Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Curr Opin Gastroenterol. 2012 Jan;28(1):57-62. doi: 10.1097/MOG.0b013e32834d2e8b.
Fecal incontinence is a common condition, which leads to impaired quality of life and huge financial cost at an individual and societal level. Recent studies have identified novel and potentially modifiable risk factors. Newer diagnostic modalities are giving more detailed information about underlying disorders, helping to implement targeted treatment. Many therapeutic options exist, and newer treatments are changing outcomes. This article will review recent developments in mechanisms, diagnosis, and treatment of fecal incontinence.
Potentially modifiable risk factors have recently been identified, and should translate to changes in clinical practice and hopefully patient outcomes. These include diarrhea, smoking, and dietary fiber. Advances have been made in anatomical and physiological testing of the anorectum and this may assist in clarifying the diagnosis and guiding management. The long-term benefit of biofeedback has been questioned but patient selection may be key. Novel pharmacological therapies (e.g., clonidine) and minimally invasive surgical procedures are changing outcomes in well selected patients. The development of a magnetic anal sphincter may add a new management alternative in patients who are refractory to conservative management.
Fecal incontinence remains a clinical challenge. Only a minority of persons with fecal incontinence seek treatment, but for those who do, improved understanding of risk factors coupled with diagnostic techniques and treatments are improving outcomes.
粪便失禁是一种常见病症，会降低个人和社会层面的生活质量并造成巨大的经济负担。最近的研究已经确定了一些新的、潜在可改变的风险因素。较新的诊断方法可提供有关潜在疾病的更详细信息，有助于实施针对性治疗。目前有许多治疗选择，新型治疗方法正在改变治疗结果。本文将综述粪便失禁的发病机制、诊断和治疗方面的最新进展。
最近已经确定了一些潜在可改变的风险因素，有望改变临床实践，并可能改善患者的预后。这些因素包括腹泻、吸烟和膳食纤维。在肛管直肠的解剖学和生理学测试方面也取得了进展，这可能有助于明确诊断并指导治疗。生物反馈的长期获益受到质疑，但患者选择可能是关键。新型药物治疗（如可乐定）和微创外科手术正在改变选择合适患者的治疗结果。磁括约肌的发展可能为难以通过保守治疗的患者提供一种新的管理选择。
粪便失禁仍然是一个临床挑战。只有少数粪便失禁患者寻求治疗，但对于那些寻求治疗的患者，对风险因素的理解以及诊断技术和治疗方法的提高正在改善预后。
