title: [Treatment for fecal incontinence in patients with anorectal malformations. Introduction of a therapeutic approach].
abstract: Fecal incontinence is a serious problem that may lead to social segregation and psychological problems. Patients with anorectal malformations frequently suffer fecal incontinence even with an excellent anatomic repair. In these patients an effective management program with enemas can improve their quality of life. We want to present our experience with bowel management and anorectal irrigation as treatment for stool incontinence.
  
  
  METHODS
  Patients who presented with soiling regardless of the type of anomaly were included in the study. The diagnostic program comprised a careful clinical history, physical examination, exact classification of the malformation and stool protocol. All patients suffering from true fecal incontinence were included in a bowel management program. These patients received oral polyethylenglykol to evacuate stool impaction. Than anorectal irrigation was initiated and repeated every 24 or 48 hours. Patients were controlled for soiling, time needed for irrigation and time interval between irrigations 6 and 12 months after start oftherapy.
  
  
  RESULTS
  40 patients aged 4 to 54 with a mean age of 15,95 years were evaluated. 12 months after start of therapy 32 patients were free of symptoms of soiling. 6 patients were soiling occasionally once or twice per week. 2 patients did not follow the therapeutic regime and therefore did not show an improved condition concerning soiling in the long run. The average time needed for irrigation was 45 minutes, irrigations where done every 24 hours in 12 patients. 25 patients irrigated twice every 48 and 72 hours to achieve a constant seven day rhythm. One patient irrigated every five days.
  
  
  CONCLUSIONS
  Patients born with anorectal malformation and suffering from stool incontinece can be kept clean of stool if they are subjected to an adequate treatment.
authors.affiliation: Klinik und Poliklinik für Kinderchirurgie, Charité Universitätsmedizin Berlin. Stefanie.maerzheuser@charite.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Märzheuser
authors.forename: Friederike
authors.initials: F
authors.lastname: Grauel
authors.forename: Karin
authors.initials: K
authors.lastname: Rothe
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000451:nursing* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004733:Enema / Q000451:nursing; D005244:Fecal Impaction / Q000451:nursing; D005242:Fecal Incontinence / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011183:Postoperative Complications / Q000451:nursing; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult
chemical_list: D011092:Polyethylene Glycols