Zentralbl Chir 2012; 137(4): 323-327
DOI: 10.1055/s-0032-1315104
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Stellenwert der konservativen Therapie bei Stuhlinkontinenz

Significance of Conservative Treatment for Faecal Incontinence
O. Schwandner
Abteilung für Proktologie, Regensburger Enddarmzentrum, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
29 August 2012 (online)

Zusammenfassung

Aufgrund der unterschiedlichen Ätiologie und den häufig kombinierten Befunden bei der Stuhlinkontinenz ist primär ein konservativer Behandlungsversuch gerechtfertigt. Konservative Therapieformen bei der Stuhlinkontinenz beinhalten medikamentöse Beeinflussung der Stuhlkonsistenz und -passage, Beckenbodengymnastik und Biofeedback sowie lokal-topische Maßnahmen. Die Bewertung der konservativen Therapie hinsichtlich Erfolg und Misserfolg ist schwierig, da die vorhandenen Studien unterschiedliche Patientenkollektive, verschiedene Inkontinenzformen und häufig eine fehlende Standardisierung aufweisen. Generell besteht ein Dilemma, subjektive Verbesserung unter konservativer Therapie objektivierbar zu machen.

Abstract

Based on a variety of aetiological factors and combined disorders in faecal incontinence, a conservative treatment option as the primary treatment can be recommended. Conservative treatment includes medical therapy influencing stool consistency and stool passage, pelvic floor exercises and biofeedback as well as local treatment options. However, defining the role of conservative treatment concepts related to success or failure remains a challenging task. The lack of evidence derived from studies is related to a variety of reasons including inclusion criteria, patient selection, treatment standardisation, and the principal difficulty to objectively define functional success.

 
  • Literatur

  • 1 Nelson RL. Epidemiology of fecal incontinence. Gastroenterology 2004; 126 (Suppl. 01) S3-S7
  • 2 Whitehead WE, Borrud L, Goode PS et al. Pelvic Floor Disorders Network. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137: 512-517
  • 3 Bartlett L, Nowak M, Ho YH. Impact of fecal incontinence on quality of life. World J Gastroenterol 2009; 15: 3276-3282
  • 4 van Tilburg MA, Squires M, Blois-Martin N et al. Parental knowledge of fecal incontinence in children. J Pediatr Gastroenterol Nutr 2012; [Epub ahead of print]
  • 5 Kyle G. An insight into continence management in patients with dementia. Br J Community Nurs 2012; 17: 125-126 128, 130–131
  • 6 Hägglund D. A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs 2010; 19: 303-312
  • 7 Roe B, Flanagan L, Jack B et al. Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus. J Advanced Nursing 2010; 67: 228-250
  • 8 Lam TJ, Kuik DJ, Felt-Bersma RJF. Anorectal function evaluation and predictive factors for faecal incontinence in 600 patients. Colorectal Dis 2012; 14: 214-223
  • 9 Chaudhary BN, Chadwick M, Roe AM. Selecting patients with faecal incontinence for anal sphincter surgery: the influence of irritable bowel syndrome. Colorectal Dis 2010; 12: 750-753
  • 10 Kang H, Jung H, Kwon K et al. Prevalence and predictive factors of fecal incontinence. J Neurogastroenterol Motil 2012; 18: 86-93
  • 11 Schwandner O, Poschenrieder F, Gehl HB et al. Differenzialdiagnostik der Beckenbodeninsuffizienz. Chirurg 2004; 75: 850-860
  • 12 Schwandner O, Denzinger S, Rössler W et al. “Beckenbodensenkungssyndrom”. Genese und Diagnostik. Chir Praxis 2008; 69: 121-134
  • 13 Schwandner O. Biofeedback bei Stuhlinkontinenz. Was ist heute gesichert?. Chir Praxis 2011; 73: 203-209
  • 14 Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg 2011; 24: 64-70
  • 15 Pehl C, Birkner B, Bittmann W et al. Stuhlinkontinenz. Dtsch Ärztebl 2000; 97: 1302-1308
  • 16 Dobben AC, Terra MP, Berghmans B et al. Functional changes after physiotherapy in fecal incontinence. Int J Colorectal Dis 2006; 21: 515-521
  • 17 Terra MP, Deutekom M, Dobben AC et al. Can the outcome of pelvic-floor rehabilitation in patients with fecal incontinence be predicted?. Int J Colorectal Dis 2008; 23: 503-511
  • 18 Wang J, Patterson T, Hart SL et al. Fecal incontinence: does age matter? Characteristics of older vs. younger women presenting for treatment of fecal incontinence. Dis Colon Rectum 2008; 51: 426-431
  • 19 Bols EMJ, Berghmans BCM, Hendriks EJM et al. A randomized physiotherapy trial in patients with fecal incontinence: design of the PhysioFIT-study. BMC Public Health 2007; 7: 355
  • 20 Heymen S, Scarlett Y, Jones K et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 2009; 52: 1730-1737
  • 21 Boselli AS, Pinna F, Cecchini S et al. Biofeedback therapy plus anal electrostimulation for fecal incontinence: prognostic factors and effects on anorectal physiology. World J Surg 2010; 34: 815-821
  • 22 Naimy N, Thomassen Lindam A, Bakka A et al. Biofeedback vs. electrostimulation in the treatment of postdelivery anal incontinence: a randomized, clinical trial. Dis Colon Rectum 2007; 50: 2040-2046
  • 23 Norton C. Fecal incontinence and biofeedback therapy. Gastroenterol Clin North Am 2008; 37: 587-604
  • 24 Lacima G, Pera M, Amador A et al. Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls. Colorectal Dis 2010; 12: 742-749
  • 25 Norton C, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2006; CD002111
  • 26 Hosker G, Cody JD, Norton CC. Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev 2007; CD001310
  • 27 Schwandner T. Wertigkeit von Nerv- und Muskeltraining bei analer Inkontinenz. 36. Koloproktologen-Kongress, München, 11.-13.10.2010. Coloproctology 2010; 32: 143-146
  • 28 Schwandner T, König IR, Heimerl T et al. Triple target treatment (3 T) is more effective than biofeedback alone for anal incontinence: the 3 T-AI Study. Dis Colon Rectum 2010; 53: 1007-1016
  • 29 Bittorf B, Ringler R, Forster C et al. Cerebral representation of the anorectum using functional magnetic resonance imaging. Br J Surg 2006; 93: 1251-1257
  • 30 Tjandra JJ, Dykes SL, Kumar RR et al. and the Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum 2007; 50: 1497-1507