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International Urogynecology Journal
Erschienen in: International Urogynecology Journal 4/2005

01.08.2005 | Review Article

Combined urinary and faecal incontinence

verfasst von: Dharmesh S. Kapoor, Ranee Thakar, Abdul H. Sultan

Erschienen in: International Urogynecology Journal | Ausgabe 4/2005

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Abstract

Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9–19% (urinary) and 5–10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.
Literatur
1.
Fialkow MF, Melville JL, Lentz GM, Miller EA, Fenner DE (2003) The functional and psychosocial impact of fecal incontinence in women with urinary incontinence. Am J Obstet Gynecol 189:127–129
2.
Sailer M, Bussen D, Debus ES, Fuchs KH, Thiede A (1998) Quality of life in patients with benign anorectal disorders. Br J Surg 85:1716–1719
3.
Roberts RO, Jacobsen SJ, Reilly WT, Pemberton JH, Lieber MM, Talley NJ (1999) Prevalence of combined fecal and urinary incontinence: a community based study. J Am Geriatr Soc 47:837–841PubMed
4.
Eva UF, Gun W, Preben K (2003) Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand 82:280–286
5.
De Lancey JOL (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–1723PubMed
6.
Shull BL, Baden WF (1989) A six-year experience with paravaginal defect repair for stress urinary incontinence. Am J Obstet Gynecol 160:1432–1439
7.
Critchley HOD, Dixon JS, Gosling JA (1980) Comparative study of the periurethral and perianal parts of the human levator ani muscle. Urol Int 35:226–232
8.
Lapides J (1958) Structure and function of the internal vesical sphincter. J Urol 80:341–353
9.
Iosif S, Ulmsten U (1981) Comparative urodynamic studies of continent and stress incontinent women in pregnancy and the puerperium. Am J Obstet Gynecol 140:645-650
10.
Van Geelen JM, Lemmens WA, Eskes TK, Martin CB (1982) The urethral pressure profile in pregnancy and after delivery in healthy nulliparous women. Am J Obstet Gynecol 144:636–649
11.
de Groat WC, Nadelhaft I, Milne RJ, Booth AM, Morgan C, Thor K (1981) Organization of the sacral parasympathetic reflex pathways to the urinary bladder and large intestine. J Auton Nerv Syst 3:135–160
12.
de Groat WC (1993) Anatomy and physiology of the lower urinary tract. Urol Clin North Am 20:383–401
13.
van der Horst HE, van Dulmen AM, Schellevis FG, van Eijk JT, Fennis JF, Bleijenberg G (1997) Do patients with irritable bowel syndrome in primary care really differ from outpatients with irritable bowel syndrome? Gut 41:669–674
14.
Longhurst PA, Briscoe JA, Rosenberg DJ, Leggett RE (1997) The role of cyclic nucleotides in guinea-pig bladder contractility. Br J Pharmacol 121:1665–1672
15.
Smith P, Heimer G, Norgren A, Ulmsten U (1990) Steroid receptors in pelvic muscles and ligaments in women. Gynecol Obstet Invest 30:27–30PubMed
16.
Dyson M (1999) Urinary system. In: Williams P, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MNJ (eds) Gray’s textbook of anatomy, 38th edn. Churchill Livingstone, London, pp 1838–1845
17.
Haadem K, Ling L, Ferno M, Graffner H (1991) Estrogen receptors in the external sphincter muscle. Am J Obstet Gynecol 164:609–610
18.
Donnelly V, O’Connell PR, O’Herlihy C (1997) The influence of oestrogen replacement therapy on faecal incontinence in postmenopausal women. Br J Obstet Gynaecol 104:311–315
19.
Henry MM, Parks AG, Swash M (1982) The pelvic floor musculature in the descending perineum syndrome. Br J Surg 69:470–472
20.
Duthie HL, Watts JM (1965) Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 6:64–68
21.
Dubrovsky B (1988) Effects of rectal distension on the sphincter ani externus and levator ani muscles in cats. Am J Physiol 254:G100–G106
22.
Fernandez-Fraga X, Azpiroz F, Malagelada JR (2002) Significance of pelvic floor muscles in anal continence. Gastroenterology 123:1441–1450PubMed
23.
Gibbons CP, Trowbridge EA, Bannister JJ, Read NW (1986) Role of anal cushions in maintaining continence. Lancet 1:886–888CrossRefPubMed
24.
Guyton AC, Hall JE (eds) (2000) Textbook of medical physiology, 10th edn. WB Saunders, Philadelphia, pp 735–736
25.
Snooks AJ, Setchell M, Swash M, Henry MM (1984) Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 2:546–550CrossRefPubMed
26.
Sultan AH, Kamm MA, Hudson CN (1994) Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol 101:22–28
27.
Snooks AJ, Barnes PR, Swash M, Henry MM (1988) Increase in pudendal nerve terminal motor latency with defecation straining. Br J Surg 75:1095–1097PubMed
28.
Ho YH, Goh HS (1995) The neurophysiological significance of perineal descent. Int J Colorectal Dis 10:107–111
29.
Ryhammer AM, Laurberg S, Hermann AP (1996) Long-term effect of vaginal deliveries on anorectal function in normal perimenopausal women. Dis Colon Rectum 39:852–859
30.
Ryhammer AM, Bek KM, Laurberg S (1995) Multiple vaginal deliveries increase the risk of permanent incontinence of flatus urine in normal premenopausal women. Dis Colon Rectum 38:1206–1209PubMed
31.
Amarenco G, Kerdraon J, Lanoe Y (1990) Perineal neuropathy due to stretching and urinary incontinence. Physiopathology, diagnosis and therapeutic implications. Ann Urol 24:463–466
32.
Snooks SJ, Barnes PR, Swash M (1984) Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 47:1269–1273PubMed
33.
Snooks SJ, Swash M (1984) Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence. Br J Urol 56:401–405
34.
Jorge JMN, Wexner SD, Ehrenpreis ED, Nogueras JJ, Jagelman DG (1993) Does perineal descent correlate with pudendal neuropathy? Dis Colon Rectum 36:475–483
35.
Aanestad O, Flink R (1999) Urinary stress incontinence. A urodynamic and quantitative electromyographic study of the perineal muscles. Acta Obstet Gynecol Scand 78:245–253CrossRefPubMed
36.
Anderson RS (1984) A neurogenic element to urinary genuine stress incontinence. Br J Obstet Gynaecol 9:41–45
37.
Smith AB, Hosker GL, Warrell DW (1989) The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 96:29–32
38.
Kjolhede P, Hallbook O, Ryden G, Sjodahl R (1997) Anorectal manometry in women with urinary stress incontinence. Acta Obstet Gynecol Scand 76:266–270
39.
Lubowski DZ, Swash M, Nicholls RJ, Henry MM (1988) Increase in pudendal nerve terminal motor latency with defecation straining. Br J Surg 75:1095–1097PubMed
40.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911PubMed
41.
Sato T, Konishi F, Minakami H, Nakatsubo N, Kanazawa K, Sato I, Itoh K, Nagai H (2001) Pelvic floor disturbance after childbirth. Dis Colon Rectum 44:1155–1161
42.
Bouvier M, Grimaud JC, Salducci J, Gonella J (1984) Role of vesical afferent nerve fibres involved in the control of internal anal sphincter motility. J Auton Nerv Syst 10:243–245
43.
Bouvier M, Grimaud JC (1984) Neuronally mediated interactions between urinary bladder and internal anal sphincter motility in the cat. J Physiol 346:461–469
44.
Thor KB, Muhlhauser MA (1999) Vesicoanal, urethroanal, and urethrovesical reflexes initiated by lower urinary tract irritation in the rat. Am J Physiol 277:R1002–R1012
45.
Thor KB, Muhlhauser MA, Sauerberg P, Shannon H, Springer JP (2000) Central muscarinic inhibition of lower urinary tract nociception. Brain Res 870:126–134
46.
Uustal Fornell E, Wingren G, Kjolhede P (2004) Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta Obstet Gynecol Scand 83:383–389CrossRefPubMed
47.
Eriksen BC, Mjolnerod OK (1987) Changes in urodynamic measurements after successful anal electrostimulation in female urinary incontinence. Br J Urol 59:45–49
48.
Jackson SL, Weber AM, Hull TL, Mitchinson AR, Walters MD (1997) Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 89:423–427
49.
Monga AK, Marrero JM, Stanton SL, Lemieux MC, Maxwell JD (1997) Is there an irritable bladder in the irritable bowel syndrome? Br J Obstet Gynaecol 104:1409–1412
50.
Cukier JM, Cortina-Borjia M, Brading AF (1997) A case control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder. Br J Urol 79:856–878
51.
Bergman A, Elia G, Cheung D, Perelman N, Nimni ME (1994) Biochemical composition of collagen in continent and stress urinary incontinent women. Gynecol Invest 37:48–51
52.
Leighton JA, Valdovinos MA, Pemberton JH, Rath DM, Camilleri M (1993) Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis. Dis Colon Rectum 36:182–185
53.
Kjelruff KH, Langenberg PW, Greenway L, Umar J, Harvey LA (2002) Urinary incontinence and hysterectomy in a large prospective cohort study in American women. J Urol 167:2088–2092
54.
Van der Vaart CH, van der Bom JG, de Leeuw JRJ, Reovans JP, Hantz AP (2002) The contribution of hysterectomy to the occurrence of urge and stress incontinence symptoms. Br J Obstet Gynaecol 109:149–154
55.
Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I (2002) Outcomes after total versus subtotal hysterectomy. N Engl J Med 347:1318–1325CrossRefPubMed
56.
Peters WA, Smith MR, Drescher CW (2001) Rectal prolapse in women with other defects of pelvic floor support. Am J Obstet Gynecol 184:1488–1495CrossRefPubMed
57.
Peschers UM, Sultan AH, Jundt K, Mayer A, Drinovac V, Dimpfl T (2003) Urinary and anal incontinence after vacuum delivery. Eur J Obstet Gynecol Reprod Biol 110:39–42
58.
Nazir M, Stein R, Carlsen E, Jacobsen AF, Nesheim BI (2003) Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study. Dis Colon Rectum 46:1245–1250
59.
Davis K, Kumar D, Stanton SL, Thakar R, Fynes M, Bland J (2003) Symptoms and anal sphincter morphology following primary repair of third-degree tears. Br J Surg 90:1573–1579
60.
Tetzschner T, Sorensen M, Lose G, Christiansen J (1996) Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 103:1034–1040PubMed
61.
Khullar V, Damiano R, Tooz-Hobson P, Cardozo L (1998) Prevalence of fecal incontinence among women with urinary incontinence. Br J Obstet Gynaecol 105:1211–1213
62.
Leroi AM, Weber J, Menard JF, Touchais JY, Denis P (1999) Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence. Neurourol Urodyn 18:579–590
63.
Lacima G, Espuna M, Pera M, Puig-Clota M, Quinto L, Garcia-Valdecasas JC (2002) Clinical, urodynamic, and manometric findings in women with combined urinary and fecal incontinence. Neurourol Urodyn 21:464–469
64.
Soligo M, Salvatore S, Milani R, Lalia M, Malberti S, Digesu GA, Mariani S (2003) Double incontinence in urogynecologic practice: a new insight. Am J Obstet Gynecol 189:438–443
65.
Manning J, Eyers AA, Korda A, Benness C, Solomon MJ (2001) Is there an association between fecal incontinence and lower urinary tract dysfunction? Dis Colon Rectum 44:790–798
66.
Thorpe AC, Roberts JP, Williams NS, Blandy JP, Badenoch DF (1995) Pelvic floor physiology in women with faecal incontinence and urinary symptoms. Br J Surg 82:173–176
67.
Bo K, Lilleas F, Talseth T, Hedland H (2001) Dynamic MRI of the pelvic floor muscles in the upright position. Neurourol Urodyn 20:167–174
68.
Tunn R, Paris S, Fischer W, Hamm B, Kuchinke J (1998) Static magnetic resonance imaging of the pelvic floor morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol Urodyn 17:579–589
69.
Kaufman HS, Buller JL, Thompson JR, Pannu HK, DeMeester SL, Genadry RR, Bluemake DA, Jones B, Rychick JL, Cundiff GIU (2001) Dynamic pelvic MR imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575-1583; discussion 1583–1584PubMed
70.
Artibani W, Andersen JT, Gatewski JB, Ostergard DR, Raz S, Tubaro A, Khullar V, Klarskov L, Rodriguez L (2002) Imaging and other investigations. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 2nd edn. Health Publication Ltd, Plymouth, pp 425–478
71.
Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ, de Bie RA, van Waalwijk Doom ES (1998) Conservative treatment of stress urinary incontinence in women: a systematic review of randomised clinical trials. Br J Urol 82:181–191CrossRefPubMed
72.
Enck P (1993) Biofeedback training in disordered defecation: a critical review. Dig Dis Sci 11:1953–1960
73.
Whitehead WE, Burgio KL, Engel BT (1985) Biofeedback treatment for fecal incontinence in geriatric patients. J Am Geriatr Soc 33:320–324
74.
Miner PB, Donelly TC, Read NW (1990) Investigation of the mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 35:1291–1298
75.
Fynes MM, Marshall K, Cassidy M, Behan M, Walsh D, O’Connell PR, O’Herlihy C (1999) A prospective randomised study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma. Dis Colon Rectum 42:753–761
76.
Tries J (2004) Protocol and therapist related variables affecting outcomes of behavioural interventions for urinary and fecal incontinence. Gastroenterology 126:S152–S158
77.
Leroi AM, Dorival MP, Lecouturier MF, Saiter C, Welter ML, Touchais JY, Denis P (1999) Pudendal neuropathy and severity of incontinence but not presence of anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 42:762–769
78.
Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA (2003) Randomised controlled trial of biofeedback for fecal incontinence. Gastroenterology 125:1320–1329
79.
Salmons S, Vrbova G (1969) The influence of activity on some contractile characteristics of mammalian fast and slow muscles. J Physiol 201:535–549
80.
Hudlicka O, Dodd L, Renkin EM, Gray SD (1982) Early changes in fiber profile and capillary density in long-term stimulated muscles. Am J Physiol 243:528–535
81.
Haskell B, Rovner H (1967) Electromyography in the management of the incompetent anal sphincter. Dis Colon Rectum 10:81–84
82.
Ross JW (2001) Laparoscopic Burch colposuspension and overlapping sphincteroplasty for double incontinence. JSLS 5:203–209
83.
Papa Petros PE (1999) Cure of urinary and fecal incontinence by pelvic ligament reconstruction suggests a connective tissue etiology for both. Int Urogynecol J Pelvic Floor Dysfunct 10:356–360
84.
Fowler CJ, Swinn MJ, Goodwin RJ, Oliver S, Craggs M (2000) Studies of the latency of pelvic floor contraction during peripheral nerve evaluation show that the muscle response is reflexly mediated. J Urol 163:881–883
85.
Bosch JL, Groen J (1995) Sacral (S3) segmental nerve stimulation as a treatment for urge-incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neuroprosthesis. J Urol 154:504–507PubMed
86.
Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124–1127CrossRefPubMed
87.
Malouf AJ, Vaizey CJ, Nicholls RJ, Kamm MA (2000) Permanent nerve stimulation for fecal incontinence. Ann Surg 232:143–148CrossRefPubMed
88.
Leroi AM, Michot F, Grise P, Denis P (2001) Effect of sacral nerve stimulation in patients with urinary and fecal incontinence. Dis Colon Rectum 44:779–789PubMed
89.
Gelet A, Meunier P, Platet RL, AbdelRahim AF, Friaa S, Lopez JG, Manzan K, Dubernard JM (1997) Treatment of dual urinary and fecal incontinence by implantation of two AMS 800 artificial sphincters. Eur Urol 31:115–117
90.
Christiansen J, Rasmussen OO, Lindorff-Larsen K (1999) Long-term results of artificial anal sphincter implantation for severe anal incontinence. Ann Surg 230:45–48PubMed
91.
Lehur PA, Michot F, Denis P, Grise P, Leborgne J, Teniere P, Buzelin JM (1996) Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations. Dis Colon Rectum 39:1352–1355PubMed
92.
Lahr CJ, Lahr SJ, Srinivasan A, Clerico ET, Limehouse VM, Serbezov IK (1999) Operative management of severe constipation. Am Surg 65:1117–1123
93.
Chrouser KL, Fick F, Goel A, Itano NB, Sweat SD, Lightner DJ (2004) Carbon coated zirconium beads in beta-glucan gel and bovine glutaraldehyde cross-linked collagen injections for intrinsic sphincter deficiency: continence and satisfaction after extended follow-up. J Urol 171:1152–1155CrossRefPubMed
94.
Kumar D, Benson MJ, Bland JE (1998) Glutaraldehyde cross-linked collagen in the treatment of faecal incontinence. Br J Surg 85:978–979
95.
Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA (2002) Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction. Gut 51:225–228CrossRefPubMed
96.
Davis K, Kumar D, Poloniecki J (2003) Preliminary evaluation of an injectable anal sphincter bulking agent (Durasphere) in the management of faecal incontinence. Aliment Pharmacol Ther 18:237–243
97.
Sultan AH, Stanton SL (1996) Preserving the pelvic floor during childbirth-elective caesarean section? Br J Obstet Gynaecol 103:731–734
98.
Baessler K, Schuessler B (2003) Childbirth-induced trauma to the urethral continence mechanism: review and recommendations. Urology 62:39–44CrossRef
99.
Bollard RC, Gardiner A, Duthie GS, Lindow SW (2003) Anal sphincter injury, fecal and urinary incontinence: a 34-year follow up after forceps delivery. Dis Colon Rectum 46:1083–1088
100.
Glazener CMA, Herbison GP, Wilson PD, Macarthur C, Lang GD, Gee H, Grant AM (2001) Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial. BMJ 323:1–5CrossRef
101.
Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1549CrossRef
102.
Weber AM (2004) The perspective of a gynecologist on treatment-related research for fecal incontinence in women. Gastroenterology 126:S169–S171
103.
Hay-Smith J, Herbison P, Morkved S (2002) Physical therapies for prevention of urinary and faecal incontinence in adults. Cochrane Database Syst Rev CD 003191
Metadaten
Titel
Combined urinary and faecal incontinence
verfasst von
Dharmesh S. Kapoor
Ranee Thakar
Abdul H. Sultan
Publikationsdatum
01.08.2005
Erschienen in
International Urogynecology Journal / Ausgabe 4/2005
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-004-1283-0

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