Stuhlinkontinenz – vom Symptom zur Therapie

Stuhlinkontinenz stellt bis heute oft ein Tabuthema dar. Erste Symptome werden lange ignoriert und erst zunehmender Leidensdruck führt zur Vorstellung beim Arzt. Die Anamnese und die ergänzende klinische Untersuchung sind wegweisend für die Therapie. Meist lassen sich die Symptome durch konservative Therapien reduzieren, eine vollständige Normalisierung der anorektalen Kontinenzleistung ist selten möglich, auch nicht durch invasive Verfahren.

Abstract

Fecal incontinence (FI) is an escalating medical problem. Due to increasing life expectancy FI becomes more evident, especially in the geriatric population. The prevalence varies from 4 % in the adult population reaching > 50 % in the octogenerians, yet most probably associated with a significant based error due to underreporting. Diagnosis is depending primarily upon history taking and gathered information from the patient and caregivers. Additional technical diagnostic procedures are of secondary importance. In most cases no single cause for FI can be identified, mostly multifactorial disorders contribute to a progressive loss of anorectal continence. The mainstay in therapeutic approaches to control symptoms comprise changes in lifestyle patterns, physiotherapy and medical therapy, but depend on the patient’s compliance. Invasive or even surgical treatments are circumstantial, although sacral neuromodulation has proofed to be a successful treatment modality during the past decades. Ultimately a permanent stoma may lead to symptom control and result in an increased quality of life.

Schlüsselwörter

Stuhlinkontinenz - Geriatrie - Lebensqualität - Behandlungskonzepte - sakrale Neuromodulation

Key words

fecal incontinence - population characteristics - quality of life - diet therapy - new technologies

Publication History

Article published online:
22 July 2022

• Literatur

• 1 Paquette IM, Varma MG, Kaiser AM. et al. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Treatment of Fecal Incontinence. Dis Colon Rectum 2015; 58 (07) 623-636
• 2 Riemsma R, Hagen S, Kirschner-Hermanns R. et al. Can incontinence be cured? A systematic review of cure rates. BMC Med 2017; 15: 63-74
• 3 Rome Foundation. Rome IV Criteria – Appendix A: Rome IV Diagnostic Criteria for FGIDs 2016. Im Internet (Stand 03.05.2022): https://theromefoundation.org/rome-iv/rome-iv-criteria/
• 4 FODMAP Ernährung bei Reizdarm und anderen Verdauungsbeschwerden. Reinheim; FODMAP – eine gesunde Ernährungsmöglichkeit für Menschen mit Reizdarm und anderen Verdauungsproblemen. Im Internet (Stand 03.05.2022): https://www.fodmaps.de/
• 5 Mölle B, Ommer A, Lange J. et al. Chirurgische Proktologie. 3. Aufl.. Heidelberg: Springer; 2018
• 6 Probst M, Pages H, Riemann JF. et al. Stuhlinkontinenz – Teil 4 der Serie Inkontinenz. Dtsch Arztebl Int 2010; 107: 34-35
• 7 Maeda J, Mimura T, Yoshioka K. et al. Japanese Practice Guidelines for Fecal Incontinence Part 2 – Examination and Conservative Treatment for Fecal Incontinence – English Version. J Anus Rectum Colon 2021; 5 (01) 67-83
• 8 Rao SSC. Current and Emerging Treatment Options for Fecal Incontinence. J Clin Gastroenterol 2014; 48: 752-764
• 9 Van Koughnett JAM, Wexner SD. Current management of fecal incontinence: Choosing amongst treatment options to optimize outcomes. World J Gastroenterol 2013; 19 (48) 9216-9230
• 10 AG GGUP. Informationen für Betroffene & Patienten. Im Internet (Stand 03.05.2022): https://www.ag-ggup.de/infos/informationen-fuer-betroffene-patienten/
• 11 Woodley SJ, Boyle R, Cody JD. et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2017; 22 (12) CD007471
• 12 Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2010; 12 (05) CD007959
• 13 van der Hagen SJ, van der Meer W, Soeters PB. et al. A prospective non-randomized two-centre study of patients with passive faecal incontinence after birth trauma and patients with soiling after anal surgery, treated by elastomer implants versus rectal irrigation. Int J Colorectal Dis 2012; 27 (09) 1191-1198
• 14 Manegold P, Herold A. Anale Inkontinenz. Chirurg 2022; 93 (05) 521-530
• 15 Omar IM, Alexander CA. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2013; 11 (06) CD002116
• 16 Browning GG, Parks AG. Postanal repair for neuropathic fecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 1983; 70: 101-104