anal incontinence
Introduction
Introduction to anal incontinence Anal incontinence is a symptom of defecation dysfunction, and the patient loses the ability to control deflation and defecation. The incidence is not high, does not directly threaten life, but causes physical and mental pain, and strictly interferes with normal life and work. Often caused by anorectal disease, sphincter damage, nervous system diseases and congenital malformations of perianal tissue. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: perianal eczema, diarrhea
Cause
Cause of anal incontinence
Anal canal, rectum, colon lesions (30%):
Most commonly seen as rectal tumors and inflammatory diseases, rectal tumor infiltration damage sphincter, ulcerative colitis, colonic disease caused by long-term diarrhea of rectal inflammation, complete rectal prolapse caused by anal relaxation, pudendal nerve traction and other damage.
Anal and rectal sphincter injuries (28%):
The most common cause is anorectal surgery and birth trauma, especially high anal fistula surgery to destroy the anorectal and sphincter, the third degree of perineal tear in the birth injury. In addition, internal hemorrhoids, anal fissures, rectal prolapse, rectal tumors and other surgical treatments are improper, or the anal canal tissue suffers from external violence, drug injection, burns, frostbite, etc. can cause anal incontinence.
Nervous system lesions (27%):
Such as central nervous system diseases, spina bifida, spinal meningocele, spinal cord and radial nerve injury, infection and myeloma.
Other (15%):
Both anorectal congenital malformations and anorectal neuropathy can cause anal incontinence.
Prevention
Anal incontinence prevention
The diet of the elderly should be based on a light diet, avoiding irritating or greasy foods.
Actively participate in minor sports activities, enhance physical fitness, improve the vitality of various organs of the body, and prevent constipation.
Strengthen the exercise of anal function, adhere to the anal movement, and enhance the contractile force of the anal sphincter.
The elderly should actively treat diseases such as senile chronic bronchitis that increase abdominal pressure for a long time.
Develop a habit of regular bowel movements, regular stools and empty stools every day to reduce the stimulation of rectal mucosal receptors.
When elderly patients have constipation, they can not use drugs or even laxatives that are used to guide stools. They should be used under the guidance of a doctor to avoid damage to the function of the colon.
How old friends can prevent anal incontinence:
Should develop the habit of arranging once a day, the best time is about 20 minutes after breakfast. Pay attention when defecation, do not read or read newspapers, do not talk to people, and should control the time of each bowel movement within 5 to 10 minutes, so as to get out of the way, do not develop an "empty sitting toilet" habit.
The anus should be kept clean. After the stool, wipe the anus as much as possible to avoid residual feces. In addition, after the stool, you can wash the anus with warm water, and wash it for 5 to 10 minutes at a time. Do not use strong alkaline soap when cleaning the anus, but also do an anal exercise. The method is as follows: put a finger cot on the index finger of the right hand, apply a small amount of erythromycin ointment on the finger sleeve, then massage the finger with the index finger at the anus mouth for 10 to 20 times, and then slowly extend the finger into the anus. Stretch out until you can't reach it, then extend the anal canal in the forward, left, right, and back directions of the finger that extends into the anus. Apply moderate force. It can be dilated for 2 to 3 minutes, then dry the anus (with acne). The patient can apply the hemorrhoid cream at the affected area at this time, stand up and lift the anus upwards by 20 to 30.
You should eat more foods rich in cellulose, such as fresh vegetables, fruits and whole grains, and eat as little spicy and irritating food as possible to avoid acne and affect bowel movements. Older people can drink a cup (about 300-400 ml) of warm boiled water or light salt water on an empty stomach every morning. This can help lubricate the intestines and stimulate the peristalsis of the intestines, helping the elderly to relieve constipation.
Complication
Anal incontinence complications Complications, perianal eczema, diarrhea
The most common complications of anal incontinence patients are inflammation of the perineum, appendix, and perianal skin. Some patients may also cause retrograde urinary tract infection or vaginitis and redness and ulceration of the skin.
This is because the feces cause irritation to the skin and mucous membranes, so that the perineal skin is often in a state of moisture and metabolite erosion, and the friction between the skin forms redness and ulceration of the skin.
There is evidence that there is a corresponding relationship between the severity of urinary fecal incontinence and skin redness and swelling. If you do not clean or clean up improper bacteria in time, it is easy to cause ascending urinary tract infection and vaginitis through the urethra.
Symptom
Anal incontinence symptoms Common symptoms Anal sphincter relaxation Anal external sphincter fracture Anal sphincter transection Anal eczema Itching diarrhea Anal relaxation Anal canal reflex disappearance Anal canal stenosis
(1) medical history
Need to ask the cause of anal incontinence, the symptoms at the beginning, the severity of the current incontinence, the history of anorectal surgery, history of radiation, history of injury, bowel habits, number of bowel movements and fecal texture, presence or absence of nervous system, metabolism A history of diseases and diseases of the urinary system.
(2) Visual inspection
Complete incontinence, common anus opening is round, or deformed, defect, scar, excretion of feces in the anus, intestinal fluid, anal skin may have eczema-like changes, the hips are retracted by hand, the anal canal is completely relaxed and round Shape, sometimes the anal canal is partially damaged. Scar formation is often seen from the round hole.
Incomplete incontinence does not close the anus, and there is fecal contamination in the anus when diarrhea occurs.
Examine
Anal incontinence check
(a) digital rectal examination
Anal relaxation, contraction of the anal canal sphincter and anorectal ring contraction is not obvious and completely disappeared, if caused by injury, the anus can be scarred and scar tissue, incomplete incontinence can be diagnosed and the sphincter contractility is weakened.
(two) endoscopy
Rectal examination can observe the presence or absence of deformity in the anal canal, anal canal skin and mucous membrane state, anal closure, fiberoptic colonoscopy can be observed whether there is colitis, Crohn's disease, polyps, cancer and other diseases, can be observed with a hard tube colonoscopy No complete rectal prolapse.
(three) sputum angiography
The anatomical structure of the anal canal sphincter, anal canal and rectum can be measured. The X-ray barium examination of the dynamic functional state can observe the incontinence and its severity. Inadvertent leakage of a large amount of expectorant is a sign of incontinence.
(four) anal tube pressure measurement
Can determine the internal, external sphincter and puborectal muscle abnormalities, anorectal inhibition of reflex, understand its basic pressure, systolic pressure and rectal swelling tolerance capacity, incontinence patients anal canal basis, systolic blood pressure decreased, internal sphincter reflex relaxation disappeared, rectum Feel the decrease in expansion tolerance capacity.
(5) Electromyography measurement
The range of sphincter function can be determined to determine the degree of voluntary muscle involuntary muscle and its nerve damage and recovery.
(6) Anal ultrasound (AUS) examination
In recent years, the application of anal canal ultrasound can clearly show the anorectal submucosa, internal and external sphincter and its surrounding tissue structure, can help diagnose anal incontinence, observe the presence or absence of sphincter damage, Yang (1993) using AUS to check anal incontinence 38 For example, 17 of 23 patients (74%) found an anal sphincter defect. The patient had a history of perianal rectal or vaginal surgery. Of the 15 patients, 6 (40%) had no history of trauma, and no routine examination was found during physical examination. There is a defect in the anal canal sphincter. After the AUS examination, the sphincter has a defect, so this examination is more valuable for anal incontinence.
Diagnosis
Diagnosis of anal incontinence
Identify with the following diseases
1. Anal fistula: The clinical manifestation of anal fistula is local recurrent pus, long time does not close, when the external mouth closes pus accumulation will be painful, or have fever, etc., due to frequent pus stimulation, the skin will have anal itching, affecting normal bowel function There are many factors, including the texture of the feces, the volume of the rectum, the feeling of the rectum, the reflex, the tension of the anal canal, and the health of the nervous system of the puborectal and external anal sphincters. Can cause anal incontinence, clinically due to sphincter damage, colon disease, nervous system diseases, congenital diseases and other diseases caused by anal incontinence. Due to the different parts and depth of the perianal abscess, the anal fistula formed has a high and low position. The lower anal fistula passes through the shallow part of the external sphincter. The injury during operation will not affect the contraction function of the anus. The high anal fistula The tube is above the plane of the anorectal ring, and the anus is incontinent when the ring is cut once during surgery.
2. Colitis.
3. Proctitis often causes anal pain, so care should be taken to distinguish between anal incontinence and proctitis.
