Anal incontinence: the role of medical management.
OBJECTIVE
Consensus recommendations suggest that patients with anal incontinence (AI) should be managed by medical treatment when indicated. Our aims were to prospectively evaluate from two different populations of patients: (1) the proportion of incontinent patients referred to a specialized center who were candidates for first line medical treatment (study 1); (2) the results of medical treatment in incontinent patients (study 2).


METHODS
In study 1, standardized management of AI based on an algorithmic decision tree was applied to 287 incontinent patients (209 women, ranging from 16 to 84 years old). In study 2, 36 other incontinent patients with transit disorders (28 women, ranging from 29 to 86 years old) seen consecutively, were treated by a medical treatment of their transit disorders. The result of the medical treatment was objectively and subjectively evaluated after 2 months.


RESULTS
Study 1: medical treatment was indicated in 126 of 287 patients (43.9%) (62 for diarrhea and 64 for constipation) while biofeedback was indicated in 52 patients (18.1%) and surgery specific for AI in 99 patients (34.5%). Eighty percent of the patients who were proposed conservative medical treatment were referred by their gastroenterologist or their general practitioner. Study 2: the continence score decreased from a median of 12 to 6.5 (P<0.001). 61% of patients regarded themselves as cured or improved after medical treatment.


CONCLUSIONS
Conservative treatment can be proposed as a first line treatment in more than 50% of patients with anal incontinence referred to a specialized center. Medical treatment for anal incontinence associated with transit disorders improves continence.
Demirci
Selma
S
Digestive Tract Research Group, ADEN EA 3234/IFR MP 23, Rouen University, Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen Cedex.
Gallas
Syrine
S
Bertot-Sassigneux
Pauline
P
Michot
Francis
F
Denis
Philippe
P
Leroi
Anne-Marie
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000930:Antidiarrheals / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002400:Cathartics / Q000627:therapeutic use; D003663:Decision Trees; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome
D000930:Antidiarrheals; D002400:Cathartics