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Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
NICE (2007) identifies that faecal incontinence is a sign or symptom, not a disease. High-risk groups for faecal incontinence include: people who are old and frail, have loose stools/diarrhoea from any cause, have a neurological or spinal disease/injury, have severe cognitive impairment, urinary incontinence, pelvic organ prolapse or rectal prolapse following colonic resection or anal surgery, people with learning disabilities and women following obstetric injury in childbirth (NICE 2007). NICE (2007) asserted that faecal incontinence is largely a hidden problem due to its social stigma but estimates that up to 10% of adults are affected by faecal incontinence and between 0.5% and 1% of adults have regular faecal incontinence affecting their quality of life.
The lower gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Faecal incontinence is defined as the recurrent uncontrolled passage of faecal material for at least three months [31]. Although rarely spoken of, faecal incontinence is common, affecting approximately 10% of the population. While women are more likely to present to their doctor with the complaint of faecal incontinence, large community-based population studies have shown the prevalence is similar between men and women [31, 32]. The potential causes of faecal incontinence are multiple; however, they can be roughly grouped into those driven by abnormal cognition, those with structural abnormalities of the anorectum (i.e., obstetrical injury causing sphincter injury), and those with functional disturbance of the defeacatory apparatus such as that seen with rectal sensory dysfunction, spinal cord injury, or neuropathy. In addition, individuals with normal anorectal function and cognition may also develop faecal incontinence if continence mechanisms are challenged by profuse diarrhoea as seen in IBD or IBS. Faecal incontinence may be managed by improving stool consistency with dietary change or medications, ensuring effective rectal emptying during defaecation (which minimises challenges to the continence mechanism by residual stool), bowel retraining and biofeedback, surgical correction of anatomical defects, or neuromodulation techniques such as sacral nerve stimulation [33].
Patient History
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Pelvic radiation for uterine or prostate cancer can produce fecal incontinence through several mechanisms. Radiation proctitis reduces rectal compliance and storage capacity, resulting in urgency, tenesmus, and incontinence. In addition, radiation may produce neurogenic damage, with resultant impairment of rectosphincteric continence mechanisms.
Current development and clinical applications of artificial anal sphincter
Published in Expert Review of Medical Devices, 2023
Minghui Wang, Yunlong Liu, Qingjun Nong, Hongliu Yu
This article first reviews the treatment of fecal incontinence. Then introduces the frontier studies of artificial sphincter. Then introduces the meaning of artificial anal sphincters in animal studies and the complications of artificial anal sphincters in clinical applications. According to the clinical and experimental result of artificial anal sphincter, the safety and effectiveness of artificial sphincter technology in clinical application are discussed. Emphasizing the maintenance of long-term biomechanical compatibility artificial sphincter with surrounding tissues is a key issue in clinical applications. Finally, this article proposes the new design of artificial anal sphincter embedding a constant force element to improve the biomechanical compatibility of the equipment, which provides a new direction for solving the clinical application of artificial anal sphincter.
Anorectal Function and Quality of Life in IBD Patients With A Perianal Complaint
Published in Journal of Investigative Surgery, 2021
Francesco Litta, Franco Scaldaferri, Angelo Parello, Veronica De Simone, Antonio Gasbarrini, Carlo Ratto
The overall mean IBDQ score was 167.6. This relatively low value could be due to the fact that our patients were all referred for a more severe disease, as our institution functions as a referral center. These explanations have already been hypothesized in similar studies [4]. Moreover, our study clearly confirmed that fecal incontinence has a major effect patients’ QoL, being the only factor significantly associated to a lower score at the IBDQ questionnaire. A similar result emerged in a study by Riss et al. where perianal surgery in CD had a significant effect on QoL measured by IBDQ: in particular, active CD, loose set drainage, more than one external fistula opening, and fecal incontinence were associated with poor QoL [22]. Finally, a recent study of 1092 patients has equally confirmed that fecal incontinence and perianal disease have a significant effect on QoL of patients [23]. Unfortunately, IBD diagnosis is an exclusion criterion in many studies investigating the surgical treatment of fecal incontinence. One of the options currently available is the pelvic floor behavioral treatment, as reported in a recent study by Khera et al., where 77% of patients experiencing fecal incontinence had greatly improved symptoms [24].
Perioperative, postoperative and anatomical outcomes of robotic sacrocolpopexy
Published in Journal of Obstetrics and Gynaecology, 2021
Gokhan Sami Kilic, Toy Lee, Kelsey Lewis, Cem Demirkiran, Furkan Dursun, Bekir Serdar Unlu
Pelvic floor disorders including genital prolapse, urinary incontinence and faecal incontinence affect more than 25% of women in the United States (Wu et al. 2014). More than 10% of women in the US will undergo surgical treatment for pelvic floor disorders at least once in their lifetime (Olsen et al. 1997; Fialkow et al. 2008). Apical and anterior compartment defects are challenging cases that urogynaecologists face on a daily basis. The abdominal sacrocolpopexy (SCP) is considered the gold standard treatment option for apical and anterior compartment defects. Compared to other apical support surgeries, abdominal SCP involves a potentially longer hospitalisation period and a higher morbidity rate: this is mostly attributed to its large abdominal incision (Culligan et al. 2002; Maher et al. 2004; Maher et al. 2010). As technology has advanced, minimally invasive approaches were implemented to overcome the shortcomings of open SCP (Elterman et al. 2014). The introduction of laparoscopy was followed by adding robotic-assistance to sacrocolpopexy surgery. In this study, we present 144 patients that underwent RSCP. Our aims were to analyse the anatomical, perioperative and postoperative outcomes of the procedure.