Soiling

Soiling

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Fecal or rectal incontinence is the involuntary removal of stool and gas. Surgery, constipation, radiation therapy, birth and other causes in women contributes to the onset of fecal incontinence. For example, surgery may damage the pelvic floor muscles or nerves pudentali (shy), chronic diarrhea or constipation can change the functional properties of the rectum, giving birth vaginally may affect the anal sphincter.
Fecal incontinence has been described as one of the most devastating physical disabilities, with consequences on self-esteem, their image and ability to maintain interpersonal relationships and develop professional careers. Many affected persons do not dare to inform the doctor or family about this disease. Instead, they limited their activities to avoid secondary accidents faecal incontinence. The result is isolation and depression.
Because patients do not seek medical help fecal incontinence is wrongly perceived as being rare. Soiling is found up to 47% of people who require home care. Studies investigating faecal incontinence in women who are hospitalized or receive specialized care resident found that more than 7% of them had experienced at least one episode of fecal incontinence per month.
Among persons with fecal incontinence, 63% are women. Although the disease is most common in the elderly, is discovered at any age, and most patients can be helped. Fecal incontinence is associated in 30% of the patients with urinary incontinence-double.
Fecal incontinence can be treated. Therapeutic option depends on the cause and severity. In most cases, treatment begins with nonchirurgicale options. These include control of diarrhea, constipation, special exercises for toning the pelvic floor muscles, biofeedback exercises. Surgical therapy includes sfincteroplastia when anal sphincter damage during natural birth, trauma or anal surgery. Sfincteroplastia is a technique that anatomical and functional anal sphincter repair. If damage is severe sphincter can strongly recommend a temporary colostomy in which the colon is attached to a hole (stoma) in the abdomen covered with a colostomy bag. If etiology is related to pelvic floor muscles are weak then it indicates that pelvic floor surgery repositions pelvic floor muscles to restore the normal angle between the colon and rectum. If nerves are damaged anal sphincter pudentali (shy) graciloplastia recommended substitution of the anal sphincter that is damaged, a fragment of the gracilis muscle.
Fecal incontinence is a disease that is treatable. Its consequences are more psychic than physical being considered a shameful disease.
Pathogenesis of fecal incontinence
Soiling is the involuntary loss of feces and gas. True fecal incontinence must be differentiated from other pathological conditions that can lead to the involuntary passage of stool through the anus. This may be a consequence of inflammatory bowel disease, improper hygiene, anal fistula, anal mucosal prolapse, hemorrhoids.
-Vaginal birth vaginally. It is accepted as the most common predisposing factor for fecal incontinence in women. It led to an outbreak of eight times higher in women than in men. Vaginal delivery leads to internal and external anal sphincter damage or nerve by stretching and compression pudentali with prolonged ischemia. Studies show a rate of de novo sphincter of infringement of 17% of women after delivery. It was discovered that 13% of primiparous and 20% of multipara had a trigger de novo fecal incontinence after delivery. 35% of women who had fractures of the anal sphincter but are asymptomatic. Repeated vaginal deliveries increase the risk of developing fecal incontinence if the patient has undergone previous sphincter injury or was symptomatic of incontinence after first delivery.
They found associations between changes in certain physiological parameters and multiple births: Maintaining a lower-perineal position at rest in bed Perineal-increasing slope with maximum forcing -Decreased sensitivity to electric stimuli Prolonged latency of the nerve-pudentali.
Other additional factors that increase the risk for fecal incontinence include: -First pregnancy, age, overall health, limitations fixice -Use of forceps, fetal weight over 4000 g -Episiotomia, prolonged labor.
Age. It plays an important role in fecal incontinence. Anal manometry studies show a low pressure and high pressure relazare anal anal contraction associated with age. These parameters decrease more rapidly after menopause. The same study showed that as it progresses in age reduced anal contraction pressure.
It was found that the external anal sphincter shows a higher concentration of estrogen receptors compared with the same woman and rectal muscle compared with the external sphincter in men.
Anatomy and physiology of the act of defecation. Anal continence requires complex integration of signals arising from the anal sphincters: the internal and external muscles and smooth muscle puborectali colon and rectum. Also requires the ability to have adequate facilities to evacuate the rectum. Damage at any level in this system may lead to fecal incontinence.
As the colonic content is presented in the rectum to distend it with parasympathetic mediated relaxation of internal anal sphincter and contraction of the external. Rectal content is allowed to enter into contact with sensitive mucosa of the upper anal canal. Then the content is separated by nature in solid, liquid or gas.
If evacuation can not be performed because of rectal unfit environment, mediated inhibition of sympathetic action enters the rectal muscles with voluntary contraction of external anal sphincter muscle and puborectale. Faecal bolus is pushed back into the rectum until rectal reservoir. A decrease in the compliance of the reservoir was associated with urgent defecation and fecal incontinence. Puborectali muscle contraction increases the anorectal angle and keep the bowl above the internal anal sphincter fecal until it can recover. The angle is created as the levator complex rupture rectum. As this complex set of muscles contracts and the rectum is pushed forward, anorectal uncle becomes sharper and prevents fecal Descent bowl.