Ewha Med J.  2022 Oct;45(4):e9. 10.12771/emj.2022.e9.

Is It a Refractory Disease?- Fecal Incontinence; beyond Medication

• Lee C
• Lee JL

• KMID: 2534747
• DOI: http://doi.org/10.12771/emj.2022.e9

Abstract

Fecal incontinence (FI) is recurrent uncontrolled passage of fecal material in patients. The life expectancy of humans has increased. Elderly patients have a significant rate of FI. Therefore, the number of patients with FI will increase. For diagnosis of FI, the digital rectal exam, ultrasonography, and anal manometry are used. In addition, the severity of FI can be assessed using the FI score system by examining symptoms. Recent applications include three-dimensional ultrasonography and other novel approaches. The treatments for FI include biofeedback therapy, anal implant, artificial sphincter, nerve modulation, SECCA, stem cell therapy, and surgical intervention. Biofeedback therapy is a noninvasive procedure. Anal implant, stem cell therapy, and SECCA are all minimally invasive treatments. And more methods constitute intrusive treatment. None of these therapies has been conclusively demonstrated to be superior. Depending on the severity of the symptoms, a non-invasive approach or an intrusive treatment is most frequently employed. In this review, I will discuss the diagnosis and treatment options for FI.

Keyword

Fecal incontinence; Treatment outcome; Implantable neurostimulators; Surgery; Stem cell transplantation

Figure

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  Fig. 1. 3D-pelvic floor ultrasonography. (A) Minimal levator hiatus (MLH), (B) mild levator ani deficiency (LAD) score, (C) severe LAD score, (D) levator ani muscle avulsion. Red dot-ted line, MLH area; asterisk, avulsion site. A, anus; PR, puborectalis muscle; PS, pubic symphysis; PV, pubovisceralis muscle; V, vaginal [31]. Adapted from Jeong et al. [31] with CC-BY-NC.

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  Fig. 2. Biofeedback therapy. An electrical device capable of monitoring the physiological activity of the anus is attached to the patient. The patient looks at the monitor and practices contraction and relaxation of the anus.

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  Fig. 3. Sacral nerve stimulation. An electrical device is inserted in subcutaneous of patient's lumbar region. This device controls the anus by providing electrical stimulation to the sacral nerve and its associated muscles.

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  Fig. 4. Anal plug. This device is designed for self-insertion and natural expulsion with defecation.

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  Fig. 5. Vaginal bowel control system. (A) Vaginal bowel control system. (B) It is a balloon-shaped structure that is inserted into the vagina. By applying pressure by hand, the balloon inflates and pressure is applied to the rectum to control the stool.

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  Fig. 6. SECCA procedure. A device that uses temperature-controlled radiofrequency energy is inserted into the anus of the patient. This device stimulates the patient's anus, causing the anal sphincter to tighten.

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  Fig. 7. Artificial sphincter. A cuff-shaped structure is wrapped around the anus and inserted (A) male, (B) female. Continence is maintained normally. Patient needs to press the pump located in the testicles or perineum for defecation. Then, cuff is closed naturally after defecation.

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  Fig. 8. Transposition of gracilis muscle. (A) This procedure is mobilization of the gracilis muscle, (B) transposition of the muscle around the anus and fixation to the contralateral ischial tuberosity.

Reference

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