NIH state‐of‐the‐science conference statement on prevention of fecal and urinary incontinence in adults. NIH Consens State Sci Statements. 2007; 24(1):1–37.
46 46. Lara LL, Troop PR, Beadleson‐Baird M. The risk of urinary tract infection in bowel incontinent men. Journal of gerontological nursing. 1990; 16(5):24–6.
47 47. Lachenbruch C, Ribble D, Emmons K, VanGilder C. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital‐Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence Survey. Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society / WOCN. 2016; 43(3):235–41.
48 48. Le Lievre S. An overview of skin care and faecal incontinence. Nursing times. 2002; 98(4):58–9.
49 49. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997; 32(9):920–4.
50 50. Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 2005; 53(4):695–9.
51 51. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012; 85(1015):865–75.
52 52. Sajid MS, Khatri K, Siddiqui MR, Baig MK. Endo‐anal ultrasound versus endo‐anal magnetic resonance imaging for the depiction of external anal sphincter pathology in patients with faecal incontinence: a systematic review. Magy Seb. 2010; 63(1):9–15.
53 53. Hidaka J, Elfeki H, Duelund‐Jakobsen J, Laurberg S, Lundby L. Functional outcome after laparoscopic posterior sutured rectopexy versus ventral mesh rectopexy for rectal prolapse: six‐year follow‐up of a double‐blind, randomized single‐center study. E Clinical Medicine. 2019; 16:18–22.
54 54. Abrams P, Andersson K‐E, Apostolidis A, et al. 6th international consultation on incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourology and urodynamics. 2018; 37(7):2271–2.
55 55. Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P. Laxatives for the management of constipation in people receiving palliative care. Cochrane database of systematic reviews. 2015( 5):CD003448.
56 56. Quigley EM. Prucalopride: safety, efficacy and potential applications. Therap Adv Gastroenterol. 2012; 5(1):23–30.
57 57. Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009; 52(10):1730–7.
58 58. Lee BA, Kim SJ, Choi DK, Kwon O, Na HR, Cho ST. Effects of pelvic floor muscle exercise on urinary incontinence in elderly women with cognitive impairment. Int Neurourol J. 2017; 21(4):295–301.
59 59. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. The New England journal of medicine. 1974; 290(12):646–9.
60 60. Whitehead WE, Burgio KL, Engel BT. Biofeedback treatment of fecal incontinence in geriatric patients. Journal of the American Geriatrics Society. 1985; 33(5):320–4.
61 61. Norton C, Kamm MA. Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults – a systematic review. Aliment Pharmacol Ther. 2001; 15(8):1147–54.
62 62. Norton C, Chelvanayagam S, Wilson‐Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003; 125(5):1320–9.
63 63. Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane database of systematic reviews. 2012( 7):CD002111.
64 64. Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009; 52(10):1681–7.
65 65. Evans C, Davis K, Kumar D. Overlapping anal sphincter repair and anterior levatorplasty: effect of patient’s age and duration of follow‐up. Int J Colorectal Dis. 2006; 21(8):795–801.
66 66. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet. 1995; 346(8983):1124–7.
67 67. Brill SA, Margolin DA. Sacral nerve stimulation for the treatment of fecal incontinence. Clin Colon Rectal Surg. 2005; 18(1):38–41.
68 68. Tjandra JJ, Chan MK, Yeh CH, Murray‐Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum. 2008; 51(5):494–502.
69 69. Kim J, Shim MC, Choi BY, Ahn SH, Jang SH, Shin HJ. Clinical application of continent anal plug in bedridden patients with intractable diarrhea. Dis Colon Rectum. 2001; 44(8):1162–7.
70 70. Norton C, Kamm MA. Anal plug for faecal incontinence. Colorectal Dis. 2001; 3(5):323–7.
71 71. Chew MH, Quah HM, Ooi BS, et al. A prospective study assessing anal plug for containment of faecal soilage and incontinence. Colorectal Dis. 2008; 10(7):677–80.
Note
1 * The terms fecal incontinence and anal incontinence are often used interchangeably. However, anal incontinence refers to involuntary passage of either faeces or flatus, whereas fecal incontinence refers to incontinence of stool alone.
CHAPTER 20 Constipation
Katherine A. Evans1 and Charlene M. Prather2
1 Rotherham NHS Foundation Trust, Rotherham, UK
2 Gastroenterology, Saint Louis University, St Louis, Missouri, USA
Defining constipation
Constipation most classically refers to reduced defecation frequency and hard stools. Physicians typically define constipation as fewer than three bowel movements per week. Patients more frequently describe constipation as defecatory difficulty with predominant complaints of straining or hard stools. This holds particularly true in older adults. Understanding the patient’s view of constipation assists in evaluation and treatment.
The normal defecatory process requires sufficient cognition (recognizing the need to defecate), normal colon transit, and normal function of the pelvic floor muscles and anal sphincters. Normal colon transit ranges from 24 to 72 hours. Defecation is most often preceded by high‐amplitude propagated colonic contractions. These colonic contractions occur in response to meals, particularly those with higher concentrations of calories and fat. Colonic motility is also more robust during waking hours and quiescent during sleep. Colonic activity propels stool into the rectum, causing distension and reflex relaxation of the internal anal sphincter; this prompts reflex contraction of the external anal sphincter and pelvic floor muscles. The brain registers the urge to defecate, and at an appropriate time, this may be voluntarily initiated through a set of coordinated actions. Initiation of the defecation process starts with relaxation of the puborectalis muscle, opening of the anorectal angle, and relaxation of the external anal sphincter. This is accompanied by a simultaneous rise in intra‐abdominal pressure assisted by valsalva contraction of the abdominal wall muscles (Figure 20.1). An abnormality affecting any of these areas results in the development of an altered bowel pattern (Table 20.1).
Constipation may be defined in many different ways. Simply stated, primary constipation refers to constipation without an obvious cause, and secondary constipation results from external aetiologies.