Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK.
Nat Rev Dis Primers. 2022 Aug 10;8(1):53. doi: 10.1038/s41572-022-00381-7.
Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.
粪便失禁是指无意识地排出固体或液体粪便，其在社区居住的成年人中的全球患病率≤7%，可显著降低生活质量。尽管如此，由于尴尬，许多患者可能不会主动提及该症状。肠道紊乱，特别是腹泻、肛门括约肌损伤（产科损伤或先前的手术）、直肠紧迫感和慢性病负担是粪便失禁的主要危险因素；其他包括神经障碍、炎症性肠病和盆底解剖结构紊乱。粪便失禁按其类型（急迫性、被动性或混合性）、病因（直肠肛门功能紊乱、肠道症状或两者兼有）和严重程度进行分类，严重程度取决于粪便泄漏的频率、量、稠度和性质（急迫性或被动性）。根据临床特征，逐步实施诊断测试和治疗。当简单措施（例如，肠道调节剂，如纤维补充剂、泻药和止泻药）无效时，进行直肠肛门测压和其他测试（经肛门成像、排粪造影、直肠顺应性和感觉以及肛门神经生理测试）。非手术选择（饮食和生活方式改变、行为措施，包括生物反馈治疗、便秘或腹泻的药物治疗以及肛门或阴道屏障装置）通常是有效的，尤其是对于轻度粪便失禁患者。此后，必要时可考虑使用肛周填充剂、骶神经调节和其他手术。
