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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 -
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 -
Anatomical Science International Jul 2023The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary... (Review)
Review
The purpose of this review is to present our researches on the pelvic outlet muscles, including the pelvic floor and perineal muscles, which are responsible for urinary function, defecation, sexual function, and core stability, and to discuss the insights into the mechanism of pelvic floor stabilization based on the findings. Our studies are conducted using a combination of macroscopic examination, immunohistological analysis, 3D reconstruction, and imaging. Unlike most previous reports, this article describes not only on skeletal muscle but also on smooth muscle structures in the pelvic floor and perineum to encourage new understanding. The skeletal muscles of the pelvic outlet are continuous, which means that they share muscle bundles. They form three muscle slings that pass anterior and posterior to the anal canal, thus serving as the foundation of pelvic floor support. The smooth muscle of the pelvic outlet, in addition to forming the walls of the viscera, also extends in three dimensions. This continuous smooth muscle occupies the central region of the pelvic floor and perineum, thus revising the conventional understanding of the perineal body. At the interface between the levator ani and pelvic viscera, smooth muscle forms characteristic structures that transfer the lifting power of the levator ani to the pelvic viscera. The findings suggest new concepts of pelvic floor stabilization mechanisms, such as dynamic coordination between skeletal and smooth muscles. These two types of muscles possibly coordinate the direction and force of muscle contraction with each other.
Topics: Pelvic Floor; Perineum; Muscle, Skeletal; Muscle, Smooth; Anal Canal
PubMed: 36961619
DOI: 10.1007/s12565-023-00717-7 -
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 -
Techniques in Coloproctology Mar 2021Faecal incontinence (FI) affects 1-19% of the general population and carries significant physical and psychological morbidity. Treatment strategies vary greatly with... (Review)
Review
BACKGROUND
Faecal incontinence (FI) affects 1-19% of the general population and carries significant physical and psychological morbidity. Treatment strategies vary greatly with respect to morbidity and efficacy and relatively little is known regarding the role of mechanical devices such as anal and vaginal inserts. This is an up-to-date systematic review of the use of these devices in the management of patients with FI.
METHODS
A systematic electronic search was performed of the Medline, Pubmed and Embase databases using the key words and/or MeSH 'anal plug', 'anal insert', 'vaginal insert' and 'faecal incontinence'. Only articles that reported clinical outcomes for these devices for FI in the English language were included. Review articles were excluded to avoid duplication of data.
RESULTS
Thirteen articles fulfilled the eligibility criteria. Two articles reported outcomes for the Eclipse vaginal insert and 11 articles reported on three types of anal inserts; the Coloplast 'Tulip' design (6), the Procon/ProTect device (2) and the Renew insert (3). When tolerated, both anal and vaginal inserts significantly improved continence, bowel function and quality of life where reported. Adverse effects included discomfort, leakage and slippage. Long-term compliance and benefit are yet to be determined.
CONCLUSIONS
Vaginal and anal inserts may be a useful treatment for FI. Better quality of evidence is needed to define its effectiveness.
Topics: Anal Canal; Fecal Incontinence; Female; Humans; Quality of Life
PubMed: 32870438
DOI: 10.1007/s10151-020-02317-3 -
Journal of Magnetic Resonance Imaging :... Oct 2019The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal... (Review)
Review
The normal function of the anal sphincter complex is crucial for quality of life, as it is the mechanism by which fecal continence is maintained. Additionally, the anal sphincter complex is an integral part of the coordinated effort of defecation. As imaging plays an important role in assessment of pathologic conditions involving the anal region, understanding the normal anatomy of the anal sphincter complex is important for correct image interpretation and accurate diagnosis. This review discusses the anatomy and function of the anal sphincter complex, important technical considerations for MRI, and various inflammatory, infectious, and neoplastic processes, as well as pathologic structural conditions that affect the anal region. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1018-1032.
Topics: Anal Canal; Anus Diseases; Humans; Magnetic Resonance Imaging
PubMed: 31115134
DOI: 10.1002/jmri.26776 -
Diseases of the Colon and Rectum Jul 2024
Topics: Humans; Endosonography; Anal Canal; Rectal Diseases
PubMed: 38479015
DOI: 10.1097/DCR.0000000000003232 -
European Journal of Obstetrics,... Jun 2023Maternal somatic birth trauma due to vaginal delivery is more common than generally assumed and an important cause of future morbidity. Maternal birth trauma may involve... (Review)
Review
Maternal somatic birth trauma due to vaginal delivery is more common than generally assumed and an important cause of future morbidity. Maternal birth trauma may involve both psychological and somatic morbidity, some of it long-term and permanent. Somatic birth trauma is now understood to encompass not just episiotomy, perineal tears and obstetric anal sphincter injuries (OASI), but also trauma to the levator ani muscle, termed 'avulsion'. This review will focus on recent developments in the imaging diagnosis of maternal birth trauma, discuss the most important risk factors and strategies for primary and secondary prevention. Translabial and exo-anal ultrasound allow the assessment of maternal birth trauma in routine clinical practice and enable the use of levator avulsion and anal sphincter trauma as key performance indicators of maternity services. This is likely to lead to a greater awareness of maternal birth trauma amongst maternity caregivers and improved outcomes for patients, not the least due to an increasing emphasis on patient autonomy and informed consent in antenatal and intrapartum care.
Topics: Pregnancy; Female; Humans; Pelvic Floor; Parturition; Delivery, Obstetric; Ultrasonography; Anal Canal; Birth Injuries
PubMed: 37087835
DOI: 10.1016/j.ejogrb.2023.04.005 -
British Journal of Hospital Medicine... Jan 2020Idiopathic cryptoglandular fistula-in-ano is a common pathological condition. Fistula-in-ano has been managed by a number of surgical techniques, and there is still no... (Review)
Review
Idiopathic cryptoglandular fistula-in-ano is a common pathological condition. Fistula-in-ano has been managed by a number of surgical techniques, and there is still no consensus regarding the management of this condition. Surgical techniques aim to treat and cure the fistula-in-ano with minimal risk of recurrence or complications, and to maintain patient continence. This article discusses the evidence available to inform the management of idiopathic cryptoglandular fistula-in-ano, and problems that surgeons face because of the lack of high-quality evidence.
Topics: Anal Canal; Evidence-Based Medicine; Female; Humans; Male; Rectal Fistula; Surgical Flaps; Treatment Outcome
PubMed: 32003630
DOI: 10.12968/hmed.2019.0353 -
European Journal of Pediatric Surgery :... Oct 2020
Topics: Anal Canal; Child; Colorectal Surgery; Humans; Pediatrics; Rectum
PubMed: 33027840
DOI: 10.1055/s-0040-1716728