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Anal incontinence

S Haas, C Brock, K Krogh, M Gram, L Lundby, A M Drewes, S Laurberg
BACKGROUND: It has been suggested that the effects of sacral nerve stimulation against fecal incontinence involve neuromodulation at spinal or supraspinal levels. OBJECTIVE: This study aims to investigate the afferent sensory pathways from the anorectum before and during sacral nerve stimulation. DESIGN: This is an explorative study. PATIENTS: Fifteen women with idiopathic fecal incontinence (mean age, 58 ± 12.2 years) were selected...
November 2016: Diseases of the Colon and Rectum
Emanuel A Shapera, Vinay K Rai
Proper surgical management of anal fistula demands sound clinical judgment and extraordinary care to prevent incontinence and adequate postoperative pain control and provide satisfactory resolution to optimize quality of life. Fecal incontinence can be a devastating complication of procedures performed for fistula in ano. We report a unique case in which temporary incontinence (for less than 4 days) followed injection of liposomal bupivacaine for postoperative pain control after draining seton placement for fistula in ano...
2016: Case Reports in Surgery
Jason Chang, Elisabeth Mclemore, Talar Tejirian
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation...
October 10, 2016: Permanente Journal
David O Prichard, Taehee Lee, Gopanandan Parthasarathy, Joel G Fletcher, Alan R Zinsmeister, Adil E Bharucha
BACKGROUND & AIMS: Contrary to conventional wisdom, the rectoanal gradient during evacuation is negative in many healthy people, undermining the utility of anorectal high resolution manometry (HRM) for diagnosing defecatory disorders. We aimed to compare HRM and magnetic resonance imaging (MRI) for assessing rectal evacuation and structural abnormalities. METHODS: We performed a retrospective analysis of 118 patients (all female; 51 with constipation, 48 with fecal incontinence, and 19 with rectal prolapse; age, 53±1 years) assessed by HRM, the rectal balloon expulsion test (BET), and MRI at Mayo Clinic, Rochester, Minnesota, from February 2011 through March 2013...
October 5, 2016: Clinical Gastroenterology and Hepatology
Paola De Nardi, Sabrina Gloria Giulia Testoni, Maura Corsetti, Hulda Andreoletti, Patrizia Giollo, Sandro Passaretti, Pier Alberto Testoni
BACKGROUND: An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AIM: The aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry. METHODS: Thirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2)...
September 22, 2016: Digestive and Liver Disease
Marcelo de Melo Andrade Coura, Silvana Marques Silva, Romulo Medeiros de Almeida, Miles Castedo Forrest, João Batista Sousa
Background: Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective: In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures...
October 2016: Arquivos de Gastroenterologia
H A Owen, G N Buchanan, A Schizas, A Emmanuel, R Cohen, A B Williams
INTRODUCTION: Anal fistula causes pain, discharge of pus and blood. Fistulotomy has the highest success, however, can risk continence; treatment balances cure with continence. This study assessed the impact of fistulotomy on Quality Of Life (QOL) and continence. METHODS: Patients selected for fistulotomy prospectively completed St Mark's Continence Score (full incontinence = 24) and Short Form - 36 questionnaires pre-operatively at two institutions with an interest in anal fistula, and reassessed 3 months post-operatively...
October 5, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Shingo Noura, Masayuki Ohue, Norikatsu Miyoshi, Masayoshi Yasui
Transanal excision (TAE) for rectal tumors is increasingly applied and it is generally recommended that the defect following full-thickness excision should be closed. The aim of this study was to compare the complications and anal function following TAE between cases where the defect was closed and those where it was not. A total of 43 consecutive rectal malignant tumor patients eligible for TAE were investigated. Regarding anorectal function, incontinence was assessed using the Wexner score. The defect of the rectum was closed in 21 of the 43 patients...
October 2016: Molecular and Clinical Oncology
S Chakraborty, K J Feuerhak, A R Zinsmeister, A E Bharucha
BACKGROUND: While widely used in clinical practice, the reproducibility of high-definition anorectal manometry (HD-ARM) remains unclear. We evaluated the intra-individual reproducibility of HD-ARM and compared pressures measured with HD-ARM and high-resolution anorectal manometry (HR-ARM). METHODS: Thirty-six women with fecal incontinence had an initial HD-ARM (HD-ARM1); on the same day, after randomization, 21 had a second (HD-ARM2). Sixteen women had a third (HD-ARM3) 4 weeks later...
October 2, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Hao Wu, Zhiwu Wang, Guozheng Yan, Wentian Jin, Shan Lu, Zerun Zhou
This article presents a novel puborectalis muscle artificial anal sphincter system (PM-AASS) with the module of sensory perception for treating severe faecal incontinence (FI). Due to the implantable feature of PM-AASS, this system applied low-power design and the total energy consumption could drop to 48.8 Ah/d. To reduce the injury of intestine and the pressure exerted on intestine, the actuator, including the structure of tings and the robot mechanism, of PM-AASS was presented and the middle ring was optimised...
September 30, 2016: Journal of Medical Engineering & Technology
Ka Lai Shek, Ixora Kamisan Atan, Hans Peter Dietz
OBJECTIVES: The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. METHODS: This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Yansong Xu, Weizhong Tang
OBJECTIVE: The aim of this analysis was to compare the advantages of the anal fistula plug (AFP) with the mucosa advancement flap (MAF) for complex anal fistulas. METHODS: Comparative studies of the efficacy of AFP and MAF were included. Two independent reviewers selected articles for inclusion. After information collection, a meta-analysis was performed using data on overall healing rates, complications, incontinences and recurrences. The quality of postoperative life and cost were also included with the clinical results...
September 29, 2016: ANZ Journal of Surgery
Ahmed Al-Badr, Rafeef Al-Juraifani, Ghadeer Al-Sheikh, Hazem Al-Mandeel, Lateefa Al-Dakhyel, Nadeen Al-Shahrani
INTRODUCTION AND HYPOTHESIS: A valid and reliable Arabic version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) is needed. METHODS: Of 238 Saudi Arabian women who fulfilled the inclusion criteria, 227 were recruited. A detailed history was obtained and pelvic examination was performed in all participants. An Arabic version of the PISQ-IR was administered with three quality of life measures. Reliability was assessed by factor analysis, and internal consistency was measured with Cronbach's α...
September 27, 2016: International Urogynecology Journal
Samia Frioui Mahmoudi, Emna Toulgui, Sonia Jemni, Khalil Ben Jeddou, Mariem Gaddour, Afif Zaoui, Faycel Khachnaoui
OBJECTIVE: To talk through our observation and a review of the literature about radiological features and diagnostic difficulties of this particular form of disk migration. OBSERVATIONS: We report the case of a 29 year-old patient who presented following the wearing of a heavy load bilateral acute lombosciatalgies associated with a deficit of both lower limbs and urinary incontinence. Clinical examination revealed a motor deficit of sural triceps and foot relievers estimated1 in bilateral, hypoesthesia of the anterolateral side of the two legs and the feet, low bone tendon reflexes were abolished, anesthesia in the saddle, hypotonic anal sphincter and bladder distension...
September 2016: Annals of Physical and Rehabilitation Medicine
Adam Lundqvist, Ida Ahlberg, Frida Hjalte, Mats Ekelund
INTRODUCTION: Anal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden. METHODS: The study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden...
September 24, 2016: International Journal of Surgery
Baharak Amir, Victoria M Allen, Susan Kirkland, Kathleen MacPherson, Scott Farrell
OBJECTIVE: To estimate the influence of labour and pregnancy factors on long-term pelvic floor health outcomes. METHODS: This population-based cohort study was conducted using linkage between the Nova Scotia Atlee Perinatal Database, the Medical Services Insurance Database, and the Canadian Institute for Health Information's Discharge Abstract Database from 1988 to 2006; this allowed for the evaluation of patient utilization of care providers for pelvic floor disorders and captured conservative and surgical interventions...
September 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Dimos Sioutis, Ranee Thakar, Abdul H Sultan
OBJECTIVES: To identify the accuracy of clinically diagnosed OASIS using 3D endoanal ultrasound and compare symptoms and anal manometry measurements between those whose anal sphincters were adequately repaired to those who had persistent anal sphincter defects. METHODS: The endoanal scan images of women who sustained OASIS and attended the perineal clinic over a 10 year period (2003 - 2013) were re-analysed from data entered prospectively of women with clinically diagnosed and repaired OASIS...
September 19, 2016: Ultrasound in Obstetrics & Gynecology
T Rautio, J Mäkelä-Kaikkonen, M Vaarala, M Kairaluoma, J Kössi, M Carpelan-Holmström, S Salmenkylä, P Ohtonen, J Mäkelä
BACKGROUND: Laparoscopic ventral rectopexy has been used to treat male patients with external rectal prolapse, but evidence to support this approach is scarce. The aim of this study was to evaluate the results of this new abdominal rectopexy surgical technique in men. METHODS: This was a retrospective multicenter study. Adult male patients who were operated on for external rectal prolapse using ventral rectopexy in five tertiary hospitals in Finland between 2006 and 2014 were included in the study...
October 2016: Techniques in Coloproctology
Zdenek Rusavy, Jaroslava Karbanova, Magdalena Jansova, Vladimir Kalis
OBJECTIVE: To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery. METHODS: The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery including mediolateral or lateral episiotomy between April 1, 2010 and March 31, 2012. Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum...
August 29, 2016: International Journal of Gynaecology and Obstetrics
Jagmohan Singh, Ettickan Boopathi, Sankar Addya, Benjamin Phillips, Isidore Rigoutsos, Raymond B Penn, Satish Rattan
A comprehensive -omic, computational, and physiological approach was employed to examine the (previously unexplored) role of microRNAs (miRNAs) as regulators of IAS smooth muscle contractile phenotype and basal tone. MicroRNA profiling, genome wide expression, validation and network analyses were employed to assess changes in mRNA and miRNA expression in IAS smooth muscles from young vs. aging rats. Multiple miRNAs, including rno-miR-1, rno-miR-340-5p, rno-miR-185, rno-miR-199a-3p, rno-miR-200c, rno-miR-200b, rno-miR-31, rno-miR-133a and rno-miR-206 were found to be up-regulated in aging IAS...
September 15, 2016: American Journal of Physiology. Gastrointestinal and Liver Physiology
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