Kapoor Dharmesh S, Thakar Ranee, Sultan Abdul H
Clinical Fellow in Urogynecology, Mayday University Hospital, Croydon, UK.
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Jul-Aug;16(4):321-8. doi: 10.1007/s00192-004-1283-0. Epub 2005 Feb 24.
Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9-19% (urinary) and 5-10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.
尿便（液体或固体）联合失禁（双重失禁）是盆底功能障碍最严重且使人衰弱的表现。社区患病率为尿失禁9 - 19%，粪失禁5 - 10%，且随年龄增长而增加。病理生理因素包括与分娩相关的肛门外括约肌损伤和阴部神经损伤、盆底下降、绝经、胶原紊乱以及类似多发性硬化的病症。动物研究中膀胱、尿道、直肠肛管和盆底之间存在交叉反射，这可能解释了尿急和便急的合并症。手术治疗基于病因，并结合诸如阴道前壁悬吊术或尿道下吊带术与重叠括约肌成形术等最佳技术。其他改善括约肌控制的方法包括骶神经调节、填充剂和人工括约肌。
