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A Journal on Surgery

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Chirurgia 2005 October;18(5):255-62

language: English

Management of anorectal incontinence in adults

Kouraklis G., Andromanakos N.


Anorectal continence has been defined as the ability to control defecation voluntary, to sense the quality of rectal contents, and to maintain nocturnal control. Various causes may produce damage in the anatomy and the innervation of the pelvic floor muscles as well as in the anorectal sensitivity and rectal compliance. Diarrheal states, as well as sphincter trauma are significant causes of fecal incontinence. Frequently, the cause of the anorectal incontinence is idiopathic. The diagnosis is achieved by a good history, physical examination, and selective specialized investigations. An increasing number of treatments have become available to manage fecal incontinence. The management of the incontinent patients may be conservative (medicinal, biofeedback training, and electrical stimulation), surgical (sphincter repair, postanal repair, neosphincter formation), or sacral nerve stimulation, after the accurate diagnosis of the incontinence cause. The surgical procedure is selected as of choice treatment in patients when the structural and functional defects in the pelvic floor muscles or the anal sphincter complex can be corrected mechanically. Neosphincter procedures include a gluteoplasty, non-stimulated unilateral or bilateral graciloplasty and artificial bowel sphincter. The newest alternative, sacral nerve stimulation seems promising.

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