5. Clinical Assessment in Fecal
IncontinenceHistory
Degree of incontinence, stool consistency, obs
history, trauma, operations, neurologic
symptoms, diabetes, laxative, rectal or genital
prolapse, associated urinary incontinence
Examination
- General
- Neurological
- Anorectal
- proctosigmoidoscopy
6.
7.
8.
9.
10.
11.
12.
13.
14. MRI vs US
Better visualization of
pelvic floor
Poorer visualization of
sphincter defects
Dynamic
For functional disorders
associated with fecal
incontinence
15. Objective assessment
Objective follow up
Identifies type of incont.
Indispensable for research
& group assessment
Expensive equipment
Expensive running costs
Time consuming, needs
trained operator
Results do not coincide
with symptoms
Anorectal Manometry
16. I am the most ancient, most durable,
inexpensive manometer
17. Sphincter EMG
Almost not used nowadays
Invasive
Painful
Subjective in squeeze & strain
Morbidity
20. Management of Faecal
Incontinence: General Rules
Correct any underlying pathology
Conservative treatment in minor
incontinence
Repair a reparable sphincter, replace a non
reparable sphincter
No sensation: Don’t play around the anus
22. Indications of Anal Sphincter
Repair
Reparable sphincter damage in absence
of contraindications
23. What is a Reparable Sphincter
Damage
Injury involving less than half the
circumference of the external sphincter
Intact motor nerve supply
Intact anorectal sensation
Internal sphincter is not reparable
24.
25. Contraindications of Anal
Sphincter Repair
Multiple sphincter defects
Defect involving more than 50% of the sphincter
Major sepsis
Anal or rectal pathology
Puodendal neuropathy
Mentally backwards
Diarrhoeal states
26.
27.
28.
29. Tips in Anal Sphincter Repair
Position on table
Adrenaline injection
Cautery dissection
Mass sphincter identification
Specific sphincter identification
Sphincter mobilization
Suture material
Keep wound open
33. Options for Non
Reparable External
Sphincter Damage
Muscle transfer
Unstimulated vs
electrostimulated
Gluteus vs Gracilis
Artificial bowel sphincter
34.
35. Results of Unstimulated Gluteus
Maximus Neosphincter
No. F.U. Continence
Good Improved Failure
All Solids None
Prochiantz, 1982 15 16y 20% 47% 33%
Chen Yuli, 1987 6 NA 17% 50% 33%
Pearl, 1991 7 NA 29% 57% 14%
Devesa, 1992 10 25m 60% 30% 10%
36. Results of Electrostimulated
Muscle Transfer and ABS
International results
The economic issue
Complications
Infection (both)
Fibrosis (ESM)
Migration (ESM)
Impaction (Both)
Erosion (ABS)
Failure of activation (ABS)
