Predictors of outcome in treatment trialsPhysiologic variables that predict the outcome of treatment for fecal incontinence
Section snippets
Physiologic variables related to fecal incontinence
A thorough understanding of the physiologic variables involved in maintaining normal continence can help provide the basis for an improved perspective of the pathologic dysfunction leading to fecal incontinence. The anal sphincter lies at the distal aspect of the rectum, and the anal canal extends 3–4 cm from the anal verge to the anorectal ring (Figure 1). The anal canal is richly innervated, with the region above the dentate line receiving its neural supply from the sympathetic and
Risk factors for developing fecal incontinence
Risk factors for developing fecal incontinence include a history of urinary incontinence, the presence of neurologic or psychiatric disease, poor mobility, age older than 70 years, and dementia.3, 25 The most common condition predisposing to fecal incontinence in the elderly is fecal impaction, which occurs in up to 42% of the institutionalized elderly.25 Among younger persons, sphincter trauma (often associated with childbirth or surgery) is the most common cause. Table 1 summarizes the main
Physiologic variables that may predict outcomes in the treatment of fecal incontinence
Traditional treatments for fecal incontinence have included biofeedback and surgery. The identification of physiologic factors predictive of response to therapy would be helpful in choosing the optimal treatment and advising patients on the likelihood of a successful outcome. Likewise, it would be valuable to determine factors that are not important in predicting positive or negative outcomes. To date, however, few physiologic parameters have been consistently identified as important in
Summary and research recommendations
Physiologic variables in fecal incontinence include anal sphincter and extrasphincteric processes. Anorectal mechanisms have been extensively studied, and there is reasonable consensus regarding the importance of rectal sensation and the use of sensory training in biofeedback therapy. Future studies may be usefully directed toward predicting outcome success based on pretreatment anorectal sensation or response to sensory retraining (e.g., reduction in the threshold for sensation). In such
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Factors Associated With Response to Anorectal Biofeedback Therapy in Patients With Fecal Incontinence
2021, Clinical Gastroenterology and HepatologyPerineal retraining improves conservative treatment for faecal incontinence: A multicentre randomized study
2014, Digestive and Liver DiseaseCitation Excerpt :The voluntary squeeze duration at baseline was indeed associated with a better response in our study, but the voluntary squeeze pressure was not. In the literature, pre-treatment anal sphincter pressures have not been shown to predict the outcome of BFB retraining [26]. On the other hand, better anal function at baseline in the standard care group may have been responsible for the lack of detectable effects of BFB therapy.
Surgical treatment of fecal incontinence
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