Isuzu Meyer

An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women

Fecal incontinence (FI) is a debilitating disorder that negatively impacts quality of life. The etiology often is multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI also can be hindered by a lack of understanding of the mechanisms and current options. This article provides a review of the evidence-based evaluation and management for FI.

Evidence-Based Update on Treatments of Fecal Incontinence in Women

Fecal incontinence is a highly prevalent and distressing condition that has a negative impact on quality of life. The etiology is often multifactorial, and the evaluation and treatment of this condition can be hindered by a lack of understanding of the mechanisms and currently available treatment options. This article reviews the evidence-based update for the management of fecal incontinence.

The Differential Impact of Flatal Incontinence in Women With Anal Versus Fecal Incontinence.

Objective The differential impact on quality of life (QOL) that leakage of both stool and flatus confers on women compared with stool only is unclear. Our aim was to characterize differences in symptom distress, impact on QOL, and anorectal testing among women with leakage of stool and flatus, stool only, and flatus only. Methods A retrospective review was conducted of women undergoing evaluation of at least monthly bowel incontinence symptoms. Subjects were divided into the following 3 groups: liquid/solid stool and flatus (anal incontinence [AI]), liquid/solid stool only (fecal incontinence [FI]), and flatal only (FL). Baseline assessment included the Modified Manchester Health Questionnaire (MMHQ) including the Fecal Incontinence Severity Index (FISI), Short Form-12 (SF-12), as well as anorectal manometry and endoanal ultrasound evaluations. Results Of 436 subjects, 381 had AI, 45 FI, and 10 FL. Significant between-group differences were noted in MMHQ (P = 0.0002) and FISI total scores (P < 0.0001) where women with AI reflected greater negative impact than women with FI. The Short Form-12 (mental and physical component summary scores) scores were similar in all 3 groups (P = 0.22, 0.08). Resting/squeeze pressures were significantly lower in AI and FI groups compared with FL (P = 0.0004), whereas rectal capacity was similar in all 3 groups. Although exploratory, MMHQ scores were similar between FI and FL groups, although FISI scores were higher in the FI group (P < 0.0001). Conclusions Women with AI have higher symptom specific distress and greater negative impact on QOL compared with women with FI. Treatment of all bowel incontinence symptoms is important to improve symptom-specific and general QOL.

Impact of age on mid- to long-term outcomes of transvaginal native tissue repair for apical vaginal prolapse

To compare surgical success rates in older versus younger women a minimum of 3 years post transvaginal native tissue repair for apical prolapse. Post‐operative symptom severity and quality of life improvement, surgical complications and retreatment were also examined.

Epidemiology, Pathophysiology and Management of Fecal Incontinence in the Older Woman

Purpose of ReviewTo review up-to-date management of fecal incontinence in older women, highlighting age-related issues.Recent FindingsFecal incontinence is highly prevalent in older women. The etiology is multifactorial; however, advanced age itself has been found to be an independent risk factor. Understanding age-related physiologic and anatomic changes and unique challenges in the geriatric population is critical in order to offer effective therapy. Evaluation should start with obtaining a thorough history and physical examination, and diagnostic tests should be reserved for refractory symptoms or specific conditions. Simple conservative approaches can be effective and should be offered without diagnostic testing. More treatment options have recently become available or are currently being investigated in an effort to provide higher long-term efficacy and safety.SummaryTreatment of fecal incontinence in older women can be challenging and often complicated by decreased health and functional status. Management should be individualized based on the patient’s health status, clinical setting (ambulatory versus institutionalized), preference, and goals of therapy.

Parturition pit: the bony imprint of vaginal birth.

PurposeTo retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data.Materials and methodsWe retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits.Results482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (p < 0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p < 0.0001). No males had pits.ConclusionOur study indicates that parturition pits are associated with prior vaginal birth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists.

Pelvic Floor Symptoms and Spinal Curvature in Women.

Objectives To characterize the association between thoracic (T) and lumbar (L) spinal curvature and pelvic floor (PF) symptoms (pelvic organ prolapse, urinary incontinence [UI], fecal incontinence [FI]). Methods Of women undergoing a bone mineral density scan from January 2007 to October 2010, patients who completed PF symptom questionnaires and had T and/or L spine radiographs or computed tomography examinations within 3 years of questionnaire completion were included in this study. The spine angles were measured using the Cobb angle method. The T and L curvatures were categorized as hypokyphosis (<20°), normal T kyphosis (20–40°), hyperkyphosis (>40°), hypolordosis (<40°), normal L lordosis (40–70°), and hyperlordosis (>70°). The presence and type of UI were identified with the 3 Incontinence Questionnaire and FI with the Modified Manchester Questionnaire. Pelvic organ prolapse was defined as a positive response to the presence of a bulge question from the PF Distress Inventory-20. Results Of 1665 eligible women, 824 and 302 (mean age 64 ± 10 for both) had T and L spine images, respectively. No differences in PF symptoms were observed in the T or L spine groups categorized by hypo-, normal, and hyperkyphosis/lordosis except for urgency UI being more prevalent in the hypolordosis group (P = 0.01). However, upon further characterization using logistic regression, no association was noted between PF symptoms and T or L spine angles; no differences in the mean angles were found between women with versus without PF symptoms (P ≥ 0.05). Conclusions The current study shows that the T and L spinal curvatures are not associated with the presence of PF symptoms.

Evolving Surgical Treatment Approaches for Fecal Incontinence in Women

Fecal incontinence (FI) is a physically and psychosocially debilitating condition which negatively impacts quality of life. Surgeries continue to be considered, especially for patients who have been refractory to conservative management approaches. In the past decade, research and development in diagnostic testing has facilitated an increased understanding of this multifactorial disorder and has yielded the development of more treatment options for our patients. This article will review the evidence-based approach for the traditional surgical procedures as well as more recently developed procedural options for the surgical management of FI.