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Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery, altered bowel habits. An estimated 2.2% of community-dwelling adults are affected. However, reported prevalence figures vary. A prevalence of 8.39% among non-institutionalized U.S adults between 2005 and 2010 has been reported, and among institutionalized elders figures come close to 50%.
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. This is usually performed during second stage of labor to quickly enlarge the aperture allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.
An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation, but with chronic fissures, pain intensity often reduces. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphincter muscle. Untreated fissures develop a hood-like skin tag which cover the fissure and cause discomfort and pain.
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular. The word proctology is derived from the Greek words πρωκτός proktos, meaning "anus" or "hindparts", and -λογία -logia, meaning "science" or "study".
A fecal impaction or an impacted bowel is a solid, immobile bulk of feces that can develop in the rectum as a result of chronic constipation. Fecal impaction is a common result of neurogenic bowel dysfunction and causes immense discomfort and pain. Its treatment includes laxatives, enemas, and pulsed irrigation evacuation (PIE) as well as digital removal. It is not a condition that resolves without direct treatment.
The internal anal sphincter, IAS, is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal. It is about 5 mm thick, and is formed by an aggregation of the smooth (involuntary) circular muscle fibers of the rectum. it terminates distally about 6 mm from the anal orifice.
Anal fistula is a chronic abnormal communication between the anal canal and usually the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.
Anal sphincterotomy is a surgical procedure that involves treating mucosal fissures from the anal canal/sphincter. The word is formed from sphincter + otomy.
The rectoanal inhibitory reflex (RAIR) (also known as the anal sampling mechanism, anal sampling reflex, rectosphincteric reflex, or anorectal sampling reflex) is a reflex characterized by a transient involuntary relaxation of the internal anal sphincter in response to distention of the rectum. The RAIR provides the upper anal canal with the ability to discriminate between flatus and fecal material.
Sacral nerve stimulation, also termed sacral neuromodulation, is a type of medical electrical stimulation therapy.
In humans, the anus is the external opening of the rectum, located inside the intergluteal cleft and separated from the genitals by the perineum. Two sphincters control the exit of feces from the body during an act of defecation, which is the primary function of the anus. These are the internal anal sphincter and the external anal sphincter, which are circular muscles that normally maintain constriction of the orifice and which relaxes as required by normal physiological functioning. The inner sphincter is involuntary and the outer is voluntary. It is located behind the perineum which is located behind the vagina or scrotum.
LIFT technique is the novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano, known as LIFT procedure. LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the intersphincteric approach. Essential steps of the procedure include, incision at the intersphincteric groove, identification of the intersphincteric tract, ligation of intersphincteric tract close to the internal opening and removal of intersphincteric tract, scraping out all granulation tissue in the rest of the fistulous tract, and suturing of the defect at the external sphincter muscle. The procedure was developed by Thai colorectal surgeon, Arun Rojanasakul, Colorectal Division Department of Surgery, Chulalongkorn University in Bangkok, Thailand. The first report of preliminary healing result from the procedure were 94% in 2007
Rectal discharge is intermittent or continuous expression of liquid from the anus. Normal rectal mucus is needed for proper excretion of waste. Otherwise, this is closely related to types of fecal incontinence but the term rectal discharge does not necessarily imply degrees of incontinence. Types of fecal incontinence that produce a liquid leakage could be thought of as a type of rectal discharge.
Solitary rectal ulcer syndrome or SRUS is a chronic, benign disorder of the rectal mucosa. It commonly occurs with varying degrees of rectal prolapse. The condition is thought to be caused by different factors, such as long term constipation, straining during defecation, and dyssynergic defecation. Treatment is by normalization of bowel habits, biofeedback, and other conservative measures. In more severe cases various surgical procedures may be indicated. The condition is relatively rare, affecting approximately 1 in 100,000 people per year. It affects mainly adults aged 30–50. Females are affected slightly more often than males. The disorder can be confused clinically with rectal cancer or other conditions such as inflammatory bowel disease, even when a biopsy is done.
Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women. It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention.
Obstructed defecation syndrome is a major cause of functional constipation, of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal, but delayed in the rectum and sigmoid colon.
In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups.
Warren operation is a surgery performed to correct anal incontinence. It is done by disrupting the anterior segment of the anal sphincter, perineal body and rectovaginal septum.
Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida.
References
- 1 2 3 Schubert MC, Sridhar S, Schade RR, Wexner SD (July 2009). "What every gastroenterologist needs to know about common anorectal disorders". World J. Gastroenterol. 15 (26): 3201–9. doi: 10.3748/wjg.15.3201 . PMC 2710774 . PMID 19598294.
- ↑ Nyam DC, Pemberton JH (October 1999). "Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence". Dis. Colon Rectum. 42 (10): 1306–10. doi:10.1007/BF02234220. PMID 10528769. S2CID 30099075.
- ↑ Bailey RV, Rubin RJ, Salvati EP (1978). "Lateral internal sphincterotomy". Dis. Colon Rectum. 21 (8): 584–6. doi:10.1007/BF02586402. PMID 738174. S2CID 6874003.
- ↑ Brown CJ, Dubreuil D, Santoro L, Liu M, O'Connor BI, McLeod RS (April 2007). "Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial". Dis. Colon Rectum. 50 (4): 442–8. doi:10.1007/s10350-006-0844-3. PMID 17297553. S2CID 24579316.
- ↑ Keighley MR, Greca F, Nevah E, Hares M, Alexander-Williams J (June 1981). "Treatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anaesthesia". Br J Surg. 68 (6): 400–1. doi:10.1002/bjs.1800680611. PMID 7016242. S2CID 40048690.
- 1 2 Corman, Marvin L (2005). Colon and rectal surgery (5 ed.). Lippincott Williams & Wilkins. p. 264. ISBN 978-0-7817-4043-2.
- ↑ Nelson, Richard L. (2010-01-20). Nelson, Richard L. (ed.). "Operative procedures for fissure in ano". The Cochrane Database of Systematic Reviews (1): CD002199. doi:10.1002/14651858.CD002199.pub3. ISSN 1469-493X. PMID 20091532.
- ↑ Khubchandani IT, Reed JF (May 1989). "Sequelae of internal sphincterotomy for chronic fissure in ano". Br J Surg. 76 (5): 431–4. doi:10.1002/bjs.1800760504. PMID 2736353. S2CID 2096023.