A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? … Fecal Incontinence: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar)
Medical history (history of illness) represents an important component in the diagnosis of fecal incontinence. Family history What is the general health of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Current medical history/systemic history (somatic … Fecal Incontinence: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Absence of angulation (kinking) of the colon. Anal atresia – lack of anoderm (anal mucosa) leads to limited sensitivity at the anus, which can lead to overflow incontinence Endocrine, nutritional and metabolic diseases (E00-E90). Diabetes mellitus Fructose intolerance (fruit sugar intolerance) Lactose intolerance (lactose intolerance) Sorbitol intolerance Cardiovascular … Fecal Incontinence: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by fecal incontinence: Skin and subcutaneous (L00-L99). Skin infections, unspecified Skin irritations, unspecified Incontinence-associated dermatitis/inflammatory reaction of the skin (IAD); DD (differential diagnoses) decubitus (pressure ulcers due to bedsores), allergic or toxic contact dermatitis, and intertrigo (itchy, weeping skin irritation that … Fecal Incontinence: Complications
Classification of fecal incontinence into severity levels (score system according to Jorge/Wexner,). Incontinence episodes Frequency never rarely(≤ 1 per month) Sometimes(≤ 1 per week) frequently(< 1 per day and > 1 per week) always(> 1 per day) Fixed 0 1 2 3 4 Liquid 0 1 2 3 4 Air 0 1 2 3 4 … Fecal Incontinence: Classification
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification. Proctoscopy (examination of the anal canal and lower rectum) – if necessary, mucosal prolapse, prolapsing (prolapsing) hemorrhoids. Dynamic proctoscopy (attempted defecation/attempted defecation) – to rule out rectoanal prolapse (prolapse). … Fecal Incontinence: Diagnostic Tests
Continence improving surgery is rarely indicated – considering the number of sufferers! Birth traumatic damage (e.g. perineal tear) is usually treated primarily by the obstetrician. Secondary treatment is only successful in less than 50% of incontinent patients. Sphincteroplasties are used only when sphincter reconstruction is not indicated or has failed: Grazilisplasty – reinforcement of the … Fecal Incontinence: Surgical Therapy
Prevention factors (protective factors) Sectio caesarea (cesarean section) → less frequent pelvic floor disorders: in the first 15 years. After vaginal delivery (natural childbirth): 34.3% stress incontinence (SUI; stress incontinence), 21.8% irritable bladder (“overactive bladder”, OAB), 30.6% fecal incontinence (“anal incontinence”, AI), 30.0% uterine prolapse (“pelvic organ prolapse”, POP; uterine prolapse). After cesarean section: 17.5% … Fecal Incontinence: Prevention
The following symptoms and complaints may indicate fecal incontinence: Symptomatology depends on severity: Stress incontinence, soiled linen. Loss of control with diapers and liquid stool Loss of control in pulpy stools Complete fecal incontinence
General measures Keeping a stool diary to detect triggering factors (lactose/fructose/sorbitol intolerance). Toilet training: Be able to estimate the available warning time to go to the toilet in time. “Toileting by the clock”: taking advantage of the “gastrocolic reflex” triggered by the ingestion of a meal or a warm drink, which causes a defecation stimulus. … Fecal Incontinence: Therapy
