Bock J U, Jongen J
Praxis für Enddarmkrankheiten Kiel.
Zentralbl Chir. 1996;121(8):659-64.
Age related, about 10% of the general population suffer from faecal incontinence. In a surgical, proctological office diagnosis is possible with carefully taken history, physical examination, digital examination of the anorectum, rigid rectosigmoidoscopy, and anoscopy. Together with special examinations (endoanal ultrasound, electromyography, pudendal nerve terminal motor latency [PNTML], anorectal manometry, defaecography, transit time of the colon) the plan for medical and surgical treatment can be made. The basic medical conservative therapy consists of regulating the form of stool (high fibre diet and/or loperamid), training of the sphincter and pelvic muscles electrical stimulation or biofeedback training. Outpatient surgery is possible for small prolapsing tumors of the lower rectum or anal canal, hemorrhoids grade 2 or segmental anal prolapse. Inpatient surgery is needed for any form of reconstruction of the sphincter or the sensitive area of the anal canal, post- and preanal repair, anal and rectal prolapse, (dynamic) gracilis sphincteroplasty, or for a terminal stoma in those patients, whose uncontrolled incontinence cannot be managed otherwise. After surgery it is needed to continue the medical therapy (regulating the bowel movements, biofeedback training, electrical stimulation of the sphincter).
随着年龄增长，普通人群中约10%患有大便失禁。在外科或直肠科门诊，通过仔细询问病史、体格检查、肛门直肠指诊、硬式直肠乙状结肠镜检查和肛门镜检查可作出诊断。结合特殊检查（腔内超声、肌电图、阴部神经终末运动潜伏期[PNTML]、肛门直肠测压、排粪造影、结肠传输时间），可以制定药物和手术治疗方案。基本的药物保守治疗包括调整大便形态（高纤维饮食和/或洛哌丁胺）、括约肌和盆底肌肉训练、电刺激或生物反馈训练。对于直肠下段或肛管的小脱垂肿瘤、2级痔疮或节段性肛门脱垂可行门诊手术。对于任何形式的括约肌或肛管敏感区重建、肛门前后修复、肛门和直肠脱垂、（动态）股薄肌括约肌成形术，或对于那些无法以其他方式控制失禁的患者行末端造口术，则需要住院手术。术后需要继续药物治疗（调节排便、生物反馈训练、括约肌电刺激）。
