Moderne Therapiestrategien bei Stuhlinkontinenz

Zusammenfassung

Hintergrund Das Krankheitsbild der Stuhlinkontinenz ist häufig mit einem signifikanten Leidensdruck für die Betroffenen und einer Verschlechterung von deren Lebensqualität vergesellschaftet, weist eine unterschätzte Prävalenz auf und wird aufgrund des demografischen Wandels in Deutschland in Zukunft noch an Bedeutung gewinnen. Hinsichtlich der Therapie einer Stuhlinkontinenz haben sich in den letzten Jahren neue Techniken entwickelt, und die Evidenz zu bestehenden Methoden hat zugenommen. Ziel dieser Arbeit ist es, aktuelle Entwicklungen und neuere Behandlungskonzepte bei Stuhlinkontinenz zu beleuchten.

Methoden und Ergebnisse Eine aktuelle Literaturanalyse bez. der Therapie von Stuhlinkontinenz wurde durchgeführt. Im Rahmen der konservativen Inkontinenztherapie haben sich Kombinationstherapien als besonders wirksam erwiesen. Unter den chirurgischen Maßnahmen haben Studien zum Langzeitverlauf in den letzten Jahren die Evidenz der sakralen Nervenstimulation und deren Stand als Erstlinientherapie bekräftigt. Die Sphinkteroplastik bleibt eine bewährte Therapieoption bei Inkontinenz infolge von Lücken des Analsphinkters. Die therapeutische Langzeiteffektivität ist gering. „Bulking agents“ stellen eine Alternative vor allem bei passiver Stuhlinkontinenz dar, obgleich die Evidenz aufgrund unterschiedlicher verwendeter Substanzen und Techniken und fehlender Langzeitergebnisse eingeschränkt ist. Zur Behandlung einer Stuhlinkontinenz im Rahmen einer maskierten Stuhlentleerungsstörung hat sich die ventrale Netzrektopexie etabliert.

Schlussfolgerungen Das Spektrum der Therapieoptionen zur Behandlung der Stuhlinkontinenz entwickelt sich kontinuierlich. Es besteht Konsens hinsichtlich des Einsatzes konservativer Maßnahmen als Initialtherapie. Es sind aktuell nur relativ wenig bewährte chirurgische Methoden verfügbar. Die Entwicklung und Evaluation neuer Behandlungsansätze wie auch die weitere Verbesserung der Evidenz der Effektivität bestehender Therapieoptionen ist anzustreben.

Abstract

Background Fecal incontinence (FI) is often associated with significant suffering for affected patients and reduction of their quality of life. Fecal incontinence has an underestimated prevalence and will gain in importance in the future due to demographic change in Germany. During the last several years, new technologies have been developed and new evidence has been gathered for existing methods. The aim of this work is to highlight current developments and new treatment options for fecal incontinence.

Methods and Results A review of recent literature on the treatment of fecal incontinence was conducted. For conservative therapy, the combination of various treatment options has been proven to be particularly effective. For surgical therapy, long term efficacy of sacral nerve stimulation has been confirmed. Sacral nerve stimulation is now considered first line therapy. Sphincteroplasty remains a valid treatment option in patients with FI due to a sphincter gap. Long term efficacy is low. “Bulking agents” are an alternative – predominantly in passive FI, although the evidence is limited due to the use of different substances and techniques, lack of long-term results and suboptimal study designs. For the treatment of FI in the context of a masked defecation disorder, ventral mesh rectopexy has become established.

Conclusion The spectrum of therapeutic options for the treatment of FI is continuously evolving. There is consensus that conservative treatment should be the initial therapy. Currently only a limited number of established surgical options are available. Development and evaluation of new treatment options and further improved evidence of efficacy of the existing treatment modalities are desirable.

Schlüsselwörter

Stuhlinkontinenz - moderne Therapiestrategien - konservative Therapie - chirurgische Therapie - sakrale Nervenstimulation

Key words

fecal incontinence - modern treatment strategies - conservative therapy - surgery - sacral nerve stimulation - sphincteroplasty

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