Fecal Incontinence: Evaluation and Treatment [sounds like]
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Fecal Incontinence: Evaluation and Treatment- Key Concepts
- Introduction
- Evaluation
- History and Physical Exam
- Anorectal Manometry
- Ultrasound
- Neurophysiology Testing
- Defecography
- Colonoscopy
- Treatment
- Anal Sling
- Conservative Treatment
- Surgical Sphincter Repair (Sphincteroplasty)
- Ventral Rectopexy
- Gracilis Muscle Transposition
- Magnetic Anal Sphincter Augmentation
- Artificial Bowel Sphincter
- Pelvic Floor Exercises
- Anal Insertion Device
- Vaginal Bowel Control System
- Sacral Neuromodulation
- Bulking Agents
- Percutaneous Tibial Nerve Stimulation
- Radiofrequency Energy Delivery
- Stem Cell Therapy
- Treatment Failure
- Conclusion
- References
Fecal Incontinence (2023)
Management of Fecal Incontinence (2023)- METHODOLOGY
- Certainty of Evidence
- EVALUATION
- A History Should Be Obtained to Help Determine the Cause of Incontinence and Should Include Specific Risk Factors for Incontinence and Characterize the Duration and Severity of Symptoms
- Measures That Assess the Nature and Severity of Incontinence and the Impact of Incontinence on Quality of Life Should Be Used as a Part of the Assessment of FI
- Anorectal Physiology Testing (Manometry, Anorectal Sensation, Volume Tolerance, and Compliance) Can Be Considered to Help Define the Elements of Dysfunction and Guide Management
- NONOPERATIVE MANAGEMENT
- Dietary and Medical Management Are Recommended as First-Line Therapy for Patients With FI
- Vaginal Mechanical Inserts Are Not Routinely Recommended for FI
- Anal Mechanical Insert Devices Are Not Routinely Recommended for FI
- SURGICAL MANAGEMENT
- Sacral Neuromodulation May Be Considered as a First-Line Surgical Option for Incontinent Patients With or Without Sphincter Defects
- Injection of Biocompatible Bulking Agents Into the Anal Canal Is Not Routinely Recommended for the Treatment of FI
- Application of Temperature-Controlled Radiofrequency Energy to the Sphincter Complex Is Not Recommended to Treat FI
- Antegrade Colonic Enemas Can Be Considered in Highly Motivated Patients Who Are Seeking an Alternative to a Stoma
- References
- Treatment of Rectal Prolapse (2017)
- Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments
Pelvic Floor- A 75-year-old female patient with fecal incontinence presents for stage 1 sacral neuromodulation. Upon lead stimulation, which of the following findings would be associated with optimal lead position?
- A 75-year-old man with a remote history of fistulotomy and radiation therapy for prostate cancer presents for evaluation of his worsening fecal incontinence. He has poor sphincter tone and a palpable muscular defect. Anal manometry confirms diminished resting and squeeze pressures that do not improve after pelvic floor physical therapy with biofeedback. His symptoms persist despite bowel habit optimization and sacral nerve stimulator implantation. The best next option for ths patient is
- Common Tests for the Pelvic Floor
Pelvic Floor- Malignancy
- A 53-year-old man with rectal cancer starting at 2 cm from anorectal ring presents to the office to discuss further management. He has undergone chemoradiation and consolidation FOLFOX chemotherapy for cT3N1aM0 microsatellite proficient tumor. He has a partial response with a residual palpable mass. He normally has up to five bowel movements per day with urgency and fecal leakage. What is the best next surgical treatment for him?
- A healthy 51-year-old man has a poorly differentiated right colon adencarcinoma with mucinous features and mismatch repair (MMR) deficient protein expression. After germline testing was performed, a diagnosis of Lynch syndrome made. The patient reports no issues with incontinence to gas or stool. What is the recommended surgery in this patient?
- Anorectal Disease
- A 29-year-old patient presents with an anovaginal fistula following a vaginal delivery 2 years ago and which was complicated by a fourth-degree perineal laceration. She reports incontinence to gas and liquid stool. Digital rectal examination demonstrates diminished sphincter tone, and anoscopy reveals a 1-cm internal fistula opening in the anterior midline at the dentate line. The most next appropriate step is
- A 45-year-old man, who reports sex only with men (MSM), has been referred to you for evaluation of a whitish anorectal lesion identified on initial screening colonoscopy. Biopsies confirmed high-grade squamous intraepithelial lesion (HSIL), for which he ultimately underwent excision and fulguration. What is the recommended surveillance?
- Rectal Prolapse
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- Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula (2022)
- Anorectal Disease
- You are asked to evaluate a 73-year-old man with a rectourethral fistula confirmed on computed tomography cystogram. It is 2 years since he underwent radiation therapy for prostate cancer. What is the best approach for definitive fistula repair using a muscle flap?
- A 52-year-old woman presents with a distal recurrent rectovaginal fistula after 2 failed endorectal advancement flap repairs. She had normal findings on colonoscopy and endorectal ultrasonography confirmed a rectovaginal fistula in the very distal rectum with an intact sphincter complex and seton in place. What is the best next surgical treatment?
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