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Revista chilena de cirugía

versão On-line ISSN 0718-4026

Resumo

VERGARA A, M. Teresa et al. Fecal incontinence in adults. Rev Chil Cir [online]. 2011, vol.63, n.3, pp.320-326. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262011000300016.

The aim of this paper is to review the knowledge of this pathology by highlighting the clinical evolution, study and treatment. These different aspects need a multidisciplinar^ approach, because of their complex physiopathology, possible association with urinary incontinence and prolapse of the three compartments of the pelvis. The fecal incontinence (FI) constitutes a highly prevalent pathology that affects at least 2% of the population and up to 45% of the patients in nursing homes. This pathology can cause serious problems in physical, psychological, social, and economical levels. The clinical evaluation may identify or suspect the cause, and guide the study of FI. The initial treatment of the FI should always be medical one, often associated to biofeedback and the surgical treatment should be only reserved for refractory FI. Sphincteroplasty is indicated by defined defaults of the external sphincter, with good initial results (at least 70%) that fall to 50% in 5 years. The artificial neosphincter and the dynamic graciloplasty represent an option for patient without sufficient sphincter mass for a plasty. In the last few years new techniques have appear with promising results, as the neuromodulation that uses electrodes in the sacral plexus or applied to the posterior tibial nerve. In conclusion the IF is a problem of large prevalence but kept in shadows because the patients tend to have reticence to declare it, and the doctors to inquire about. The focus should be multidisciplinary and the initial treatment must be medical one. The surgical treatment should be reserved for refractory FI.

Palavras-chave : Fecal incontinence; endosonography; anal manometry; biofeedback; sphincteroplasty.

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