Wet and dirty anus and perineum
Introduction
Introduction Older fecal incontinence or anal incontinence refers to defecation and deflation that are not controlled at least twice or more per day. It is a kind of clinical symptom with various pathophysiological basis caused by various reasons. The incidence rate of the elderly is about 1%. The elderly inpatients are more common than the average female. Fecal incontinence is common in elderly people with mild fecal incontinence and is often not reported by patients and doctors. Physical examination showed that the perineal perineal area was wet and unclean.
Cause
Cause
There are many causes of fecal incontinence, one or more causes can cause fecal incontinence. There are many classification methods for fecal incontinence, which can be classified according to the degree, nature, rectal sensation and etiology of incontinence, or TCM syndrome differentiation, but currently There is no uniform classification standard, and the causes are classified as follows:
1, changes in stool characteristics:
(1) irritable bowel syndrome.
(2) Inflammatory bowel disease
(3) Infectious diarrhea
(4) Abuse of laxatives.
(5) Absorption syndrome.
(6) Short bowel syndrome.
(7) Radiation enteritis.
2. Abnormal intestinal capacity or compliance:
(1) Inflammatory bowel disease
(2) rectal volume defect
(3) rectal ischemia
(4) Collagen vascular disease.
(5) Rectal tumors.
(6) External rectal compression.
3, rectal sensation:
(1) Neurological lesions.
(2) Overflow incontinence.
4, sphincter or pelvic floor function abnormalities:
(1) Anatomy of the sphincter.
(2) pelvic floor muscle loss innervation
(3) Congenital anomalies.
The cause of fecal incontinence in the elderly may be due to fecal blockage, rectal paresthesia, decreased anal sphincter pressure, neuromuscular dysfunction, dementia, iatrogenic and so on.
Examine
an examination
Related inspection
Anal examination, anal examination, pelvic floor electromyography, endoscopy
Careful inquiry and physical examination can identify the cause of most fecal incontinence. Pre-treatment radiology and physiology can confirm the diagnosis, and relevant gastrointestinal dysfunction and detection of anal sphincter defects can provide objective basic data.
1. Consultation
50% of patients with fecal incontinence do not take the initiative to complain of symptoms, unless a detailed inquiry about medical history is an art. At the time of the patient's visit, the doctor has the responsibility to encourage the patient to detail the medical history and guide or directly ask about the situation.
(1) Medical history: to know whether there is surgery, birth injury, trauma history, course of disease and treatment.
(2) Symptoms: including: 1 self-control ability of defecation, whether there is any intention, daily self-care conditions of stool frequency; 2 anorectal symptoms, such as abnormal urination, spinal condition, intellectual intelligence and mental status.
2. Local inspection
Anal examination can be used to understand the presence or absence of local factors leading to fecal incontinence.
(1) Visual inspection: pay attention to the presence or absence of fecal contamination, ulcers, eczema skin scars, mucosal prolapse, anal expansion and so on.
(2) refers to the diagnosis: attention to the anal sphincter contraction force anorectal ring tension and so on.
(3) Endoscopy: Observe the color of the rectal mucosa, with or without ulcers, inflammation, bleeding tumors, stenosis and anal fistula.
3. Laboratory inspection
The function of the anorectal has a complex mechanism that includes many different factors that allow defecation and maintenance of self-control at any time. Therefore, a special examination can test one aspect of this mechanism, and clinical evaluation must be considered comprehensively based on various examination results. Common diagnostic tests for evaluating pelvic floor and sphincter function include:
(1) Anorectal manometry: including the resting pressure controlled by the internal anal sphincter, the maximum pressure at the time of external contraction of the external sphincter, and the threshold of stimulation at the time of diastole. Anal resting pressure and maximum pressure are reduced during fecal incontinence.
(2) Electromyography: It is an objective basis for reflecting the physiological activities of the pelvic floor muscles and sphincters to understand the location and extent of nerve and muscle injuries.
(3) Defecation angiography: The dynamic changes during defecation can be recorded, and the state of the puborectal muscle and the degree of injury can be estimated by the change of the rectal angle.
(4) Saline enema test: 1500ml of normal saline was injected into the rectum by sitting, and the leakage and maximum retention were recorded to understand the self-control ability of defecation. When the stool is incontinent, the amount of retention decreases or is zero.
(5) Anal canal ultrasound: The thickness of the internal sphincter can be accurately determined by accurately determining the location and asymmetry of the anal sphincter defect.
Diagnosis
Differential diagnosis
Identification: Clinically, it must be differentiated from diarrhea caused by intestinal inflammation, ulcerative colitis, proctitis, and anal fistula.
Diagnosis: Careful interrogation and physical examination identify the cause of most fecal incontinence. Pre-treatment radiology and physiology can confirm the diagnosis, and relevant gastrointestinal dysfunction and detection of anal sphincter defects can provide objective basic data.
