Anal incontinence: causes and treatments
Anal incontinence: we investigate causes and treatments thanks to Dr. Tessera, colonproctologist.
Anal incontinence is a disabling symptom with multifactorial etiology that can lead to physical and psychological disability , resulting in the progressive isolation of the affected patient from social and relational life. It affects older adults and women more, especially in relation to obstetric trauma in vaginal births . Fecal continence is a complex physiological function determined by the interaction of various factors, including stool consistency, intestinal motility, rectal storage capacity, rectal sensitivity, the functional and anatomical integrity of the anal sphincter mechanism, and the functional and anatomical integrity of the pelvic floor muscles and nerves.
The causes are multiple (but sometimes the cause cannot be found), often linked to one another, but they can all be traced back to the alteration of these three sectors:
- From altered fecal consistency – diarrhoeal state
- Due to reduced capacity of the rectal ampulla or reduced sensitivity
- From alteration of the sphincter complex
The diagnosis sometimes requires various types of in-depth investigations, both of a purely colonproctological nature (anorectal manometry, colonoscopy, endoanal ultrasound with a rotating probe, etc.) and of a more general nature (evaluation of the presence of complicated diabetes mellitus, or nervous disease, or pelvic trauma, etc.).
Therapy
Obviously, treatment varies depending on the cause and the patient’s general condition. Often, the first step in therapy is non-surgical therapy : bowel management (for example , antidiarrheal medications ) and, in almost all cases, rehabilitation, if the patient is able to perform the maneuvers recommended by the therapist. The most common methods use dedicated electromedical devices , primarily biofeedback and electrostimulation of the sphincter muscles. In selected cases and at qualified centers, sacral neuromodulation can also be performed , which involves, after a specific test, the implantation of an electrode through the sacrum with a pacemaker inserted under the skin. Surgical therapy is also possible, albeit more rarely, for example in the reconstruction of sphincters damaged by accidental trauma or obstetric trauma during childbirth.
Contact us and make an appointment with the
Dr. Gaetano Tessera
, Medical Surgeon,
Specialist in General Surgery, Digestive System Surgery, and Surgical Digestive Endoscopy – Colonproctologist