This open access book describes the latest advances in the anal incontinence diagnostic and therapeutic processes. Anal incontinence is a devastating condition heavily impacting on the patients’ lives. Those suffering from this disorder are generally very embarrassed and reluctant to undergo an appropriate clinical evaluation, thus becoming more isolated and worsening the quality of their life. Luckily, nowadays a wide range of treatments is available to improve this oppressive condition; however, the recognition of the related pathophysiological alterations is mandatory to grant its successful management.
This volume will help the surgeons community to keep abreast of developments in diagnostics and treatment of this impairing condition. and will provide all health professionals with the appropriate tools to face this impairing condition.
Author(s): Ludovico Docimo, Luigi Brusciano
Series: Updates in Surgery
Publisher: Springer
Year: 2022
Language: English
Pages: 209
City: Cham
Foreword
Preface
Contents
Part I: Overview
1: History of Anal Incontinence and its Treatments
1.1 History of Anal Incontinence
1.2 History of Treatments for Anal Incontinence
1.2.1 Colonic Irrigation and Colostomy
1.2.2 Anal Sphincter Repair
1.2.3 Muscle Transposition and Artificial Sphincter
1.2.4 Bulking Agents
1.2.5 Other Treatments and Techniques
References
2: Epidemiology, Anorectal Anatomy, Physiology and Pathophysiology of Continence
2.1 Introduction and Epidemiology
2.2 Anatomy and Physiology of Continence
2.3 Pathophysiology of Fecal Incontinence
References
Part II: Diagnosis
3: Clinical Evaluation, Etiology, and Classification of Anal Incontinence
3.1 Clinical Evaluation of Anal Incontinence
3.1.1 How to Examine the Patient
3.2 Etiology of Anal Incontinence
3.2.1 Anal Incontinence after Operations for Anal Fissure
3.2.2 Anal Incontinence after Operations for Anal Fistula
3.2.3 Anal Incontinence after Operations for Hemorrhoids
3.2.4 Anal Incontinence after Operations for Anal Tumors
3.2.5 Anal Incontinence after Operations for Rectal Cancer
3.2.6 Anal Incontinence Following Operations for Slow-Transit Constipation
3.2.7 Anal Incontinence Following Operations for Anorectal Stricture
3.2.8 Anal Incontinence Following Surgery for Inflammatory Bowel Diseases
3.3 Classification of Anal Incontinence
References
4: Neurofunctional Diagnosis and Anorectal Manometry
4.1 Introduction
4.2 Neurofunctional Diagnosis
4.2.1 Anal Electromyography
4.2.2 Sacral Reflexes
4.2.3 Evoked Potentials
4.3 Anorectal Manometry
References
5: Role of Ultrasonography for Anal Incontinence
5.1 Introduction
5.2 Ultrasound Technique
5.3 Normal Ultrasound Anatomy
5.4 Ultrasound in Anal Incontinence
5.5 Internal Anal Sphincter Lesions
5.6 External Anal Sphincter Lesions
5.7 Puborectalis Muscle Lesions
References
6: Cross-Sectional Imaging in Fecal Incontinence
6.1 Introduction
6.2 Imaging Techniques
6.2.1 X-Ray Defecography
6.2.1.1 Execution Protocol
6.2.1.2 Image Analysis
6.2.1.3 Imaging Findings
6.2.2 Magnetic Resonance Defecography
6.2.2.1 Acquisition Protocol
6.2.3 Magnetic Resonance Anatomy of the Anal Canal
6.2.4 Morphologic Diagnostic Criteria
6.2.5 Functional Diagnostic Criteria
6.2.5.1 Rectal Prolapse
6.2.5.2 Rectocele
6.2.5.3 Rectoanal Intussusception
6.3 Conclusions
References
Part III: Treatment
7: Medical Management and Supportive/Hygienic Measures
7.1 Introduction
7.2 Nursing Assessment
7.3 Hygiene and Dietary Guidelines
7.4 Medical Treatment
7.5 Mechanical Treatments and Containment Devices
7.6 Mind and Incontinence
7.7 Conclusions
References
8: Diet in Fecal Incontinence
8.1 General Principles of Diet
8.2 Dietary Therapeutic Strategies
8.2.1 Low FODMAP Diet
8.2.2 Percentage of Macronutrients
8.2.3 Coffee
8.2.4 Spices, Spicy and Smoked Foods
8.2.5 Supplementation with Vitamins and Minerals
8.3 Importance of Healthy Foods
8.3.1 Fruit and Vegetables
8.3.2 Fish
8.3.3 Extra Virgin Olive Oil
References
9: Role of Pelvic Floor Rehabilitation: Patient Selection and Treatment
9.1 Introduction
9.2 Clinical Physiatric Evaluation
9.3 Pelvic Floor Rehabilitation Treatment
9.3.1 The Re-Education Phase
9.3.2 Pelvic Floor Rehabilitation “Tools”
9.3.3 Post-Rehabilitation Assessment
References
10: Sacral and Percutaneous Tibial Nerve Stimulation, Stem Cell Therapy, and Transanal Irrigation Device
10.1 Sacral Nerve Stimulation
10.1.1 How It Works
10.1.2 Patient Selection
10.1.3 Surgical Procedure
10.1.4 Complications
10.2 Percutaneous Tibial Nerve Stimulation
10.2.1 Procedure
10.2.2 Literature Results
10.3 Stem Cell Therapy
10.4 Transanal Irrigation
10.4.1 Procedure
10.4.2 How It Works
10.4.3 Literature Results
References
11: Sphincter Reconstruction: Dynamic Myoplasty, Artificial Bowel Sphincter, Antegrade Colonic Enemas and Colostomy
11.1 Introduction
11.2 Dynamic Myoplasty
11.2.1 Technique
11.2.2 Results
11.3 Artificial Bowel Sphincter
11.3.1 Acticon Neosphincter
11.3.1.1 Technique
11.3.1.2 Results
11.3.2 Fenix Neosphincter
11.3.2.1 Technique
11.3.2.2 Results
11.4 Antegrade Colonic Enemas
11.4.1 Results
11.5 Colostomy
References
12: Surgical Reconstruction of Traumatic Perineal and Sphincter Muscle Defects
12.1 Introduction
12.2 Pathophysiology of Anal Sphincter Injuries
12.2.1 Mechanisms of Sphincter Injuries
12.2.2 Acute Anal Sphincter Injury and Healing
12.3 Anal Sphincter and Levator Ani Repair
12.3.1 General Considerations for Surgery
12.3.2 Surgical Technique for Sphincter Repair
12.3.3 Surgical Technique for Levator Ani Repair
12.3.4 Postoperative Management
12.3.5 Postoperative Complications
12.4 Functional Results of Sphincter and Levator Ani Repair
12.4.1 Early Postoperative Results of Sphincteroplasty
12.4.2 Prognostic Factors in Sphincter Repair Success
12.4.2.1 Age
12.4.2.2 Pudendal Nerve Integrity
12.4.3 Late Results of Sphincter Repair
12.4.4 What Is the Best Option for Failed Sphincter Repair?
12.4.5 Results of Levator Ani Repair
12.5 Future in Sphincter and Perineum Repair
12.6 Conclusions
References
13: Injectable Bulking Agents and SECCA Radiofrequency Treatment
13.1 Injectable Bulking Agents
13.1.1 Background
13.1.2 Early Applications
13.1.3 Recent Applications
13.1.4 Conclusions
13.2 SECCA Procedure
References
14: Implantation of Self-Expandable Solid Prostheses for Anal Incontinence
14.1 Introduction
14.2 Indications and Contraindications
14.3 Surgical Technique
14.4 Implantation Results
14.5 Adverse Effects: Displacement
References
15: When Everything Fails: Prevention and Therapy of Treatment Failures
15.1 Introduction
15.2 Sphincteroplasty with or Without Postanal Repair
15.2.1 What to Do when Sphincteroplasty Fails?
15.3 Injectable Anal Bulking Agents
15.4 Adynamic Anal Sphincter Reinforcement by Prosthetic Implants
15.4.1 Gatekeeper and Sphinkeeper
15.4.2 Fenix Device
15.4.3 Silastic Band
15.5 SECCA Radiofrequency Treatment
15.6 Dynamic Anal Neosphincters
15.6.1 Dynamic Graciloplasty
15.6.2 Artificial Bowel Sphincters
15.7 Sacral Nerve Stimulation
15.8 Last Options for Patients Unsuccessfully Treated for Fecal Incontinence
15.9 Conclusions
References
Part IV: Special Considerations and Multidisciplinary Perspectives
16: Cesarean Section Delivery to Prevent Anal Incontinence
16.1 Introduction
16.2 Anal Incontinence and Mode of Delivery
16.3 Conclusions
References
17: Interrelatedness of Urological Conditions and Anal Incontinence
17.1 Introduction
17.2 Urological Diseases Associated with Anal Incontinence
17.2.1 Prostate Cancer
17.2.1.1 Anal Incontinence After Radical Prostatectomy
17.2.1.2 Anal Incontinence After Radiotherapy for Prostate Cancer
17.2.2 Anal Incontinence Following Radical Cystectomy for Bladder Cancer
17.3 Coexistence of Anal Incontinence and Lower Urinary Tract Symptoms
17.4 Urinary Tract Infections in Patients with Anal Incontinence
References
18: Coexistence of Fecal Incontinence and Constipation
18.1 Introduction
18.2 Evidence from Clinical Studies
18.3 Patients’ Quality of Life
18.4 Pathophysiology
18.4.1 Rectal Overflow
18.4.2 Incomplete Rectal Emptying
18.4.3 Pelvic Floor Weakness
18.5 Diagnosis and Therapy
References
19: Gut Microbiota Characterization in Fecal Incontinence and Irritable Bowel Syndrome
19.1 Introduction
19.2 Clinical Features
19.3 Epidemiology and Risk Factors
19.4 Diagnosis
19.5 Pathophysiology
19.6 Gut Microbiota Characterization
19.7 Gut Microbiota Modulation
19.8 Conclusions
References
20: Low Anterior Resection Syndrome
20.1 Definition and Risk Factors
20.1.1 Anal Sphincter Injury
20.1.2 Type of Anastomosis and Configuration of the Neorectum
20.1.3 Motility of Neorectum
20.1.4 Neoadjuvant Radiotherapy/Radio-Chemotherapy
20.1.5 Total Mesorectal Excision and Height of Anastomosis
20.1.6 Diverting Stoma (Ileo-Colostomy)
20.2 Prevalence
20.3 Diagnosis
20.3.1 LARS Score
20.4 Treatment
20.4.1 Medical Treatments
20.4.2 Physiotherapy
20.4.3 Transanal Irrigation
20.4.4 Neuromodulation
20.4.5 Stoma
References
21: Incontinence-Associated Dermatitis: An Insidious and Painful Condition
21.1 Introduction
21.2 Prevalence
21.3 Pathophysiology
21.4 Risk Factors
21.5 Clinical Presentation
21.6 Differential Diagnosis
21.7 Management: Prevention and Treatment
21.7.1 Absorbent Devices: Diaper Selection
21.7.2 Skin Cleansing Techniques
21.7.3 Skin Care Products
21.7.4 Structured Skin Care Regimen
21.8 Conclusion
References
22: Perineal Descent and Incontinence
22.1 Introduction
22.2 Definition and Diagnosis
22.3 Pathophysiology
22.4 Principles of Treatment
References
23: Reconstruction of Wide Anal Sphincter Defects by Crossing Flaps of Puborectalis Muscle
23.1 Introduction
23.2 Rational Bases for Crossing Flaps of Puborectalis Muscle
23.3 Exclusion Criteria
23.4 Surgical Technique
23.4.1 Wide Defect of the Lateral Anal Sphincter
23.4.2 Anterolateral or Circumferential Sphincter Defect
23.4.3 Anterolateral Sphincter Defect Associated with Rectovaginal Fistula
23.4.4 Rectovaginal Cloaca
23.5 Results
23.6 Conclusions
References
24: Treatment Cost Reimbursement in Italy
24.1 Introduction
24.2 DRG Surgical Procedures for Fecal Incontinence
24.3 Reimbursement of DRGs
24.4 Reimbursement of Perineal Pelvis Rehabilitation
References
