Which are the symptoms?
Patients are unable to control or delay the urge to defecate. The disorder can present at various levels of severity, from modest leakage of stool to a total inability to control defecation. Abdominal bloating, flatulence, ulcers and anal itching may be associated. Other secondary symptoms may include infections of the skin, rectum and urinary tract, as well as stress related to the impact on social life. In addition, there is a correlation with urinary incontinence (20% of sufferers report fecal incontinence); in these cases, a multidisciplinary approach is necessary.
- Involuntary leakage of gas and stools
How is it diagnosed?
Endoanal ultrasound is the gold standard for anatomical evaluation of the sphincter system (there is an intact sphincter or anatomical deficiency). In addition, anorectal manometry is usually used, which is a method of functional diagnostics that allows to identify defects in the function of the anal sphincter and possible changes in the distensivity/sensitivity of the rectal ampoule. In some cases, an MRI of the pelvis may be useful to expand the scope of the study to tissues located further from the anal canal. Neurophysiological methods of the second level are represented by anal electromyography and motor delay of the terminal portion of the pudendal nerve (PNTML) and are able to study the nerve and muscle components of the pelvic floor.
How is it treated?
In general, patients with mild symptoms respond well to conservative treatment; constipation and antidiarrheal medications such as loperamide may be sufficient. Significant results may be achieved with the help of pelvic and perineal rehabilitation (biofeedback), which uses methods of re-education of the perineal muscles; the number of sessions varies, at that, additional auxiliary procedures need to be conducted. If these therapeutic techniques do not help, surgical intervention should be considered, using methods of sphincteroplasty or reconstruction of the anal sphincter, or sacral neuromodulation.