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Evaluation of continence in children with Hirschsprung disease and anorectal malformation
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Michael D. Rollins, Richard J. Wood, Victoria Lane
Functional problems following pull-through surgery can include constipation, enterocolitis, and fecal incontinence. Children with HD are born with an intact sphincter mechanism and dentate line and therefore should be continent. Fecal incontinence may be due to overflow pseudo-incontinence from severe constipation, loose stools from rapid colonic transit time following an extensive resection, or due to an intraoperative complication resulting in damage to the dentate line and/or sphincters.
Incontinence and Normal Sphincter Function
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Anorectal continence is the ability to store feces and evacuate them at socially convenient times. To accomplish that, some requirements must be attained, such as central nervous control, reservoir function of the rectum, and sufficient anal sphincter muscles. Fecal incontinence is a manifestation of a disturbance of any of these functions or a combination of them. Most common is a defect function of the sphincter apparatus which can be suspected at clinical examination and confirmed by anorectal manometry. Various causes for such sphincter insufficiency have been described earlier in this section. Some patients present, however, with incontinence not only for flatus but also for liquid and solid feces, in spite of showing resting and squeeze pressures in the anal canal that are within the normal range. The high-pressure zone should also be included in the evaluation of the anal sphincter function. Pressure levels and the high-pressure zone can be expressed and calculated as the high-pressure area. Also, when this is within the normal range fecal incontinence can occur. In this chapter disturbances of the central nervous control and the reservoir function of the rectum are discussed as causes of fecal incontinence.
Rectal Prolapse and Associated Pelvic Organ Prolapse Syndromes
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
André D’Hoore, Oliver M. Jones
Classical symptoms of isolated ODS include straining, incomplete emptying, vaginal or rectal digitation, digital perineal support during defaecation and pain. Repeated toilet visiting can be very disruptive and have a significant impact on quality of life. Patients may require regular laxatives or enemas/suppositories. There are often significant symptoms of faecal incontinence.
The Prevalence of Bladder and Bowel Dysfunction in Children with Cerebral Palsy and its Association with Motor, Cognitive, and Autonomic Function
Published in Developmental Neurorehabilitation, 2023
Moriah Baram, Luba Zuk, Tohar Stattler, Michal Katz-Leurer
When looking at the CP population, there is a high incidence of bladder and bowel (BBD) dysfunction,3 with continence achieved later, compared to the general population.4 BBD includes daytime and nighttime enuresis, urinary urgency or frequency, encopresis (fecal soiling), chronic and functional constipation, and pain in the lower abdominal area and pelvis.5 In children with typical development, the incidence of daytime enuresis by 12 years old was between 2–19.2%.6 Additionally, nighttime enuresis was between 3–20% by ten years old.6 The incidence of constipation in children was 22.6%, and encopresis was 4.4%.5 In children with CP, the incidence of daytime enuresis ranges between 8.8–40.8% and nighttime enuresis between 6.5–25.5%.7 The incidence of fecal incontinence was 39.2–54%,7,8 and constipation was 26–74%.9
Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury
Published in The Journal of Spinal Cord Medicine, 2021
Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Catherine S. Wilson, Mark Korsten
In individuals with SCI, several factors contribute to fecal incontinence. Anorectal sensibility and voluntary contraction of the external anal sphincter muscle are reduced or absent.5,16,17 Individuals with reflexic NBD tend to have increased tone and contractility of the rectum,5,7,8,22 causing reflex defecation.4 In those with areflexic NBD, poor emptying of the rectum, hypotonic rectum, and poor sphincter function may cause fecal impaction and incontinence.8–10 Fecal incontinence in NBD depends on several factors, including reduced or absent anorectal sensibility, lack of voluntary contraction of the external anal sphincter muscle, fecal impaction, and reflex defecation.9,10,22 Overflow incontinence from significant constipation should always be a consideration in both reflexic and areflexic NBD.
Hip exercises improve intravaginal squeeze pressure in older women
Published in Physiotherapy Theory and Practice, 2020
Lori J. Tuttle, Taylor Autry, Caitlin Kemp, Monique Lassaga-Bishop, Michaela Mettenleiter, Haley Shetter, Janelle Zukowski
The pelvic floor muscles (PFM) are partly responsible for controlling urinary and bowel functions of both males and females. The PFM consist of pubovisceral, puborectalis, and iliococcygeus, which originate on the pubis and the tendinous arch of the levator ani and insert on the perineal body, vaginal wall, between the internal and external anal sphincter, behind the rectum and in the iliococcygeal raphe (Kearney, Sawhney, and Delancey, 2004). These muscles work together to support internal organs and assist in maintaining posture and urinary and fecal continence (Raizada and Mittal, 2008; Rocca Rossetti, 2016). Pelvic Floor Dysfunction (PFD) is most often seen in postmenopausal women but affects both sexes and people of all ages (Milsom et al., 2014; Pierce, Perry, Chiarelli, and Gallagher, 2016; Shamliyan, Kane, Wyman, and Wilt, 2008). Nearly 26–30% of women report experiencing symptoms of PFD at some point in their lifetime, demonstrating its high prevalence in society (Nygaard et al., 2008; Wu et al., 2014). Symptoms may include: urinary and/or fecal incontinence (e.g. stress, urge, or mixed incontinence); frequent urination; and pelvic pain during urination or intercourse. A myriad of factors has been implicated in the development of PFD including, but not limited to: vaginal childbirth; constipation; diabetes; aging; injury; pelvic trauma; and obesity (Delancey et al., 2008; Pierce, Perry, Chiarelli, and Gallagher, 2016; Tinelli et al., 2010).