GASTROENTEROLOGY ARTICLE OF THE WEEK
April 4, 2002
Rudolph W, Galandiuk S. A practical guide to the diagnosis and management of fecal incontinence. Mayo Clin Proc 2002;77:271-275.
1. In the treatment of incontinence
a. Bulk agents are of no benefit
b. Loperamide is superior to diphenoxylate in the treatment of patients with diarrhea and incontinence because loperamide increases internal anal sphincter tone
c. Enemas can be used to treat incontinence in patients with solid stool incontinence who do not have diarrhea.
d. Biofeedback therapy may be helpful for patients developing incontinence after anal surgery.
True or False
2. Repair of rectal prolapse restores continence in >80% of patients.
3. Incontinence due to anal sphincter trauma during childbirth manifests itself within 6-12 months after delivery.
4. Hemorrhoid surgery may lead to fecal incontinence by damaging the nerves involved in maintaining continence.
5. The most common cause of incontinence is rectal prolapse
6. A rectal examination in the left lateral decubitus position that does not demonstrate rectal prolapse is sufficient evidence that prolapse is not present.
7. Anorectal manometry is superior to endoanal ultrasonography in assessing anal sphincter integrity.
8. If anorectal EMG studies show pudendal nerve damage, surgical correction of incontinence (sphincteroplasty) is less likely to be effective.
9. Surgical options in the treatment of incontinence include
a. Hemorrhoidectomy in cases with large prolapse hemorrhoids
b. Sphincteroplasty in cases with pudendal nerve injury
c. Sphincter repair in cases of incontinence due to sphincter disruption
d. Correction of rectal prolapse if present
e. Experimental procedures for those unable to undergo sphincter reconstruction.