Schiller Lawrence R.
Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
Curr Treat Options Gastroenterol. 2003 Aug;6(4):319-327. doi: 10.1007/s11938-003-0024-7.
Fecal incontinence is a symptom of many disorders that can affect the nerves and muscles controlling defecation; it is not just due to exceptionally voluminous diarrhea. Underlying problems should be identified and treated, because that may improve incontinence. If treatment of the underlying problem does not correct incontinence, several approaches can be employed successfully. General approaches include stimulation of defecation at intervals to empty the rectum under supervised conditions; treatment of diarrhea, if present; addressing coexisting psychologic problems, such as depression; use of continence aids, such as adult diapers; and perineal skin care to prevent skin breakdown. Drug therapy includes use of constipating drugs, such as loperamide or diphenoxylate, that can impede the gastrocolic reflex, thereby limiting rectal filling and the likelihood of incontinence. Biofeedback training is useful in patients with some ability to sense rectal distention and to contract the external anal sphincter; instrumental learning using manometric or electromyographic biofeedback can be used to reinforce the rectoanal contractile response to rectal distention. Improvement in continence has been noted in up to 70% of suitable candidates with a single biofeedback training session. Patients with external anal sphincter disruption due to childbirth injury or other trauma may benefit from direct external anal sphincter repair (sphincteroplasty). In others, tightening up the anal canal by encirclement with nonabsorbable mesh (Thiersch procedure), perianal injection of fat, collagen, or synthetic gel, or radiofrequency electrical energy (Stretta procedure) may provide some palliation. Creation of a new sphincter mechanism by muscle transposition and encirclement of the anal canal is another approach that has been improved by use of electrical stimulators to keep the neosphincter contracted. Artificial anal sphincters patterned after artificial urinary sphincters have met with some success, but local infection remains problematic. When all else fails, fecal diversion (ileostomy, colostomy) can be effective in rehabilitating patients.
大便失禁是许多疾病的症状，这些疾病会影响控制排便的神经和肌肉；它不仅仅是由于腹泻量异常大。应识别并治疗潜在问题，因为这可能改善失禁情况。如果对潜在问题的治疗不能纠正失禁，可成功采用几种方法。一般方法包括在监督下定期刺激排便以排空直肠；治疗腹泻（如果存在）；解决并存的心理问题，如抑郁症；使用失禁辅助用品，如成人尿布；以及进行会阴皮肤护理以防止皮肤破损。药物治疗包括使用止泻药，如洛哌丁胺或地芬诺酯，它们可阻碍胃结肠反射，从而限制直肠充盈和失禁的可能性。生物反馈训练对有一定能力感知直肠扩张并收缩肛门外括约肌的患者有用；使用测压或肌电图生物反馈的工具性学习可用于增强直肠对直肠扩张的收缩反应。单次生物反馈训练后，高达70%的合适患者的失禁情况得到改善。因分娩损伤或其他创伤导致肛门外括约肌受损的患者可能受益于直接的肛门外括约肌修复（括约肌成形术）。对于其他患者，用不可吸收网片环绕肛管收紧肛管（蒂尔施手术）、肛周注射脂肪、胶原蛋白或合成凝胶或射频电能（斯特雷塔手术）可能会提供一些缓解。通过肌肉移位和环绕肛管创建新的括约肌机制是另一种方法，通过使用电刺激器保持新括约肌收缩，这种方法得到了改进。模仿人工尿道括约肌制作的人工肛门括约肌取得了一些成功，但局部感染仍然是个问题。当其他方法都失败时，粪便转流（回肠造口术、结肠造口术）对患者康复可能有效。
