Anale Stuhlinkontinenz

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• 作者：Prof. Dr. T. Frieling
• 关键词：Analsphinkter ; Manometrie ; Magnetresonanztomographie ; Obstipation ; Toilettentraining ; Anal sphincter ; Manometry ; Magnetic resonance imaging ; Constipation ; Toilet training
• 刊名：Der Gastroenterologe
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：10
• 期：3
• 页码：185-190
• 全文大小：394 KB
• 参考文献：1.Bharucha AE et al (2015) Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. Am J Gastroenterol 110:127-36View Article PubMed
  2.Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126(Suppl 1):PS3–PS7View Article
  3.Miner PB (2004) Economic and personal impact of fecal and urinary incontinence. Gastroenterology 126(Suppl 1):PS8–PS13View Article
  4.Rao SSC (2004) Pathophysiology of fecal incontinence. Gastroenterology 126(Suppl 1):PS14–PS22View Article
  5.Norton C (2004) Behavioural management of fecal incontinence in adults. Gastroenterology 126(Suppl 1):PS64–PS70View Article
  6.Bharucha AE (2004) Outcome measures for fecal incontinence: anorectal structure and function. Gastroenterology 126(Suppl 1):PS90–PS98View Article
  7.Cotterill N et al (2011) Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: the ICIQ-B. Dis Colon Rectum 54:1235-250View Article PubMed
  8.Sansoni J et al (2013) The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum 56:652-59View Article PubMed
  9.Keller J, Wedel T, Seidl H et al (2011) S3 guideline of the German Society for Digestive and Metabolic Diseases (DGVS) and the German Society for Neurogastroenterology and Motility (DGNM) to the definition, pathophysiology, diagnosis and treatment of intestinal motility. Z Gastroenterol 49:374-90View Article PubMed
  10.Andresen V, Enck P, Frieling T et al (2013) S2k Leitlinie Chronische Obstipation. Z Gastroenterol 51:651-72View Article PubMed
  
• 作者单位：Prof. Dr. T. Frieling (1)
  
  1. Medizinische Klinik II, Innere Medizin mit Gastroenterologie, Hepatologie, Infektiologie, Neurogastroenterologie, H?matologie, Onkologie und Palliativmedizin, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland
  
• 刊物主题：Gastroenterology; General Practice / Family Medicine; Internal Medicine; Hepatology; Infectious Diseases; Oncology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1861-969X

文摘

Background Fecal incontinence is defined by the unintentional loss of solid or liquid stool, and anal incontinence includes leakage of gas and/or fecal incontinence. Anal–fecal (AF) incontinence is not a diagnosis but a symptom. Many patients hide the problem from their families, friends, and even their doctors. Epidemiologic studies indicate a prevalence between 7 and 15-, up to 30- in hospitals, and up to 70- in long-term care settings. AF incontinence causes significant socio-economic burden. Pathophysiology and diagnostics There is no widely accepted approach for classifying AF incontinence available. Currently, AF incontinence is classified by separate systems based on etiology, pathophysiology, type of leakage, or symptom severity scales. AF continence is provided by the structural and functional integrity of the anorectum and, therefore, the causes of AF incontinence are mostly multifactorial. AF continence is maintained by anatomical factors, rectoanal sensation, and rectal compliance. AF incontinence occurs when one or more continence-maintaining factors are disturbed. The diagnostic approach comprises muscle and nerve injuries by iatrogenic, obstetric or surgical trauma, descending pelvic floor or associated diseases. Detection of reduced rectal compliance by rectal inflammation and disturbance of rectal visceral sensitivity by polyneuropathy are of particular interest. A basic diagnostic work-up is sufficient to characterize the different manifestations of fecal incontinence in most of the cases. This includes patient history with daily stool protocol, clinical and endoscopic investigation. In specific cases, additional anorectal investigations may warranted. Therapy Therapeutic interventions are focused on the individual symptoms and should be provided in close cooperation with gastroenterologists, surgeons, gynecologists, urologists, physiotherapeutics, and psychologists. Surgical treatment, which includes stapled transanal resection of the rectum (STARR) for rectoanal prolapse and sacral nerve stimulation for chronic constipation and AF incontinence, should be considered only after conservative treatment options have been exhausted.