The Korean Journal of Medicine

  • 제83권5호
  • /
  • Pages.580-584
  • /
  • 2012
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

대변실금의 진단과 치료

Diagnosis and Treatment of Fecal Incontinence

  • 박수경 (울산대학교 의과대학 서울아산병원 소화기내과) ;
  • 명승재 (울산대학교 의과대학 서울아산병원 소화기내과)
  • Park, Soo-Kyung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Myung, Seung-Jae (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2012.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Fecal incontinence is a common condition, which leads to impaired quality of life and huge financial cost at an individual and societal level. Recent studies have identified novel and potentially modifiable risk factors. Newer diagnostic modalities are giving more detailed information about underlying disorders, helping to implement targeted treatment. Many therapeutic options exist, and newer treatments are changing outcomes. This article will review recent developments in mechanisms, diagnosis, and treatment of fecal incontinence.

키워드

참고문헌

  1. Nelson RL. Epidemiology of fecal incontinence. Gastroenterology 2004;126(1 Suppl 1):S3-S7.
  2. Whitehead WE, Wald A, Norton NJ. Treatment options for fecal incontinence. Dis Colon Rectum 2001;44:131-142. https://doi.org/10.1007/BF02234835
  3. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009;137:512-517. https://doi.org/10.1053/j.gastro.2009.04.054
  4. Nelson R, Norton N, Cautley E, Furner S. Community- based prevalence of anal incontinence. JAMA 1995;274:559-561. https://doi.org/10.1001/jama.1995.03530070057030
  5. Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology 2004;126(1 Suppl 1):S14-S22.
  6. Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med 1992;326:1002-1007. https://doi.org/10.1056/NEJM199204093261507
  7. Rao SS; American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence: American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 2004;99:1585-1604. https://doi.org/10.1111/j.1572-0241.2004.40105.x
  8. Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol 2010;8:955-960. https://doi.org/10.1016/j.cgh.2010.06.031
  9. Saclarides TJ. Endorectal ultrasound. Surg Clin North Am 1998;78:237-249. https://doi.org/10.1016/S0039-6109(05)70311-X
  10. Falk PM, Blatchford GJ, Cali RL, Christensen MA, Thorson AG. Transanal ultrasound and manometry in the evaluation of fecal incontinence. Dis Colon Rectum 1994;37:468-472. https://doi.org/10.1007/BF02076193
  11. Wald A. Colonic and anorectal motility testing in clinical practice. Am J Gastroenterol 1994;89:2109-2115.
  12. Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques: American Gastroenterological Association. Gastroenterology 1999;116:732-760. https://doi.org/10.1016/S0016-5085(99)70194-0
  13. 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;63:9-15. https://doi.org/10.1556/MaSeb.63.2010.1.2
  14. Stoker J. Magnetic resonanceimaging in fecal incontinence. Semin Ultrasound CT MR 2008;29:409-413. https://doi.org/10.1053/j.sult.2008.09.001
  15. Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet 2004;364:621-632. https://doi.org/10.1016/S0140-6736(04)16856-6
  16. Wald A. Fecal incontinence. Curr Treat Options Gastroenterol 2005;8:319-324. https://doi.org/10.1007/s11938-005-0025-9
  17. Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 1982;27:807-814. https://doi.org/10.1007/BF01391374
  18. Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 1980;79:1272-1275.
  19. Santoro GA, Eitan BZ, Pryde A, Bartolo DC. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 2000;43:1676-1681. https://doi.org/10.1007/BF02236848
  20. MacLeod JH. Management of anal incontinence by biofeedback. Gastroenterology 1987;93:291-294.
  21. Ryn AK, Morren GL, Hallbook O, Sjodahl R. Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum 2000;43:1262-1266. https://doi.org/10.1007/BF02237433
  22. Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE. Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum 2001;44:728-736. https://doi.org/10.1007/BF02234575
  23. Diamant NE, Kamm MA, Wald A, Whitehead WE. AGA technical review on anorectal testing techniques. Gastroenterology 1999;116:735-760. https://doi.org/10.1016/S0016-5085(99)70195-2
  24. Van Tets WF, Kuijpers JH, Bleijenberg G. Biofeedback treatment is ineffective in neurogenic fecal incontinence. Dis Colon Rectum 1996;39:992-994. https://doi.org/10.1007/BF02054687
  25. Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 2003;125:1320-1329. https://doi.org/10.1016/j.gastro.2003.09.039
  26. Christiansen J. Modern surgical treatment of anal incontinence. Ann Med 1998;30:273-277. https://doi.org/10.3109/07853899809005855
  27. Madoff RD, Rosen HR, Baeten CG, et al. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 1999;116:549-556. https://doi.org/10.1016/S0016-5085(99)70176-9
  28. Wong MT, Meurette G, Stangherlin P, Lehur PA. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence. Dis Colon Rectum 2011;54:773-779. https://doi.org/10.1007/DCR.0b013e3182182689
  29. Vaizey CJ, Kamm MA, Nicholls RJ. Recent advances in the surgical treatment of faecal incontinence. Br J Surg 1998;85:596-603. https://doi.org/10.1046/j.1365-2168.1998.00754.x
  30. Stojkovic SG, Lim M, Burke D, Finan PJ, Sagar PM. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg 2006;93:1514-1518. https://doi.org/10.1002/bjs.5394
  31. Tjandra JJ, Lim JF, Hiscock R, Rajendra P. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum 2004;47:2138-2146. https://doi.org/10.1007/s10350-004-0760-3
  32. Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum 2007;50:1950-1967. https://doi.org/10.1007/s10350-007-9009-2
  33. Leroi AM, Parc Y, Lehur PA, et al. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 2005;242:662-669. https://doi.org/10.1097/01.sla.0000186281.09475.db
  34. 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;51:494-502. https://doi.org/10.1007/s10350-007-9103-5
  35. Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology 2001;121:536-541. https://doi.org/10.1053/gast.2001.27120
  36. Hetzer FH. Fifteen years of sacral nerve stimulation: from an open procedure to a minimally invasive technique. Colorectal Dis 2011;13(Suppl 2):S1-S4.

피인용 문헌

  1. 농촌거주 여성의 변실금과 우울 vol.25, pp.3, 2012, https://doi.org/10.12799/jkachn.2014.25.3.198