Pelvic floor function bowel disorders in gynaecology TOG 2020 Flashcards
How common is faecal incontinence?
10% population
50% those in nursing home
What scoring system can be used to score incontinence?
St Marks Incontience Score sheet
What proportion of women who have had a vaginal delivery are effected by anal incontinence?
13-25%
What Ix can assess sphincter pathology?
Endoanal USS , probe gently inserted into the anal canaal to depth 6cm
What is anorectal mamometry?
Objectively measure the pressure of anal sphincter muscles at rest and during squeeze
The internal anal sphincter is responsible for what portion of the pressure in resting period?
52-85%
65-85mmHg
Maximal resting region 1-1.5cm above anal verse
A squeeze should increase the anal pressure by how much vs resting pressure
Double the value
What investigation can be used to assess pudendal nerve?
Pudenal nerve terminal motor latency - stimulate pudenal nerve as it transverses ischial spin. Measure contraction.
Normal contraction within 1.9 seconds, higher values may indicated pudendeal nerve injury
Initial management
Dietary changes
Drink 1.5L if hard stoool
Food diary
Toilet after meal
Pelvic floor training, bowel retiring, electrical stimulation, rectal irrigation
What other specilist management options
Tibial nerve stimulation
Sacral nerve modulation
Surgery - if full length external anal sphincter defect >90 or greater on USS
How common is chronic consiption
14% population
40% pregnancy
Which criteria can be used for Dx chronic constiption?
Rome IV criteria
4 main groups of idiopathic constipation?
1.Slow transit constipation
2.Obstructed defection syndrome
3. Constipation - IBS
4. mixed slow transit and obstructed defaecation
Drugs associated with constipation
Aluminium-containing antacids; iron or calcium supplements
Analgesics, such as opiates and nonsteroidal anti-inflammatory drugs
Antimuscarinics, such as procyclidine and oxybutynin
Antidepressants, such as tricyclic antidepressants; antipsychotics, such as amisulpride, clozapine or quetiapine
Antiepileptic drugs, such as carbamazepine, gabapentin, oxcarbazepine, pregabalin or phenytoin
Antihistamines, such as hydroxyzine
Antispasmodics, such as dicycloverine or hyoscine
Diuretics, such as furosemide; calcium-channel blockers, such as verapamil.
If no response to lifestyle measures 1st line laxative
Bulk forming e.g. isphagula (unless taking opioids)
Grades of haemorrhoids
