#210 Fecal Incontinence Flashcards
Fecal incontinence is estimated to affect what % of community-dwelling women?
7-15%
What % of women that self-report fecal incontinence will have this diagnosis in their medical record?
<3%
What is the definition of fecal incontinence?
Recurrent, involuntary loss of solid or liquid stool or mucus from the rectum
What is the definition of anal incontinence?
Recurrent, involuntary loss of solid or liquid stool or mucus from the rectum, but also includes loss of flatus with or without the loss of liquid and solid stool.
What is the risk of fecal incontinence in age 20-29? Adults 70 years and older?
- 6% in age 20-29.
15. 3% in age 70+
Is fecal incontinence more prevalent in men or women?
Similar. Women 8.9%; Men 7.7%
What % of individuals with fecal incontinence symptoms do not seek help or report them to their health care provider?
75-80%
What are common nonneurologic etiologies of fecal incontinence?
Diarrheal diseases, IBD, fistula, severe constipation with overflow, rectal prolapse, hemorrhoids, sphincter lacs/anal trauma, systemic diseases, medications
What are risk factors associated with fecal incontinence?
Loose or watery stools, increased frequency of stools (more than 21 per week), two or more chronic illnesses. Urinary incontinence, obesity, smoking, increasing age, decreased physical activity, anal intercourse, hx of OASIS, hx pelvic irradiation, other med comorbidities (eg DM, IBD)
What are nonsurgical treatment options for fecal incontinence?
Protective devices, dietary manipulations (fiber, fluid), anticonstipation meds, fiber supplement, antidiarrheal med, pelvic floor physical therapy, devices (anal plugs, vaginal bowel control devices)
What is an invasive, non surgical option for management of fecal incontinence?
Perianal tissue bulking injection
What surgical options are available for treatment of fecal incontinence?
Neuromodulation, anal sphincter repair, radiofrequency anal sphincter remodeling, sphincter muscle transposition, artificial anal sphincter, colostomy
What questions should be asked regarding symptom assessment for fecal incontinence?
Questions about type and timing of accidental bowel leakage (solid, liquid, gas, mucus), frequency, severity (volume), relationship to fecal urgency, and effective on daily activities and quality of life
What is the name of the scale that describes form of stool?
Bristol stool form scale
What is the “dovetail” sign (Re: Fecal incontinence)?
Loss of the normal puckering around the anus anteriorly – may indicate a disruption of the external anal sphincter
What is the sensitivity and specificity of the digital rectal examination for detection of complete anal sphincter disruption?
82% sensitivity
32% specificity
Why do stool-modifying agents help with fecal incontinence?
Improve stool consistency because the fecal continence mechanism works best for patients with formed, bulky, soft stool
What symptoms are associated with rapid increase in fiber intake?
Flatus, bloating, abdominal cramping
How many grams of fiber should a woman consume per day (ages 19-30, 31-50, 51+)?
19-30yo: 28g
31-50yo: 25.2g
51+yo: 22.4g
What is the medical mainstay therapy for overflow fecal incontinence associated with constipation or impaction?
Osmotic laxatives such as lactulose or polytheylene glycol
In which cases of fecal incontinence would you primarily offer surgery prior to lifestyle changes?
Fistulas or rectal prolapse
True or false, fecal incontinence surgeries are associated with longterm improvement in symptoms
False. Provide only short-term improvement (3-6mo)
What neuromodulation exists to address fecal incontinence?
Sacral nerve stimulation and peripheral tibial nerve stimulation
What nerve is targeted with sacral nerve stimulation?
Third sacral nerve root
True or false, sacral nerve stimulation is a treatment option for women with fecal incontinence with or without anal sphincter disruption?
True
What typical adverse events can occur after sacral nerve stimulation?
Pain, infection, lead migration, hematoma, need for battery replacement or revisions to the wire or battery pocket site
Is end-to-end or overlapping manner of sphincteroplasty better?
Similar outcomes
What is radiofrequency anal sphincter remodeling?
Radiofrequency energy is directed toward the submucosa at the anorectal juncture to create scarring and fibrosis of the anal sphincter. Currently no data from high-quality studies to support its use
For how long would you expect anal sphincter bulking agents to be effective in decreasing fecal incontinence episodes?
Up to 6 months
Which women are candidates for anal sphincteroplasty?
Women with anal sphincter disruption and fecal incontinence symptoms who have failed conservative treatments
Which women with fecal incontinence should be considered for colonoscopy?
Change in bowel habbits especially with “red flag” symptoms, including unexplained weight loss, abdominal pain, rectal bleeding, melena, or anemia.
