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FECAL INCONTENCE
FECAL INCONTENCE
NORMAL CONTINENCE
INCONTENCENCE - TYPES
Sensory
Motor
Urgency
Radiation, IBD
Poor reservoir
Soiling
FUNCTIONAL
Diarrhoea/diarrhe
Overflow
SPHINCTER DEFECT
Congenital
Imperforate anus
Spina bifida
Trauma
Obstetric
Fistulotomy
Haemorrhoidctomy
Sphincterotomy
Anal stretch
Disease
Tumor
Rectal prolapse
TRAUMA
WOWNESS!
Its
FABULOUS!
Oh wait my
chin hurts a
bit
OBSTETRIC INJURY
Pudental neuropathy
May be asymtomatic worsen
with time
Neurological
Pudendal neuropathy
Diabetes
Degenerative
Spinal cord injury
idiopathic
ASSESSMENT - HISTORY
Details of incontinence
Frequency
Nature solid, liquid & gas
CONTINENCE SCORING
SYSTEM
EXAMINATION
Underwear, pads
General physical
Perineal deformity, scars
Perineal descent
Prolapse
Rectal exam
Resting + squeeze pressure
Perineal sensation
INVESTIGATION
Colonoscopy
Manometry
EUS
MRI
PNTML
ENDOANAL
ULTRASONOGRAPHY
MRI
multi-planar capability
Higher inherent
Contrast resolution than EUS
Not operator dependent
More expensive
IAS hyperintense, EAS hypointense
Good for EAS atrophy
MANOMETRY
Sphincter
Rectal balloon
Sensation
Compliance
Capacity
RAIR
CONSERVATIVE
MANAGEMENT
SURGICAL OPTIONS
Sphincter repair
Injectable agents
Sacral nerve stimulation
Dynamic graciloplasty
Artificial sphincter
Stoma
ACE
ANTERIOR SPHINCTER
REPAIR
EAS defect
Overlapping vs
direct apposition
80% improved
Function
deteriorates with
time
INJECTABLE AGENTS
IAS pathology
Silicone
biomaterial
Submucosal vs
intersphincteric
Approx 50 to 70%
gain >50%
improvement
SACRAL NERVE
STIMULATION
Good results up to
90% report
improvement
DYNAMIC GRACILOPLASTY
ARTIFICIAL BOWEL
SPHINCTER
Not recommended
for routine use
Only in cases of
STOMA
not without
complication
Parastomal hernia
Mucus leakage
Diversion colitis
MANAGEMENT OF FECAL
INCONTINENCE
NURSING ASSESSMENT
NURSING DIAGNOSIS
FI