[Diagnostics and conservative treatment of anal incontinence].
Anal incontinence is diagnosed primarily by clinical and proctologic examination. Etiological factors of the disease are found in 85% of the patients by additional examinations. Motility dysfunction of colon and rectum has to be excluded (stenosis, dyschezia, internal hernias). Because anal incontinence is a multifactorial disease as a rule, the single compounds have to be diagnosed and have to undergo therapy. Accordingly, useful investigations are: endorectal ultrasound (defect of muscle, inflammatory or tumour infiltration), manometry (alteration of either anal resting pressure and/or anal squeezing pressure) and surface electromyography (ability of contraction, duration of contraction, strength). Neurophysiological examinations are: needle electromyography, pudendal nerve latency time measurement (PNLT). The occurrence of nerve damage determines the outcome of operative intervention! Conservative treatment is indicated in 80 to 90% of all patients, even higher when one includes all patients in the perioperative period. Possible therapy modalities are: nutrition consultation, physiotherapy, pelvic floor training, biofeedback training of pelvic floor and sphincter muscles, electrostimulation and the combination of both (EMG-triggered electrostimulation). Short-term results are satisfying in up to 85% of patients, but later, successful results depend on the patient's willingness or ability to continue training, and on his/her age.
Geile
Dorothea
D
Proktologisches Institut München Ost, München, Deutschland. dr-geile@t-online.de
Osterholzer
Georg
G
Rosenberg
Robert
R
D001003:Anal Canal / Q000294:innervation; D001676:Biofeedback, Psychology; D003937:Diagnosis, Differential; D004599:Electric Stimulation Therapy; D004576:Electromyography; D019160:Endosonography; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008365:Manometry; D010043:Outcome and Process Assessment, Health Care; D026741:Physical Therapy Modalities; D011930:Reaction Time / Q000502:physiology; D009435:Synaptic Transmission / Q000502:physiology