-
World Journal of Gastroenterology Jan 2017Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only... (Review)
Review
Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient's self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.
Topics: Anal Canal; Combined Modality Therapy; Digestive System Surgical Procedures; Fecal Incontinence; Humans; Pelvic Floor; Physical Therapy Modalities; Precision Medicine; Quality of Life; Rectum; Treatment Outcome
PubMed: 28104977
DOI: 10.3748/wjg.v23.i1.11 -
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 -
BMJ Clinical Evidence Mar 2015More than 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least one third of women in... (Review)
Review
INTRODUCTION
More than 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least one third of women in the UK and US. Perineal trauma can lead to long-term physical and psychological problems.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of different methods and materials for primary repair of first- and second-degree tears and episiotomies? What are the effects of different methods and materials for primary repair of obstetric anal sphincter injuries (third- and fourth-degree tears)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (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 33 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: conventional suturing; different methods and materials for primary repair of obstetric anal sphincter injuries; non-suturing of muscle and skin (or perineal skin alone); and sutures (absorbable synthetic sutures, catgut sutures, continuous sutures, interrupted sutures).
Topics: Anal Canal; Episiotomy; Female; Humans; Perineum; Pregnancy; Sutures; Treatment Outcome
PubMed: 25752310
DOI: No ID Found -
Canadian Family Physician Medecin de... May 2013
Topics: Anal Canal; Anus Neoplasms; Contraindications; Humans; Proctoscopy
PubMed: 23673588
DOI: No ID Found -
Orphanet Journal of Rare Diseases Jul 2007Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary and genital... (Review)
Review
Anorectal malformations comprise a wide spectrum of diseases, which can affect boys and girls, and involve the distal anus and rectum as well as the urinary and genital tracts. They occur in approximately 1 in 5000 live births. Defects range from the very minor and easily treated with an excellent functional prognosis, to those that are complex, difficult to manage, are often associated with other anomalies, and have a poor functional prognosis. The surgical approach to repairing these defects changed dramatically in 1980 with the introduction of the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and genitourinary tract. Better imaging techniques, and a better knowledge of the anatomy and physiology of the pelvic structures at birth have refined diagnosis and initial management, and the analysis of large series of patients allows better prediction of associated anomalies and functional prognosis. The main concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function. With early diagnosis, management of associated anomalies and efficient meticulous surgical repair, patients have the best chance for a good functional outcome. Fecal and urinary incontinence can occur even with an excellent anatomic repair, due mainly to associated problems such as a poorly developed sacrum, deficient nerve supply, and spinal cord anomalies. For these patients, an effective bowel management program, including enema and dietary restrictions has been devised to improve their quality of life.
Topics: Anal Canal; Digestive System Abnormalities; Digestive System Surgical Procedures; Female; Humans; Male; Rectum
PubMed: 17651510
DOI: 10.1186/1750-1172-2-33 -
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 -
BMC Research Notes Jun 2016Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Perineal schwannomas are exceptional, and rarely reported in the literature. We...
BACKGROUND
Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Perineal schwannomas are exceptional, and rarely reported in the literature. We report a case of a perineal schwannoma, close to the anal sphincter, and provide a short summary of clinical, radiological and surgical features of this rare entity.
CASE PRESENTATION
A 62 year-old male patient was admitted for a suspected perineal mass. At clinical examination, he had a soft mass, located on the right of the anus. Computed tomography showed a perineal mass, located on the right side of the anal sphincter that enhanced after injection of the contrast medium. Complete surgical excision of the tumor was performed. The most challenging part during the surgery was the dissection and preservation of the anal sphincter to avoid anal incontinence. Pathologic examination revealed a completely excised schwannoma.
CONCLUSIONS
Perineal schwannomas are very rare tumors that are usually asymptomatic, and which present as large masses. Complete excision is necessary to avoid recurrences. Surgical resection may be difficult depending of proximity to the anal sphincter. A cautious dissection in such cases is required in order to reduce the risk of incontinence.
Topics: Anal Canal; Humans; Immunohistochemistry; Male; Middle Aged; Neurilemmoma; Perineum; S100 Proteins; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27297080
DOI: 10.1186/s13104-016-2108-1 -
American Journal of Physiology.... Oct 2020Fecal continence is maintained by several mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength,... (Review)
Review
Fecal continence is maintained by several mechanisms including anatomical factors, anorectal sensation, rectal compliance, stool consistency, anal muscle strength, mobility, and psychological factors. The homeostatic balance is easily disturbed, resulting in symptoms including fecal incontinence and constipation. Current technologies for assessment of anorectal function have limitations. Overlap exist between data obtained in different patient groups, and there is lack of correlation between measurements and symptoms. This review describes a novel technology named Fecobionics for assessment of anorectal physiology. Fecobionics is a simulated stool, capable of dynamic measurements of a variety of variables during defecation in a single examination. The data facilitate novel analysis of defecatory function as well as providing the foundation for modeling studies of anorectal behavior. The advanced analysis can enhance our physiological understanding of defecation and future interdisciplinary research for unraveling defecatory function, anorectal sensory-motor disorders, and symptoms. This is a step in the direction of improved diagnosis of anorectal diseases.
Topics: Anal Canal; Biomechanical Phenomena; Defecation; Feces; Humans; Manometry; Models, Biological; Pressure; Rectum; Sensation
PubMed: 32783614
DOI: 10.1152/ajpgi.00242.2020 -
Gastroenterology Jan 2014Gastroenterologists frequently encounter pelvic floor disorders, which affect 10% to 15% of the population. The anorectum is a complex organ that collaborates with the... (Review)
Review
Gastroenterologists frequently encounter pelvic floor disorders, which affect 10% to 15% of the population. The anorectum is a complex organ that collaborates with the pelvic floor muscles to preserve fecal continence and enable defecation. A careful clinical assessment is critical for the diagnosis and management of defecatory disorders and fecal incontinence. Newer diagnostic tools (eg, high-resolution manometry and magnetic resonance defecography) provide a refined understanding of anorectal dysfunctions and identify phenotypes in defecatory disorders and fecal incontinence. Conservative approaches, including biofeedback therapy, are the mainstay for managing these disorders; new minimally invasive approaches may benefit a subset of patients with fecal incontinence, but more controlled studies are needed. This mini-review highlights advances, current concepts, and controversies in the area.
Topics: Anal Canal; Anus Diseases; Biofeedback, Psychology; Constipation; Defecography; Fecal Incontinence; Humans; Manometry; Rectal Diseases; Rectum
PubMed: 24211860
DOI: 10.1053/j.gastro.2013.10.062