University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, California; and the Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin Texas.
Obstet Gynecol. 2020 Oct;136(4):811-822. doi: 10.1097/AOG.0000000000004054.
Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician-gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.
9%的成年女性至少每月会经历一次粪便失禁。粪便失禁在老年女性和患有慢性肠功能紊乱、糖尿病、肥胖、先前肛门括约肌损伤或尿失禁的人群中更为常见。粪便失禁会降低生活质量和心理健康，并增加入住疗养院的风险。只有不到 30%的粪便失禁女性寻求治疗，而缺乏有效的解决方案信息是患者和医疗保健专业人员的重要障碍。即使在同时患有尿失禁和粪便失禁并接受妇科泌尿学护理的女性中，粪便失禁症状的口头披露率仍然很低。本文概述了妇产科医生在处理粪便失禁方面的评估和管理，纳入了美国妇产科医师学会、美国胃肠病学会和美国结肠直肠外科学会的现有指导意见。粪便失禁的初始临床评估需要进行重点病史采集和体格检查。使用标准日记或问卷记录患者症状有助于记录症状和治疗反应。在开始治疗时，通常不需要进行侵入性诊断性检查和影像学检查，但在复杂病例中可能需要考虑。大多数女性的症状较轻，通过优化粪便稠度和药物治疗可以改善。其他治疗选择包括骨盆底肌肉强化治疗，包括有或无生物反馈的治疗、经肛门或阴道放置的装置以及手术治疗，包括骶神经刺激、肛门括约肌成形术，以及对于其他干预措施失败的严重受影响个体进行结肠分流术。
