Anal Incontinence: Clinical Management and Surgical Techniques

Foreword
Preface
Contents
Part I: Overview
	1: History of Anal Incontinence and its Treatments
		1.1	 History of Anal Incontinence
		1.2	 History of Treatments for Anal Incontinence
			1.2.1	 Colonic Irrigation and Colostomy
			1.2.2	 Anal Sphincter Repair
			1.2.3	 Muscle Transposition and Artificial Sphincter
			1.2.4	 Bulking Agents
			1.2.5	 Other Treatments and Techniques
		References
	2: Epidemiology, Anorectal Anatomy, Physiology and Pathophysiology of Continence
		2.1	 Introduction and Epidemiology
		2.2	 Anatomy and Physiology of Continence
		2.3	 Pathophysiology of Fecal Incontinence
		References
Part II: Diagnosis
	3: Clinical Evaluation, Etiology, and Classification of Anal Incontinence
		3.1	 Clinical Evaluation of Anal Incontinence
			3.1.1	 How to Examine the Patient
		3.2	 Etiology of Anal Incontinence
			3.2.1	 Anal Incontinence after Operations for Anal Fissure
			3.2.2	 Anal Incontinence after Operations for Anal Fistula
			3.2.3	 Anal Incontinence after Operations for Hemorrhoids
			3.2.4	 Anal Incontinence after Operations for Anal Tumors
			3.2.5	 Anal Incontinence after Operations for Rectal Cancer
			3.2.6	 Anal Incontinence Following Operations for Slow-Transit Constipation
			3.2.7	 Anal Incontinence Following Operations for Anorectal Stricture
			3.2.8	 Anal Incontinence Following Surgery for Inflammatory Bowel Diseases
		3.3	 Classification of Anal Incontinence
		References
	4: Neurofunctional Diagnosis and Anorectal Manometry
		4.1	 Introduction
		4.2	 Neurofunctional Diagnosis
			4.2.1	 Anal Electromyography
			4.2.2	 Sacral Reflexes
			4.2.3	 Evoked Potentials
		4.3	 Anorectal Manometry
		References
	5: Role of Ultrasonography for Anal Incontinence
		5.1	 Introduction
		5.2	 Ultrasound Technique
		5.3	 Normal Ultrasound Anatomy
		5.4	 Ultrasound in Anal Incontinence
		5.5	 Internal Anal Sphincter Lesions
		5.6	 External Anal Sphincter Lesions
		5.7	 Puborectalis Muscle Lesions
		References
	6: Cross-Sectional Imaging in Fecal Incontinence
		6.1	 Introduction
		6.2	 Imaging Techniques
			6.2.1	 X-Ray Defecography
				6.2.1.1	 Execution Protocol
				6.2.1.2	 Image Analysis
				6.2.1.3	 Imaging Findings
			6.2.2	 Magnetic Resonance Defecography
				6.2.2.1	 Acquisition Protocol
			6.2.3	 Magnetic Resonance Anatomy of the Anal Canal
			6.2.4	 Morphologic Diagnostic Criteria
			6.2.5	 Functional Diagnostic Criteria
				6.2.5.1	 Rectal Prolapse
				6.2.5.2	 Rectocele
				6.2.5.3	 Rectoanal Intussusception
		6.3	 Conclusions
		References
Part III: Treatment
	7: Medical Management and Supportive/Hygienic Measures
		7.1	 Introduction
		7.2	 Nursing Assessment
		7.3	 Hygiene and Dietary Guidelines
		7.4	 Medical Treatment
		7.5	 Mechanical Treatments and Containment Devices
		7.6	 Mind and Incontinence
		7.7	 Conclusions
		References
	8: Diet in Fecal Incontinence
		8.1	 General Principles of Diet
		8.2	 Dietary Therapeutic Strategies
			8.2.1	 Low FODMAP Diet
			8.2.2	 Percentage of Macronutrients
			8.2.3	 Coffee
			8.2.4	 Spices, Spicy and Smoked Foods
			8.2.5	 Supplementation with Vitamins and Minerals
		8.3	 Importance of Healthy Foods
			8.3.1	 Fruit and Vegetables
			8.3.2	 Fish
			8.3.3	 Extra Virgin Olive Oil
		References
	9: Role of Pelvic Floor Rehabilitation: Patient Selection and Treatment
		9.1	 Introduction
		9.2	 Clinical Physiatric Evaluation
		9.3	 Pelvic Floor Rehabilitation Treatment
			9.3.1	 The Re-Education Phase
			9.3.2	 Pelvic Floor Rehabilitation “Tools”
			9.3.3	 Post-Rehabilitation Assessment
		References
	10: Sacral and Percutaneous Tibial Nerve Stimulation, Stem Cell Therapy, and Transanal Irrigation Device
		10.1	 Sacral Nerve Stimulation
			10.1.1	 How It Works
			10.1.2	 Patient Selection
			10.1.3	 Surgical Procedure
			10.1.4	 Complications
		10.2	 Percutaneous Tibial Nerve Stimulation
			10.2.1	 Procedure
			10.2.2	 Literature Results
		10.3	 Stem Cell Therapy
		10.4	 Transanal Irrigation
			10.4.1	 Procedure
			10.4.2	 How It Works
			10.4.3	 Literature Results
		References
	11: Sphincter Reconstruction: Dynamic Myoplasty, Artificial Bowel Sphincter, Antegrade Colonic Enemas and Colostomy
		11.1	 Introduction
		11.2	 Dynamic Myoplasty
			11.2.1	 Technique
			11.2.2	 Results
		11.3	 Artificial Bowel Sphincter
			11.3.1	 Acticon Neosphincter
				11.3.1.1	 Technique
				11.3.1.2	 Results
			11.3.2	 Fenix Neosphincter
				11.3.2.1	 Technique
				11.3.2.2	 Results
		11.4	 Antegrade Colonic Enemas
			11.4.1	 Results
		11.5	 Colostomy
		References
	12: Surgical Reconstruction of Traumatic Perineal and Sphincter Muscle Defects
		12.1	 Introduction
		12.2	 Pathophysiology of Anal Sphincter Injuries
			12.2.1	 Mechanisms of Sphincter Injuries
			12.2.2	 Acute Anal Sphincter Injury and Healing
		12.3	 Anal Sphincter and Levator Ani Repair
			12.3.1	 General Considerations for Surgery
			12.3.2	 Surgical Technique for Sphincter Repair
			12.3.3	 Surgical Technique for Levator Ani Repair
			12.3.4	 Postoperative Management
			12.3.5	 Postoperative Complications
		12.4	 Functional Results of Sphincter and Levator Ani Repair
			12.4.1	 Early Postoperative Results of Sphincteroplasty
			12.4.2	 Prognostic Factors in Sphincter Repair Success
				12.4.2.1	 Age
				12.4.2.2	 Pudendal Nerve Integrity
			12.4.3	 Late Results of Sphincter Repair
			12.4.4	 What Is the Best Option for Failed Sphincter Repair?
			12.4.5	 Results of Levator Ani Repair
		12.5	 Future in Sphincter and Perineum Repair
		12.6	 Conclusions
		References
	13: Injectable Bulking Agents and SECCA Radiofrequency Treatment
		13.1	 Injectable Bulking Agents
			13.1.1	 Background
			13.1.2	 Early Applications
			13.1.3	 Recent Applications
			13.1.4	 Conclusions
		13.2	 SECCA Procedure
		References
	14: Implantation of Self-Expandable Solid Prostheses for Anal Incontinence
		14.1	 Introduction
		14.2	 Indications and Contraindications
		14.3	 Surgical Technique
		14.4	 Implantation Results
		14.5	 Adverse Effects: Displacement
		References
	15: When Everything Fails: Prevention and Therapy of Treatment Failures
		15.1	 Introduction
		15.2	 Sphincteroplasty with or Without Postanal Repair
			15.2.1	 What to Do when Sphincteroplasty Fails?
		15.3	 Injectable Anal Bulking Agents
		15.4	 Adynamic Anal Sphincter Reinforcement by Prosthetic Implants
			15.4.1	 Gatekeeper and Sphinkeeper
			15.4.2	 Fenix Device
			15.4.3	 Silastic Band
		15.5	 SECCA Radiofrequency Treatment
		15.6	 Dynamic Anal Neosphincters
			15.6.1	 Dynamic Graciloplasty
			15.6.2	 Artificial Bowel Sphincters
		15.7	 Sacral Nerve Stimulation
		15.8	 Last Options for Patients Unsuccessfully Treated for Fecal Incontinence
		15.9	 Conclusions
		References
Part IV: Special Considerations and Multidisciplinary Perspectives
	16: Cesarean Section Delivery to Prevent Anal Incontinence
		16.1	 Introduction
		16.2	 Anal Incontinence and Mode of Delivery
		16.3	 Conclusions
		References
	17: Interrelatedness of Urological Conditions and Anal Incontinence
		17.1	 Introduction
		17.2	 Urological Diseases Associated with Anal Incontinence
			17.2.1	 Prostate Cancer
				17.2.1.1	 Anal Incontinence After Radical Prostatectomy
				17.2.1.2	 Anal Incontinence After Radiotherapy for Prostate Cancer
			17.2.2	 Anal Incontinence Following Radical Cystectomy for Bladder Cancer
		17.3	 Coexistence of Anal Incontinence and Lower Urinary Tract Symptoms
		17.4	 Urinary Tract Infections in Patients with Anal Incontinence
		References
	18: Coexistence of Fecal Incontinence and Constipation
		18.1	 Introduction
		18.2	 Evidence from Clinical Studies
		18.3	 Patients’ Quality of Life
		18.4	 Pathophysiology
			18.4.1	 Rectal Overflow
			18.4.2	 Incomplete Rectal Emptying
			18.4.3	 Pelvic Floor Weakness
		18.5	 Diagnosis and Therapy
		References
	19: Gut Microbiota Characterization in Fecal Incontinence and Irritable Bowel Syndrome
		19.1	 Introduction
		19.2	 Clinical Features
		19.3	 Epidemiology and Risk Factors
		19.4	 Diagnosis
		19.5	 Pathophysiology
		19.6	 Gut Microbiota Characterization
		19.7	 Gut Microbiota Modulation
		19.8	 Conclusions
		References
	20: Low Anterior Resection Syndrome
		20.1	 Definition and Risk Factors
			20.1.1	 Anal Sphincter Injury
			20.1.2	 Type of Anastomosis and Configuration of the Neorectum
			20.1.3	 Motility of Neorectum
			20.1.4	 Neoadjuvant Radiotherapy/Radio-Chemotherapy
			20.1.5	 Total Mesorectal Excision and Height of Anastomosis
			20.1.6	 Diverting Stoma (Ileo-Colostomy)
		20.2	 Prevalence
		20.3	 Diagnosis
			20.3.1	 LARS Score
		20.4	 Treatment
			20.4.1	 Medical Treatments
			20.4.2	 Physiotherapy
			20.4.3	 Transanal Irrigation
			20.4.4	 Neuromodulation
			20.4.5	 Stoma
		References
	21: Incontinence-Associated Dermatitis: An Insidious and Painful Condition
		21.1	 Introduction
		21.2	 Prevalence
		21.3	 Pathophysiology
		21.4	 Risk Factors
		21.5	 Clinical Presentation
		21.6	 Differential Diagnosis
		21.7	 Management: Prevention and Treatment
			21.7.1	 Absorbent Devices: Diaper Selection
			21.7.2	 Skin Cleansing Techniques
			21.7.3	 Skin Care Products
			21.7.4	 Structured Skin Care Regimen
		21.8	 Conclusion
		References
	22: Perineal Descent and Incontinence
		22.1	 Introduction
		22.2	 Definition and Diagnosis
		22.3	 Pathophysiology
		22.4	 Principles of Treatment
		References
	23: Reconstruction of Wide Anal Sphincter Defects by Crossing Flaps of Puborectalis Muscle
		23.1	 Introduction
		23.2	 Rational Bases for Crossing Flaps of Puborectalis Muscle
		23.3	 Exclusion Criteria
		23.4	 Surgical Technique
			23.4.1	 Wide Defect of the Lateral Anal Sphincter
			23.4.2	 Anterolateral or Circumferential Sphincter Defect
			23.4.3	 Anterolateral Sphincter Defect Associated with Rectovaginal Fistula
			23.4.4	 Rectovaginal Cloaca
		23.5	 Results
		23.6	 Conclusions
		References
	24: Treatment Cost Reimbursement in Italy
		24.1	 Introduction
		24.2	 DRG Surgical Procedures for Fecal Incontinence
		24.3	 Reimbursement of DRGs
		24.4	 Reimbursement of Perineal Pelvis Rehabilitation
		References