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American Family Physician Jun 2021Obstetric lacerations are a common complication of vaginal delivery. Lacerations can lead to chronic pain and urinary and fecal incontinence. Perineal lacerations are... (Review)
Review
Obstetric lacerations are a common complication of vaginal delivery. Lacerations can lead to chronic pain and urinary and fecal incontinence. Perineal lacerations are defined by the depth of musculature involved, with fourth-degree lacerations disrupting the anal sphincter and the underlying rectal mucosa and first-degree lacerations having no perineal muscle involvement. Late third-trimester perineal massage can reduce lacerations in primiparous women; perineal support and massage and warm compresses during the second stage of labor can reduce anal sphincter injury. Conservative care of minor hemostatic first- and second-degree lacerations without anatomic distortion reduces pain, analgesia use, and dyspareunia. Minor hemostatic lesions with anatomic disruption can be repaired with surgical glue. Second-degree lacerations are best repaired with a single continuous suture. Lacerations involving the anal sphincter complex require additional expertise, exposure, and lighting; transfer to an operating room should be considered. Limited evidence suggests similar results from overlapping and end-to-end external sphincter repairs. Postdelivery care should focus on controlling pain, preventing constipation, and monitoring for urinary retention. Acetaminophen and nonsteroidal anti-inflammatory drugs should be administered as needed. Opiates should be avoided to decrease risk of constipation; need for opiates suggests infection or problem with the repair. Osmotic laxative use leads to earlier bowel movements and less pain during the first bowel movement. Simulation models are recommended for surgical technique instruction and maintenance, especially for third- and fourth-degree repairs.
Topics: Anal Canal; Delivery, Obstetric; Female; Humans; Injury Severity Score; Lacerations; Pain Management; Perineum; Pregnancy; Vagina
PubMed: 34128615
DOI: No ID Found -
World Journal of Gastroenterology Jan 2015Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of... (Review)
Review
Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of new sphincter-preserving techniques.
Topics: Anal Canal; Digestive System Surgical Procedures; Humans; Postoperative Complications; Rectal Fistula; Risk Factors; Treatment Outcome
PubMed: 25574077
DOI: 10.3748/wjg.v21.i1.12 -
Clinics in Geriatric Medicine Feb 2021Fecal incontinence can be a challenging and stigmatizing disease with a high prevalence in the elderly population. Despite effective treatment options, most patients do... (Review)
Review
Fecal incontinence can be a challenging and stigmatizing disease with a high prevalence in the elderly population. Despite effective treatment options, most patients do not receive care. Clues in the history and physical examination can assist the provider in establishing the diagnosis. Direct inquiry about the presence of incontinence is key. Bowel disturbances are common triggers for symptoms and represent some of the easiest treatment targets. We review the epidemiology and impact of the disease, delineate a diagnostic and treatment approach for primary care physicians to identify patients with suspected fecal incontinence and describe appropriate treatment options.
Topics: Aged; Algorithms; Anal Canal; Diarrhea; Fecal Incontinence; Humans; Lumbosacral Plexus; Pain; Pelvic Floor; Treatment Outcome
PubMed: 33213775
DOI: 10.1016/j.cger.2020.08.006 -
BMJ (Clinical Research Ed.) Feb 2017
Review
Topics: Abscess; Adult; Anal Canal; Anus Diseases; Bacterial Infections; Female; Humans; Incidence; Male; Rectal Fistula; Risk Factors; United Kingdom
PubMed: 28223268
DOI: 10.1136/bmj.j475 -
Current Gastroenterology Reports Sep 2020Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal... (Review)
Review
PURPOSE OF REVIEW
Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice.
RECENT FINDINGS
This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice.
Topics: Anal Canal; Anus Diseases; Humans; Manometry; Rectal Diseases; Terminology as Topic
PubMed: 32935278
DOI: 10.1007/s11894-020-00793-z -
Journal of Gynecology Obstetrics and... Sep 2019The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter...
INTRODUCTION
The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms.
MATERIAL AND METHODS
These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS).
RESULTS
A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (Grade C). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (Grade C). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (Grade C). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (Grade C). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
Topics: Anal Canal; Delivery, Obstetric; Episiotomy; Female; Gynecology; Humans; Infant, Newborn; Lacerations; Obstetrics; Parturition; Perineum; Pregnancy; Risk Factors; Societies, Medical
PubMed: 30553051
DOI: 10.1016/j.jogoh.2018.12.002 -
Annals of African Medicine 2019An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which...
BACKGROUND
An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life.
AIMS
To study the predilection sites, presentation and treatment of haemorrhoidal disease.
PATIENTS AND METHOD
A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY.
RESULTS
One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively.
CONCLUSION
The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal; Cohort Studies; Endoscopy; Female; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Nigeria; Pain, Postoperative; Rectum; Sclerotherapy; Severity of Illness Index; Sex Distribution; Treatment Outcome; Young Adult
PubMed: 30729927
DOI: 10.4103/aam.aam_4_18 -
Ugeskrift For Laeger Sep 2021Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge... (Review)
Review
Cryptoglandular anal fistulas (AF) cause recurrent anal abscesses and patients risk multiple surgeries due to low healing rates of sphincter-saving procedures. Knowledge of anal anatomy and imaging with MRI or endoanal sonography is crucial to classify AF as simple or complex depending on risk of anal incontinence after fistulotomy as summarised in this review. Fistulotomy has healing rates of > 90%, risks incontinence, and the procedure is reserved for simple fistulas. Complex AF are treated with a draining seton and then with sphincter-saving procedures which have long-term healing rates of about 50%.
Topics: Anal Canal; Fecal Incontinence; Humans; Magnetic Resonance Imaging; Rectal Fistula; Treatment Outcome
PubMed: 34498577
DOI: No ID Found -
BMJ Clinical Evidence Nov 2014Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a... (Review)
Review
INTRODUCTION
Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a risk factor.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of surgical treatments for chronic anal fissure? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found nine studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: anal advancement flap, anal stretch/dilation, and internal anal sphincterotomy.
Topics: Anal Canal; Fissure in Ano; Humans; Risk Factors; United States
PubMed: 25391392
DOI: No ID Found -
Ugeskrift For Laeger Nov 2017
Topics: Anal Canal; Delivery, Obstetric; Female; Hot Temperature; Humans; Massage; Obstetric Labor Complications; Pregnancy; Rupture
PubMed: 29297997
DOI: No ID Found