Exxcellence pearls: fecal incontinence Flashcards
What is the prevalence of fecal incontinence in US?
8.9% of women with 15% of those older than 70 affected.
What is the difference between fecal incontinence and anal incontinence?
Fecal incontinence means involuntary loss of liquid or solid stool whereas anal incontinence includes the loss of gas.
What are risk factors for obstetric anal sphincter injury?
Operative vaginal delivery, primaparity, episiotomy, occiput posterior position, macrosomia, prolonged second stage.
What is the dentate line? Describe the histology and innervation of flanking tissues.
Separation between the anus and rectum characterized by stratified epithelium with somatic nerves versus columnar epithelium and autonomic innervation.
What percentage of women will have an anal sphincter defect who present with fecal incontinence?
Approximately 75% of primiparous women.
What is the differential diagnosis for fecal incontinence?
Chronic diarrhea such as infection, malabsorption, irritable bowel
Overflow incontinence from fecal impaction
Colorectal neoplasms
Anatomic injury to the anal sphincter complex
Neuropathic dysfunction
What diagnostic tests are helpful in evaluating fecal incontinence?
Colonoscopy, endoanal ultrasonography, anal manometry
What historical features should be considered for fecal incontinence?
Onset and duration of symptoms, quality and consistency of stool that is stored versus leaked, bowel habit history. Past medical, surgical, obstetrical history.
What physical exam features should be evaluated for fecal incontinence?
Perineal skin for soiling, “dovetail” sign, presence of tissue that may preclude anal coaptation, perineal body length, evaluation of pelvic organ prolapse, neurological exam including pinprick and light touch discrimination and bulbocavernosus reflex, rectal exam to assess for masses and resting and squeeze anal tone.
What other treatments can be considered after medical management fails for fecal incontinence?
Biofeedback and surgery such as sphincteroplasty
What medications should be considered for relief of fecal incontinence?
Medications to decrease colonic motility such as loperamide (Imodium) and cholestyramine
Stool-bulking agents such as Citrucel and Metamucil
