At the International Continence Society (ICS) meeting in Florence in 2017, there was a round table session dedicated to anal (or fecal) incontinence.
Right from the start in the opening statement, it was established that breaking the silence surrounding fecal incontinence is the most important first step. This is also the main conclusion of a recently published review, which covers clinical management of fecal incontinence from the gynecologist’s perspective: Medical professionals should always ask the patient about anal and fecal incontinence.
The round table discussion at the ICS meeting concluded that even if the patients are asked, we often do not know what treatments and/or therapies will work. This is supported by a new survey study showing that while a majority of continence advisors in the UK ask and give advice about fecal incontinence, almost half of them feel that they need more education to be able to give proper advice to their patients. It is also important to continuously ask about and discuss bowel problems even though if the problems have been known and treated for a long time, as in children with Hirschsprung’s disease and anorectal malformation.
The stigma of bowel problems and the need for independence when growing up are investigated in a recent qualitative study which concludes that communication is imperative to help these children and parents on the path to independence.
Summary of Publications
Faecal incontinence: a narrative review of clinic-based management for the general gynaecologist.
https://www.ncbi.nlm.nih.gov/pubmed/28934892
Author and Origin
Williams KS, Shalom DF, Winkler HA. US
Summary
A review of management of fecal incontinence for the general gynecologist. The review covers
prevalence, pathophysiology, examinations and clinic-based treatments.
Conclusions
It is important for general gynecologists to ask patients about fecal and anal incontinence, both at first and subsequent visits. A non-verbal screening may be better for those patients who are reluctant to respond to a face-to-face inquiry.
Comments
A US-based review of management of fecal incontinence from the gynecologist’s perspective.
Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey.
https://www.ncbi.nlm.nih.gov/pubmed/28736932
Author and Origin
Leo CA, Maeda Y, Collins B, Thomas GP, Hodgkinson JD, Murphy J, Vaizey CJ. UK
Summary
A survey study of 226 continence advisors. 76.9% of the continence advisors treated both fecal and
urinary incontinence. In management of fecal incontinence (FI) 147 (65 %) advised on rectal irrigation.
Conclusions
Even though a majority of continence advisors are able to initiate a broad range of conservative treatment options in FI, 89 (42.6%) of the advisors felt that they had not been adequately trained to provide a bowel continence service.
Comments
A survey study that covers UK continence advisors’ knowledge of continence management and the
adequacy of their training.
Understanding Experiences of Youth Growing Up with Anorectal Malformation or Hirschsprung’s Disease to Inform Transition Care: A Qualitative In-Depth Interview Study.
https://www.thieme-connect.de/DOI/DOI?10.1055/s-0037-1605351
Author and Origin
Nah S.A., Ong C.C.P., Lie D., Marimuttu V.J., Hong J., Te-Lu Y., Low Y., Jacobsen A.S. Singapore
Summary
A qualitative study of pediatric patients between the ages of 14 and 21 years, with Hirschsprung’s
disease and anorectal malformation. The study explored the physical, social, and emotional impact of the conditions to develop transition care strategies.
Conclusions
It is important for clinicians to independently engage with patients in late childhood to address evolving emotional and information needs and encourage increasing autonomy.
Comments
A qualitative study in children with Hirschprung’s disease and anorectal malformation, showing
the importance of early introduction of independence.
This blog post is an extract of the Science Alert from Oct 2017 (76040-USX-1710)
