapter elucidates the long road in developing on implantable bioengineered IAS “ BioSphincter ™ ” that would benefit and improve the quality of life of a large socially distressed segment of the population.
{"title":"BioSphincter a Regenerative Medicine Approach to Treat FI","authors":"Prabhash Dadhich, K. Bitar","doi":"10.5772/intechopen.86345","DOIUrl":"https://doi.org/10.5772/intechopen.86345","url":null,"abstract":"A healthy sphincter physiology is a complex interplay between neural and muscle population, responsible for relaxation and contraction, which allow feces to pass and reestablishment of closure. The loss of integrity of neuromuscular functionality or cellular component results in fecal incontinence (FI). The current available treatments have been disappointing in long-term relief. This chapter represents a regenerative medicine approach to this debilitating disease, wherein a new internal anal sphincter (IAS) BioSphincter ™ is bioengineered from the patient ’ s own cells and implanted. It results in long-term restoration of the cellular integrity and reinstatement of the physiological function of the IAS. Following implantation in rodents, the engineered sphincters became vascularized and maintained their phenotype and functionality. The developed IAS BioSphincter ™ were validated to treat the FI in large animals and successfully restored anorectal functionality. According to NIH/NIDDK, one out of seven people report to health care providers complaining of fecal incontinence. This chapter elucidates the long road in developing on implantable bioengineered IAS “ BioSphincter ™ ” that would benefit and improve the quality of life of a large socially distressed segment of the population.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114140854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-22DOI: 10.5772/INTECHOPEN.86268
D. Linardoutsos
Fecal incontinence is not a rare clinical pathology in general population. Although it is more common in geriatric population, fecal incontinence should not be underestimated in younger genders. Obstructive defecation syndrome (ODS) has become a well-known syndrome with different clinical etiology and symptoms. The main symptom is inability of proper rectal emptying, but it can also overlap with symptoms of incontinence. In this chapter, we emphasize on the assessment of ODS, focusing on the coexistence and clinical relation to fecal incontinence. Anorectal studies are of great importance for the evaluation of the symptoms. Biofeedback is the key to the proper management of patients with ODS, showing significant improvement in incontinence as well. Surgical treatment of anatomic deformities that cause ODS is also important.
{"title":"Assessment and Treatment of Obstructed Defecation Syndrome","authors":"D. Linardoutsos","doi":"10.5772/INTECHOPEN.86268","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86268","url":null,"abstract":"Fecal incontinence is not a rare clinical pathology in general population. Although it is more common in geriatric population, fecal incontinence should not be underestimated in younger genders. Obstructive defecation syndrome (ODS) has become a well-known syndrome with different clinical etiology and symptoms. The main symptom is inability of proper rectal emptying, but it can also overlap with symptoms of incontinence. In this chapter, we emphasize on the assessment of ODS, focusing on the coexistence and clinical relation to fecal incontinence. Anorectal studies are of great importance for the evaluation of the symptoms. Biofeedback is the key to the proper management of patients with ODS, showing significant improvement in incontinence as well. Surgical treatment of anatomic deformities that cause ODS is also important.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132763128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-13DOI: 10.5772/INTECHOPEN.86346
K. Tantiphlachiva
Fecal incontinence is a disturbing condition, which reduces the quality of life of patients. Prevalence of this apprehensive problem is usually underestimated. However, it is more common in female, elderly, and institutionalized subjects. Factors that may be associated are urinary incontinence, diabetes mellitus, depression, diarrhea, history of anorectal surgery, anorectal trauma, pelvic organ surgery, and pelvic irradiation. To improve this condition, physicians should have insight into the individual’s pathophysiology through the process of careful history taking, severity, and quality of life assessment, thorough physical examination and comprehensive anatomic and neurophysiologic evaluation. These tests include imaging, anorectal manometry, and neural conduction tests. Finally, by these gathered information, individualized treatment for the patient is designed. Patient’s educa-tion and judicious follow-up are also parts of the plan.
{"title":"Comprehensive Clinical Approach to Fecal Incontinence","authors":"K. Tantiphlachiva","doi":"10.5772/INTECHOPEN.86346","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86346","url":null,"abstract":"Fecal incontinence is a disturbing condition, which reduces the quality of life of patients. Prevalence of this apprehensive problem is usually underestimated. However, it is more common in female, elderly, and institutionalized subjects. Factors that may be associated are urinary incontinence, diabetes mellitus, depression, diarrhea, history of anorectal surgery, anorectal trauma, pelvic organ surgery, and pelvic irradiation. To improve this condition, physicians should have insight into the individual’s pathophysiology through the process of careful history taking, severity, and quality of life assessment, thorough physical examination and comprehensive anatomic and neurophysiologic evaluation. These tests include imaging, anorectal manometry, and neural conduction tests. Finally, by these gathered information, individualized treatment for the patient is designed. Patient’s educa-tion and judicious follow-up are also parts of the plan.","PeriodicalId":414826,"journal":{"name":"Current Topics in Faecal Incontinence","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133728939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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