Fecalincontinence.ppt

Fecal incontinence Tova Rainis Gastroenterology unit Bnai-zion Introduction Common medical problem that is under-reported to physicians Second leading cause of nursing home placement, more common than dementia Some degree of fecal incontinence will develop in 3% of women who give birth by vaginal delivery Pathophysiology and etiology Partial incontinence – loss of control to flatus and minor soiling Major incontinence – frequent and regular deficiency in the ability to control stool of normal consistency Four basic physiologic factors: stool consistency, rectal compliance, rectal and anal sensation pelvic floor function can lead to a defective continence mechanism Incontinence with normal pelvic floor function Altered stool consistency Inflammatory bowel disease Infectious diarrhea Laxative abuse Radiation enteritis Short bowel syndrome Malabsorption syndrome Incontinence with normal pelvic floor function - 2 Inadequate rectal compliance Inflammatory bowel disease Absent rectal reservoir (ileoanal, low ant. resection) Rectal ischemia Collagen vascular disease (scleroderma, amyloidosis, dermatomyositis) Rectal neoplasms Incontinence with normal pelvic floor function -3 Inadequate rectal sensation Dementia, CVA, MS, brain or spinal cord injury/neoplasm, sensory neuropathy, tabes dorsalis Overflow incontinence Fecal impaction – leading cause of incontinence in institutionalized elderly patients Diabetes – multifactorial, impaired rectal sensation is important Incontinence with abnormal pelvic floor function Anatomic sphincter defect – internal or external Traumatic Obstetric injury – prolonged difficult labor with forceps application, episiotomy complications, third or fourth-degree lacerations Anorectal surgery – anal fistula surgery - most common operative procedure that results in fecal incontinence; hemorrhoidectomy Incontinence with abnormal pelvic floor function - 2 Pelvic floor denervation – degenerative neurogenic factors are a common cause of n