Anal incontinence


Introduction

Anal incontinence is the inability or difficulty in retaining stools and gases. It usually occurs unintentionally and at undesired times, being a significant limitation of personal, social and working life.

The most common cause in women is a trauma to the anal sphincter induced by vaginal delivery that may result in an injury or weakness of the muscles that control defecation.

Incontinence can occur after delivery, or years later, when other factors are added, such as physiological aging of the muscle and ligamentous structures of the pelvis. Other common causes, in both sexes, are anal fistula surgery, haemorrhoids and fissure, rectal cancer surgery, rectal prolapse, rectocele, and some neurological diseases.

Mild faecal incontinence can be treated with dietary changes, medication, and rehabilitation of the anorectal function.


Treatment

Patients who do not have a structural lesion of the anal musculature should be treated initially with dietary, pharmacological measures and with rehabilitation of the pelvic musculature.

If there is no-response to medical and rehabilitation treatment, there are surgical options. In case of muscle injury, sphincter repair is indicated. If this surgery is not enough (or in case of patients with integral sphincters), it is possible to improve anal control by implanting prostheses or infiltrating products, which increase muscle thickness. Another new treatment is anal lipofilling or infiltration of stem cells from the patient’s own fat, to increase muscle volume.

In patients with severe incontinence or when other treatments have not brought any benefit, the stimulation of sacral roots may be used.

Stimulation or neuromodulation of sacral roots is an innovative minimally invasive treatment that can be performed with local anaesthesia on an outpatient basis. It consists in stimulating one of the nerves that controls the function of the anal sphincter, rectum and perineal musculature through an impulse generator that works as a pacemaker. In patients with faecal and urinary incontinence, both problems are often corrected.

In other cases, or when less invasive treatments have failed, the implant of an artificial anal sphincter that the patient activates and deactivates may be evaluated, according to his/her needs of passing stool.


Benefits

The expected result after the application of the treatment is the significant decrease or disappearance of involuntary losses of stools and gases with a significant increase in quality of life, improvement of self-esteem and recovery of safety in social and working relationships.



Expert opinion

Dr. Domenico Fraccalvieri
Dr.  Domenico Fraccalvieri


Faecal incontinence represents a very invalidating health problem, a source of shame, depression, isolation and deterioration of the quality of life; however, today it is a disease with solution for patients of any age. The choice of treatment will depend on a correct evaluation of symptoms, causes and severity of the case.

Implanting small prostheses between the anal muscles through minimal incisions is a new, painless and effective treatment for patients with mild to moderate incontinence. The treatment of stimulation of sacral roots is the technique that offers the highest rate of success in the most serious situations, regardless of the cause of incontinence. In many patients with double incontinence (faecal and urinary), this treatment may improve significantly both problems.


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