Materiały źródłowe

• #1 Pathophysiology of adult fecal incontinence – PubMed

  https://pubmed.ncbi.nlm.nih.gov/14978634/

  Fecal incontinence occurs when the normal anatomy or physiology that maintains the structure and function of the anorectal unit is disrupted. Incontinence usually results from the interplay of multiple pathogenic mechanisms and is rarely attributable to a single factor. The internal anal sphincter (IAS) provides most of the resting anal pressure and is reinforced during voluntary squeeze by the external anal sphincter (EAS), the anal mucosal folds, and the anal endovascular cushions. Disruption or weakness of the EAS can cause urge-related or diarrhea-associated fecal incontinence. […] Damage to the endovascular cushions may produce a poor anal „seal” and an impaired anorectal sampling reflex. The ability of the rectum to perceive the presence of stool leads to the rectoanal contractile reflex response, an essential mechanism for maintaining continence. Pudendal neuropathy can diminish rectal sensation and lead to excessive accumulation of stool, causing fecal impaction, mega-rectum, and fecal overflow. The puborectalis muscle plays an integral role in maintaining the anorectal angle. Its nerve supply is independent of the sphincter, and its precise role in maintaining continence needs to be defined.

• #2 Fecal Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459128/

  Fecal incontinence is the inability to control bowel movements, leading to the involuntary release of gas or stool. Numerous factors, including muscle or nerve damage, digestive disorders, and other underlying medical conditions, can contribute to its development. […] Understanding the physiology of continence is important to understand the pathophysiology of incontinence. The anatomical structures that help maintain control of bowel function include: […] To maintain fecal continence, there is a complex interplay of several organ systems and nerves. As the fecal mass presents to the rectum, this causes distension. The parasympathetic nerves (S2-S4) transmit the sensation of rectal distension, which induces relaxation of the rectoanal inhibitor reflex and contraction of the rectoanal contractile reflex. […] Any pathology that interferes with these processes, like trauma, stroke, vaginal delivery, or paralysis, can result in fecal incontinence.

• #3

  https://fascrs.org/patients/diseases-and-conditions/a-z/fecal-incontinence-expanded

  Fecal incontinence is the impaired ability to control the release of gas and stool at a desired time. […] The ability to control gas and stool is a complex function involving multiple organ systems. […] Fecal incontinence, or loss of control, can occur if the person has loose stools, or if they have diseases or injuries to the rectum, the anus, or the nerves that control the anal muscles. […] Fecal incontinence is a major burden to both patients and society. […] Fecal incontinence is approximately twice as common among women as it is among men. […] Fecal incontinence is very common among nursing home and hospitalized patients and may be due, in part, to a decreased mobility, making it difficult for the patient to get to the bathroom. […] Prior pregnancy changes in continence can occur after childbirth, especially after prolonged labor, an episiotomy (surgical incision), or the use of instrumentation such as vacuum assistance and forceps.

• #3

  https://fascrs.org/patients/diseases-and-conditions/a-z/fecal-incontinence-expanded

  Prior anorectal surgery people who have had surgery for an anal fissure (small tear in the anus), an anal fistula (abnormal passageway between the bowel and nearby organs or between the bowel and skin), or hemorrhoids are at risk for fecal incontinence. […] Prior rectal resection patients who have had part or their entire rectum removed are at risk for fecal incontinence, because the reservoir function of the original rectum is difficult to reproduce. […] Pelvic radiation can injure the nerves that control the anus and/or decrease the elasticity in the rectum, which increases the risk for fecal incontinence. […] The symptoms of fecal incontinence can range from minor changes in the ability to control gas to complete loss of control of solid stool without warning, and varying degrees in-between.

• #4 Efficacy and mechanism of sub-sensory sacral (optimised) neuromodulation in adults with faecal incontinence: study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2689-1

  Faecal incontinence (FI) is a substantial health problem with a prevalence of approximately 8% in community-dwelling populations. […] The clinical efficacy of SNM has never been rigorously determined in a trial setting and the underlying mechanism of action remains unclear. […] The importance of sensory dysfunction on both urinary and bowel control is being increasingly appreciated and there is strong evolving evidence (including our own pilot data in humans and experimental animals) that the mechanism of action of SNM results primarily from modulation of afferent nerve activity. […] It is now well appreciated that patients with FI resulting from pathophysiology other than primary sphincter dysfunction also benefit from treatment. […] Pulling the above evidence together it is clear that the clinical efficacy of SNM has never been rigorously determined in a trial setting.

• #5 Pathophysiology of Faecal Incontinence | SpringerLink

  https://link.springer.com/chapter/10.1007/978-88-470-0638-6_3

  The ability to control evacuation, as discussed in Chapter 1, is guaranteed by many factors. These include intact anal sphincter mechanism, compliant reservoir, efficient evacuation, stool volume and consistency, intestinal motility, pelvic floor structural integrity, cortical awareness, cognitive function, mobility and access to facilities. Normal defecation is a process of integrated somatovisceral responses, which involve coordinated colo-recto-anal function. Incontinence occurs when one or more of these mechanisms are impaired and the remaining mechanisms are unable to compensate. Although integrity of the sphincteric mechanism plays a major part, there are other important aspects, such as stool volume and consistency, colonic transit, rectal compliance and sensation, anorectal sensation and anorectal reflexes. In this chapter, all these aspects are discussed separately, but in the majority of cases (80% according to Rao et al.), the cause of faecal incontinence (FI) is multifactorial.

• #6 Comprehensive Clinical Approach to Fecal Incontinence | IntechOpen

  https://www.intechopen.com/chapters/67111

  Fecal incontinence is a disturbing condition, which reduces the quality of life of patients. […] To improve this condition, physicians should have insight into the individuals pathophysiology through the process of careful history taking, severity, and quality of life assessment, thorough physical examination and comprehensive anatomic and neurophysiologic evaluation. […] Normal control of defecation requires intact neuromuscular structures, including rectum, anal canal, pelvic floor, and neural network. […] Disruption of one or more compositions of the system leads to FI. In clinical practice, most patients with FI were found to have multiple contributing factors. […] Rectum is the distal part of colon, which extends from the rectosigmoid junction, dilates to form a reservoir, and ends at the tight circular anal canal.

• #6 Comprehensive Clinical Approach to Fecal Incontinence | IntechOpen

  https://www.intechopen.com/chapters/67111

  Surgical removal of rectum or physical injury to rectum such as radiation predisposes the subject to FI. […] Anal canal is the terminal part of the gastrointestinal tract. […] Anal sphincter and pelvic floor muscle act together to close the bowel. […] Impaired levator ani contraction is strongly correlated with severity of FI. […] Sensory innervation of the anorectal area is responsible for correct afferent information of the luminal content. […] Sacral reflexes, including rectoanal inhibitory reflex (RAIR), sampling reflex, and cough reflex, are additional mechanisms of sensing and controlling stool. […] FI occurs when one or more of the controlling mechanisms were damaged. […] Obvious etiology of FI is anal sphincter damage. […] Risk factors include forcep delivery, prolonged second stage of labor (5 h), shoulder dystocia, ano-vulvar distance 2 cm, perineal scar and third or fourth-degree perineal injury, and infant birth weight 3500 g.

• #6 Comprehensive Clinical Approach to Fecal Incontinence | IntechOpen

  https://www.intechopen.com/chapters/67111

  Symptoms of continence may occur later in life as there are other compensatory mechanisms to compensate. […] Normal rectum is a low-pressure space acting as a reservoir of fecal material until a coordinated and effective evacuation is appropriate. […] Neurological interruption of the central, peripheral, or autonomic nervous system is another cause of FI. […] Other contributing risk factors of FI are stool consistency and transit function of the colon. […] In obesity, increased body mass index predisposed the subjects to FI due to weakening of pelvic floor musculature and increased intra-abdominal pressure. […] Abnormal anorectal reflex can be demonstrated together with rectal sensation. […] Clinical utility of ARM in FI is to assess the weakness of sphincter muscle and abnormal anorectal sensation.

• #7 Fecal Incontinence: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/268674-overview

  Bowel function is controlled by multiple factors including anal sphincter pressure, anorectal sensation, rectal compliance, colonic transit time, and stool volume and consistency. In addition, adequate cognitive function with appropriate ability to access bathroom facilities are necessary for continence. If any of these factors are compromised, incontinence can occur. […] Fecal continence is maintained by the structural and functional integrity of the anorectal unit. Normal anal sphincter function is a critical part of continence. The anal sphincter is comprised of 2 components: the internal anal sphincter (IAS), which is a 0.3-0.5 cm expansion of the circular smooth muscle layer of the rectum and the external anal sphincter (EAS), a 0.6-1.0 cm expansion of the levator ani muscles. The IAS is chiefly responsible for maintaining continence at rest and contributes approximately 70-80% of the resting sphincter tone. This barrier is reinforced during voluntary squeeze by the EAS, the anal mucosal folds, and the anal endovascular cushions.

• #8 Urology & Continence Care Today | May 2025

  https://www.ucc-today.com/journals/issue/launch-edition/article/faecal-incontinence-forgotten-symptom

  The internal anal sphincter (IAS) is an involuntary circular smooth muscle approximately 0.3cm wide and ends 10mm above the anal verge. It is able to maintain tonic contraction for long periods of time and contributes to 85% of the resting anal tone, ranging from 60-110cm H2O in healthy individuals, and is under autonomic innervation. […] The anorectal inhibitory reflex enables the internal sphincter to relax, allowing anal sensory receptors to sense rectal contents. This helps to differentiate solid or liquid stool from gas. […] The puborectalis muscle is part of the pelvic floor complex. It is a mixture of slow and fast twitch muscles and contains both types of muscle fibres. Its function is to close the upper anal canal and forms part of the anorectal angle. […] The whole pelvic floor/anorectal angle mechanism works in conjunction with the anal sphincters during defaecation.

• #9 Fecal Incontinence: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/268674-overview

  These barriers are further augmented by the puborectalis muscle, which forms a sling around the rectum and creates a forward pull to reinforce the anorectal angle. The anorectal angle, which is approximately 90 degrees at rest, is created as the rectum perforates the levator complex. During voluntary squeeze, the angle becomes more acute, whereas during defecation, the angle becomes more obtuse. Innervation of the EAS is from the pudendal nerve, a mixed motor and sensory nerve that arises from the second, third, and fourth sacral nerves (S2, S3, and S4). Innervation of the puborectalis arises more directly from the sacral nerves listed above. […] Continence requires the complex integration of signals among the smooth muscle of the colon and rectum, the puborectalis muscle, and the anal sphincters. As colonic contents are presented to the rectum, the rectum distends. The sensation of rectal distension is most likely transmitted along the S2, S3, and S4 parasympathetic nerves. This results in a parasympathetically mediated relaxation of the IAS (rectoanal inhibitory reflex) and a contraction of the EAS (rectoanal contractile reflex).

• #10 New concepts in the pathophysiology of fecal incontinence – Knowles – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/8307/html

  Urge-related episodes of incontinence were recently reported by 75% of 2,452 patients presenting with FI to a tertiary center. […] The control of rectal contractility, like the bladder, is subject to intrinsic reflexes. […] The rectum must contract or be compressed to evacuate fecal contents. […] The rectum should therefore not be considered a passive reservoir. Rather, it is a contractile and sensate organ, that like the bladder, is subject to fine reflex control. […] Overall, rectal sensory disturbances in FI are common (~20% overall) with hypersensitivity more frequently found in females, and hyposensitivity in males. […] The rectum provides afferent information for the rectoanal inhibitory reflex (RAIR). […] The IAS has an important role in guarding the anal canal. […] The rectum is subject to a fine balance of local reflexes (pro-expulsion) and autonomic reflexes (pro-basal state). […] The important functions of the rectum, colon and CNS can be integrated with the classical barrier-centric model of FI pathophysiology. […] This new version of the barrier is more than just the goalkeeper (it also controls play in the defence and midfield).

• #10 New concepts in the pathophysiology of fecal incontinence – Knowles – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/8307/html

  The pathophysiology of fecal incontinence (FI) is often considered to primarily depend on disturbed mechanisms of faecal containment. […] However, this barrier-centric containment model is insufficient to explain many lived observations of FI, including the origin of the symptom of urgency and continence development over the life course. […] This review presents a revisionist view where reflex control of rectal contractility is considered central to FI pathogenesis and the anorectum is considered a single functional unit that cooperates with the colon and central nervous system (CNS) to maintain continence. […] This revised understanding implicates the barrier not only as a means of containment but also as a reflex controller of rectal function. […] The major factor missing from this conceptualisation is recognition of the sensation of urge that is described by the majority of patients before they become aware of incontinence.

• #11 Fecal Incontinence: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/268674-overview

  The decreased anorectal sensation and abnormal sampling likely contribute in the pathogenesis of anal incontinence as sampling facilitates the fine tuning of the continence barrier. This process is incompletely understood. […] In essence, any process that interferes with these mechanisms, including trauma from vaginal delivery or a neurological insult, can result in fecal incontinence.

• #12 Pathophysiology of adult fecal incontinence – PubMed

  https://pubmed.ncbi.nlm.nih.gov/14978634/

  Obstetric trauma, the most common cause of anal sphincter disruption, may involve the EAS, the IAS, and the pudendal nerves, singly or in combination. It remains unclear why most women who sustain obstetric injury in their 20s or 30s typically do not present with fecal incontinence until their 50s. There is a strong need for prospective, long-term studies of sphincter function in nulliparous and multiparous women.

• #13 Anal Incontinence

  https://exxcellence.org/list-of-pearls/anal-incontinence/

  Anal incontinence may be caused by anatomical abnormalities of the muscle (sphincter or puborectalis), or nerve injury, including the pudendal nerve or functional factors such as anorectal sensation, stool characteristics including consistency, and medications. […] The greatest risk factor for anal sphincter injury Patients is operative vaginal delivery (forceps higher risk than vacuum), followed by primiparity, midline episiotomy, occiput posterior head position, macrosomia, and prolonged second stage. […] Additionally, rectal urgency is a significant risk factor for fecal incontinence in women.

• #14 Urinary and Fecal Control and Incontinence: Pathogenesis and Mana

  https://www.longdom.org/open-access/urinary-and-fecal-control-and-incontinence-pathogenesis-and-management-17707.html

  Structural damage of the IAS will lead to fecal incontinence (FI). The structural damage is caused mainly by CBT, but may be caused by direct injury like anal intercourse or forcing a hard object into the anal canal. […] Structural injury of the collagen chassis of the IAS leads to a weak sphincter that cannot stand rises of abdominal pressure and leads to escape of stool /or flatus (FI). On medical imaging with MRI and/or 3DUS the lacerations in the collagen chassis of the IAS will be seen in addition to an open anal canal in patients with FI. Structural damage is corrected by reconstructive surgery urethro-anovaginoplasty we mend the torn collagen chassis of the IUS, IAS and the vagina. Correction of the torn chassis will restore the normal function.

• #14 Urinary and Fecal Control and Incontinence: Pathogenesis and Mana

  https://www.longdom.org/open-access/urinary-and-fecal-control-and-incontinence-pathogenesis-and-management-17707.html

  Laceration of the collagen chassis of the IUS leads to its weakness and subsequent stress urinary incontinence (SUI) and/or over active bladder (OAB). […] Similarly, lacerations of the collagen chassis of the IAS lead to its weakness and subsequent fecal incontinence (FI). […] The lacerations in one/or both sphincters are mainly caused by childbirth trauma (CBT). The pelvic collagen is hormone dependent and drop in the estrogen level causes further weakness of the sphincters. […] Structural damage of the IUS caused in women by CBT leads to a weak sphincter which cannot stand sudden rise of abdominal pressure as on coughing, sneezing /or jumping, will allow some urine to enter the urethra. Urine in the urethra will either cause compelling sensation of desire to void (over active bladder OAB) or escapes (stress urinary incontinence SUI).

• #15 faecal incontinence; a taboo – Dr Philippe Bull

  https://www.dr-bull.at/en/faecal-incontinence-a-taboo/

  The most common causes of sphincter incontinence are changes in the anal canal, often accompanied by nervous disorders in this region. These include sphincter damage by: […] The reasons for the lack of stool control are manifold: […] In old age, sphincter control is weakened. In women, birth delivery may often damage the sphincter. This does not have to be noticed immediately after birth. Frequently, incontinence only appears much later. […] Following surgery to the rectum, e.g. because of haemorrhoids, incontinence may occur. Rectal trauma can lead to incontinence. […] In case of severe constipation, it can happen that the liquid stool goes off involuntarily past the hard masses of the stool.

• #16 Fecal (Bowel) Incontinence: What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence

  Nerve damage: Many of the same things that can damage your muscles, like surgery and a difficult vaginal delivery, can also damage the nerves that control their movement. This includes nerves that control rectal sensation, the signal that tells you its time to poop. Several chronic conditions affecting your nerves increase your risk of fecal incontinence. Overusing laxatives can also damage these nerves. […] The muscles of your rectum should be stretchy to help you hold poop. If theyre not elastic enough, poop can seep out. Conditions and procedures that cause scarring can prevent your rectum from stretching. Scar tissue isnt as stretchy as healthy tissue. For example, Crohn’s disease can lead to scarring that prevents stretching, and so can radiation therapy. […] POP is when weakened pelvic muscles cant fully support your pelvic organs. These organs include your rectum, vagina, uterus and bladder. As a result, the organs slip or sag. A rectal prolapse occurs when your rectum falls into your anus. A rectocele occurs when your rectum slips onto your vaginas back wall. Both forms of prolapse can lead to fecal incontinence.

• #17 Cary Gastroenterology Associates | Dealing With Fecal Incontinence:…

  https://www.carygastro.com/blog/dealing-with-fecal-incontinence-causes-and-treatment

  Damage to the nerves in the vicinity of the anus (part of the enteric nervous system) can be related to the same causes as muscle damage, but it can also be a result of nerve damage related to a spinal cord injury or even a stroke. […] Chronic constipation is a long term bowel irregularity problem that can cause you to frequently attempt to pass hard, dry stools; over time, excessive straining to pass these stools can lead to a weakening of the sphincter muscles on either side of the anal canal. […] The watery, loose stools associated with diarrhea are more difficult to hold in the rectum than solid stools. […] Though relatively rare, it is possible for the rectum to become prolapsed; this means that the rectum is pushed out into the anal canal and causes the anal sphincter muscles to be stretched.

• #17 Cary Gastroenterology Associates | Dealing With Fecal Incontinence:…

  https://www.carygastro.com/blog/dealing-with-fecal-incontinence-causes-and-treatment

  Similar to general nerve damage, some neurological conditions like multiple sclerosis, Parkinsons disease, and even dementia can cause fecal incontinence because of the impact of those diseases on the neurological health of the digestive system and the body as a whole. […] Depending on the underlying cause, medication, therapeutic exercises, or surgery may be used to treat or manage incontinence.

• #18 Fecal incontinence: challenges in electrodiagnosis and rehabilitation | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-023-00229-2

  Electrodiagnostic tests of the pelvic floor muscles represent a valid method for studying the functional integrity of neural pathways, localizing a pathological process, and possibly revealing its mechanism and severity. […] Pudendal and perineal nerve conduction studies have established a link between pudendal neuropathy and fecal incontinence. […] Prolongation of PNTML suggests pudendal neuropathy, and bilateral, not unilateral, neuropathy has been associated with diminished sphincter function and higher incontinence scores. […] The test of pudendal nerve has been found to be relatively insensitive to axonal lesion, because amplitude of response is variable between control subjects. […] The pudendal nerve study assesses the large, myelinated, fastest-conducting fibers in a nerve, and hence, loss of the slower-conducting fibers may be missed. […] The most valuable tests for the evaluation of FI are anorectal manometry, endoanal ultrasound, MRI with or without defecography, and neurophysiological studies.

• #18 Fecal incontinence: challenges in electrodiagnosis and rehabilitation | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-023-00229-2

  FI has complex etiology including altered rectal sensibility, dysfunction of the pelvic floor muscles, and damage to the anal sphincter complex. […] The mechanism of fecal continence relies on the coordinated function of the nervous system, gastrointestinal tract, anal sphincter, and pelvic floor musculature. […] The pelvic floor, particularly the puborectalis, also generally relaxes during defecation. […] FI is a multifactorial problem including altered rectal sensibility, dysfunction of the pelvic floor, and damage to the anal sphincter complex. […] The etiology of the condition includes central or autonomic nervous system insults as cerebrovascular strokes, multiple sclerosis and spinal cord injury in addition to inflammatory bowel disease, irritable bowel syndrome, diabetes mellitus, previous anal surgery, and vaginal delivery.

• #19

  https://www.grepmed.com/images/8356/incontinence-pathophysiology-stool-fecal-geriatrics

  Fecal Incontinence – Pathogenesis and Complications Continence mechanisms are impaired […] Local neuronal damage […] External and Internal anal sphincter impairment […] Continence mechanisms are intact, but overwhelmed or ignored […] Movement Disorders […] Inflammation of colon (e.g., Ulcerative colitis, Radiation proctitis) […] Chronic diarrhea, diarrhea-predominant irritable bowel syndrome, laxatives […] Chronic constipation […] Sensory neuropathy (e.g. Diabetes) […] Altered mental conditions (e.g. stroke, dementia)

• #20 Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence

  https://www.mdpi.com/2624-5647/6/3/53

  The purpose of this study is to examine the effect of pelvic floor muscle training on faecal incontinence. Faecal incontinence is a condition in which stool leaks from the anus involuntarily or uncontrollably. Faecal incontinence is common in elderly people and patients with underlying diseases, but the pathophysiology of faecal incontinence is diverse, and treatment methods must be varied accordingly. […] Pelvic floor muscle training can improve urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles such as the external anal sphincter and levator ani. However, the specific types of faecal incontinence patients that can effectively benefit from pelvic floor muscle training is unclear. […] The causes of faecal incontinence in frail patients are often neurogenic and involve conditions such as stroke, dementia, diabetes, and faecal embolism, as well as limitations in movement and visual impairment.

• #20 Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence

  https://www.mdpi.com/2624-5647/6/3/53

  The initial treatment basically involves conservative therapy for faecal incontinence. […] Faecal incontinence has a negative impact on quality of life, makes it difficult for individuals to be independent, and leads to isolation from society. […] The specific types of faecal incontinence patients that can benefit from pelvic floor muscle training is currently unknown. It is believed that faecal incontinence patients who are eligible for the program are those who can understand the content of the instruction and have sufficient motivation to continue the training. […] Pelvic floor muscle training is a method of improving urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles, such as the external anal sphincter and levator ani muscles. […] The effectiveness of pelvic floor muscle training for treating faecal incontinence ranges from 41% to 66%, and there are reports that this rate of effectiveness is lower than that of biofeedback therapy, as well as reports that there is no significant difference between the therapies. […] Pelvic floor muscle training is useful as a simple treatment method.

• #21

  https://link.springer.com/article/10.1007/BF01536628

  Manometric testing was performed on three groups of subjects: 14 patients complaining of fecal incontinence, 14 age- and sex-matched continent patients, and 14 sex-matched younger normal controls. The younger group displayed significantly stronger contractions of the external anal sphincter and puborectalis than the two patient groups, which did not differ. No differences were found in the relaxation of the internal anal sphincter. The incontinent group required a significantly larger stimulus in order to detect rectal distension compared to either the continent patients or the younger normals. An additional group of unmatched normals and incontinent patients demonstrated significant differences in their ability to retain rectally infused saline. The patients leaked sooner and retained less; however, the performance of the normals was considerably reduced from that reported in previous studies. The aging process seems to result in weakening of the striated muscles of the anal canal, although fecal incontinence need not occur. The afferent limb of the anorectal sensorimotor mechanism does not necessarily deteriorate with aging. A lower threshold for sensation of rectal distension among continent individuals apparently helps them to avoid incontinent episodes, even though maximum contractile pressures in their anal canal are no different from a comparable group of incontinent individuals.

• #22 Anal Incontinence | GLOWM

  https://www.glowm.com/section-view/heading/Anal%20Incontinence/item/72

  In normal, continent patients, sensations of temperature and pressure from stool or flatus in the anal canal are better appreciated and evoke an increase in sphincter tone. Differences in sensation are postulated to contribute to the difficulty that incontinent patients typically experience in differentiating flatus from solid stool. […] Pudendal neuropathy is most accurately assessed by measurement of PNTML; however, this test is not widely available and may be inaccurate unless performed by an experienced clinician.

• #23 Faecal incontinence is associated with an impaired rectosigmoid brake and improved by sacral neuromodulation | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.11.30.21266844v2.full-text

  The rectosigmoid brake, characterized by retrograde cyclic motor patterns on high-resolution colonic manometry has been postulated as a contributor to the maintenance of bowel continence. […] This study aims to investigate the colonic motility patterns in the distal colon of patients with faecal incontinence, and how these are modulated by SNM. […] The rectosigmoid brake was suppressed in this cohort of patients with faecal incontinence. SNM may exert a therapeutic effect by modulating this rectosigmoid brake. […] The mechanisms of action of sacral neuromodulation remain inadequately understood and may include modulation of the rectosigmoid brake. […] We found that patients with faecal incontinence had an impaired rectosigmoid brake, characterized by a reduced frequency of colonic motor patterns in response to a meal. Rectosigmoid brake activity was upregulated by sacral neuromodulation.

• #24 Faecal incontinence is associated with an impaired rectosigmoid brake and improved by sacral neuromodulation | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.11.30.21266844v2.full-text

  This study has shown that patients with faecal incontinence have an impaired rectosigmoid brake. […] Secondly, this study has shown that SNM significantly increases the total number of propagating contractions in the rectosigmoid region, particularly retrograde propagating contractions, demonstrating a likely mechanism through which SNM exerts its therapeutic benefit. […] Our data demonstrate that SNM effectively upregulates this pathway to effect enhanced retrograde distal colonic motility in patients with faecal incontinence, thereby confirming and extending previous work by Patton et al who first applied HRCM to demonstrate this effect. […] The rectosigmoid brake is likely an important contributor to faecal continence and may represent a key biomarker for the effect of SNM.

• #25 Quality of Life Differences in Female and Male Patients with Fecal Incontinence

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm15088

  Fecal incontinence is regarded as a multifactorial condition as it is not usually associated with just one pathogenic abnormality. […] Pathogenesis was assessed using the Thekkinkattil et al and Muñoz-Duyos et al fecal incontinence classifications. The Thekkinkattil classification considers four causes (traumatic, neuropathic, combined and idiopathic), whereas the Muñoz-Duyos classification considers 6 causes (obstetric, muscular non-obstetric, neuropathic, congenital, multifactorial, and idiopathic). […] Our finding of differences in male and female pathophysiology and pathogenesis has been corroborated by other studies. Essentially, more women have an impaired EAS function (in our study, almost all the women compared to just one third of men), whereas impaired IAS function is common in both sexes (in our study, around three quarters of the women and almost half of the men).

• #26 Fecal incontinence – Wikipedia

  https://en.wikipedia.org/wiki/Fecal_incontinence

  FI is a sign or a symptom, not a diagnosis, and represents an extensive list of causes. […] The most common factors in the development are thought to be obstetric injury and after-effects of anorectal surgery, especially those involving the anal sphincters and hemorrhoidal vascular cushions. […] Deficits of individual functional components of the continence mechanism can be partially compensated for a certain period, until the compensating components themselves fail. […] The anal canal presents the final barrier to continence. […] The resting tone of the anal canal is not the only important factor; both the length of the high-pressure zone and its radial translation of force are required for continence. […] Disruption of the function of the internal anal sphincter results in reduced resting pressure in the anal canal. […] The mechanisms and factors contributing to normal continence are multiple and interrelated. […] Problems affecting any of these mechanisms and factors may be involved in the cause.

• #27 Neuromodulation for fecal incontinence: An effective surgical intervention

  https://www.wjgnet.com/1007-9327/full/v19/i41/7048.htm

  Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. […] Recently, sacral nerve electrostimulation, lately named neuromodulation, has been reported to benefit patients with fecal incontinence in randomized controlled trials more than placebo stimulation and conservative management, by some unknown mechanism. […] However, its mechanism of action remains ill defined. […] The authors speculated that NRM worked via complex neuromodulation of sacral reflexes to regulate rectal sensitivity and anorectal motility. […] However, no definitive evidence could be found to support any of these and a multifactorial component was further speculated to justify the efficacy of NRM. […] The authors concluded that NRM is effective almost certainly via modulation of spinal and/or supraspinal afferent inputs, but many gaps remain in the understanding of the mechanism of action of NRM.

• #28 Sacral Nerve Stimulation and Fecal Incontinence: Current Uses and Emerging Trends | ClinMed International Library | Obstetrics and Gynaecology Cases – Reviews |

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-088.php?jid=ogcr

  Fecal incontinence (FI) is a socially devastating condition affecting both men and women. […] Its mechanism of action is incompletely understood though is thought to work on afferent pathways. […] How SNS effects improvement in FI has yet to be fully elucidated. […] SNS mechanism of action was initially thought to be due to augmentation of anal sphincter function. […] Instead, current evidence points to SNS working on afferent (sensory) pathways, though whether this is via modulating somato-visceral reflexes or by moderating the perception of afferent signalling remains to be defined.

• #29 Sacral Nerve Stimulation and Fecal Incontinence: Current Uses and Emerging Trends | ClinMed International Library | Obstetrics and Gynaecology Cases – Reviews |

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-088.php

  Fecal incontinence (FI) is a socially devastating condition affecting both men and women. […] Its mechanism of action is incompletely understood though is thought to work on afferent pathways. […] How SNS effects improvement in FI has yet to be fully elucidated. […] SNS mechanism of action was initially thought to be due to augmentation of anal sphincter function. […] Instead, current evidence points to SNS working on afferent (sensory) pathways, though whether this is via modulating somato-visceral reflexes or by moderating the perception of afferent signalling remains to be defined. […] A recent study by Altomare et al. demonstrated that SNS takes advantage of neuroplasticity, restoring neural circuitry to its prior, pre-incontinence state.

• #30 Faecal Incontinence and Autoimmune Diseases | IntechOpen

  https://www.intechopen.com/chapters/69125

  Fecal incontinence is characterized by inability to control bowel motions, causing the unexpected leakage of flatus and feces per rectum. […] Other causes of faecal incontinence include immunological disorders that cause muscle damage due to formation of autoantibodies in autoimmune diseases. […] The precise cause and mechanism how autoimmune diseases cause faecal incontinence are unknown, but multiple factors are probably involved. These factors include deterioration and destruction of collagen framework by the effect of autoantibodies, resulting in inflammation, reduced compliance of rectal muscles with consequent urgency, and urge faecal incontinence.

• #31 Faecal incontinence – O&G Magazine

  https://www.ogmagazine.org.au/16/1/faecal-incontinence/

  An accepted and standardised definition of faecal incontinence (FI) does not exist, but usually it incorporates the involuntary loss of control of bowel motions, occurring with any level of frequency. It usually also includes flatus incontinence, particularly in patient-generated definitions. […] Normal bowel continence is a multifactorial mechanism, which is important to keep in mind when assessing a patient reporting these symptoms. The mechanism can be considered as five main components: […] Approximately 2025 per cent of primiparous women will experience some early postpartum alteration of faecal continence after vaginal delivery. […] This last point reinforces the fact that, while a significant obstetric tear can cause IAS and EAS damage, several other events in parturition can affect bowel continence. […] Faecal incontinence is a multifactorial disorder and there is a move away from a sphincter-centric treatment approach. Patients may present several years following an apparent obstetric anal injury and this often reflects a multifactorial failure of the continence mechanism.

• #32 Comprehensive Clinical Approach to Fecal Incontinence | IntechOpen

  https://www.intechopen.com/chapters/67111

  The common parameter used to determine FI was maximal resting pressure. […] The saline continence test quantifies the severity of FI. […] Novel neurophysiological investigations can be used to assess the spino-anorectal neuropathy with higher sensitivity. […] The latter tests for brain-gut-axis are mostly performed in the tertiary specialized institutes. […] Further study regarding brain-gut-microbiota interaction is continuing for a better understanding of this group of patients.

• #33 Bowel incontinence | PPT

  https://www.slideshare.net/slideshow/bowel-incontinence/58221376

  Fecal incontinence has many potential causes including injuries during childbirth, neurological conditions, and diseases affecting the colon or rectum. Assessment involves a detailed history, examination, and tests like endoanal ultrasound and MRI to evaluate the sphincter muscles and detect any anatomical defects. Initial management focuses on lifestyle modifications, biofeedback training, bulking agents, and topical therapies. Surgery is usually only considered if other options fail, with options like sphincter repair, injectable bulking agents, sacral nerve stimulation, graciloplasty, or an artificial bowel sphincter depending on the individual case. Stoma formation is effective but often avoidable in most patients.

• #34 Treatments for Fecal Incontinence | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/fecal-incontinence/research-protocol

  Treatments for FI may be nonsurgical or surgical. Nonsurgical treatments include pelvic floor muscle training exercises (PFMT), dietary modification (including dietary fiber), medications, biofeedback, bowel schedules, anal plugs, rectal irrigation, or combinations thereof. […] FI etiologies and other patient factors dictate feasible treatment options. For example, the range of treatment approaches used for FI in adults with spinal cord (neurologic) injury would differ from those used to treat pelvic floor muscle atrophy (structural weakness) or anal sphincter injury (structural damage). Treatment goals are to decrease the frequency and severity of FI episodes in affected adults. In general, initial FI treatments tend to be conservative (diet, drugs, exercises, etc.) and become progressively more invasive (local injections of tissue-bulking material, surgical procedures) if desired treatment effects are not obtained with less invasive approaches.

• #35 Pathogenesis and Management of Fecal Incontinence in the Adult

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W2406448818

  Patients with fecal incontinence are depressed and embarrassed. They have often been told by friends, relatives, and their family doctor that there is little that can be done and not to complain. It is essential in the initial consultation with the patient that this defeatist attitude be countered. Much can be done to restore full function by relatively simple measures which may include surgery. For the surgeon they represent a very gratifying group of patients to treat.

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