Kernaussagen
Pathophysiologie und Diagnostik
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Eingeschränkte Reservoirfunktion, Defekte der Sphinkterfunktion, nervale Störungen, Stuhlimpaktion im Rektum bei verminderter Rektumsensibilität und der Rektumprolaps sind die häufigsten Ursachen der Stuhlinkontinenz.
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Die Stuhlinkontinenz ist somit kein einheitliches Krankheitsbild. Ohne detaillierte Anamnese, proktologische Untersuchung und evtl. gezielte technische Untersuchungen lässt sich daher kein Therapievorschlag machen.
Therapie
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Kontrollierte Therapiestudien sind rar, insbesondere solche, die sich auf pathophysiologische Subgruppen beziehen.
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Die globale Besserungsrate über Monate beträgt 60 – 80 %, unabhängig vom eingesetzten Therapieverfahren. Wahrscheinlich stellt die detaillierte Diagnostik mit den dabei gegebenen Erklärungen eine Art Sensibilitätstraining dar.
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Für Sphinktertraining und Biofeedback-Verfahren fehlen überzeugende Wirksamkeitsnachweise. Insbesondere von aufwendigen Verfahren wird daher abgeraten.
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Chirurgische Maßnahmen sollten nicht erwogen werden, ohne dass zuvor ein konservativer Versuch gemacht wurde, mit Loperamid die Stuhlkonsistenz zu erhöhen und die anorektale Physiologie zu beeinflussen.
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Prof. Dr. Stefan Müller-Lissner
Abteilung Innere Medizin
Park-Klinik Weißensee
Schönstraße 80
13086 Berlin
Email: mueli@park-klinik.com
