1/131. Idiopathic spinal cord herniation: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Idiopathic spinal cord herniation (ISCH) is a rare condition, reported in only 25 patients thus far, in which the thoracic cord is prolapsed through an anterior dural defect. It typically presents in middle age as either brown-sequard syndrome or spastic paraparesis. CLINICAL PRESENTATION: A 55-year-old woman initially presented at the age of 41 years with brown-sequard syndrome at the T8 disc space level on the left side. Investigations, including primitive magnetic resonance imaging, were deemed negative at that time. After a stepwise deterioration over 14 years, she presented again with spastic paraparesis and double incontinence, in addition to her previous spinothalamic dysfunction. magnetic resonance imaging at this stage suggested either ISCH or a dorsal arachnoid cyst. INTERVENTION: Through a T7-T8 laminectomy, a left-of-midline ISCH was identified and easily reduced by gentle cord traction. No dorsal arachnoid cyst was identified. The anterior dural defect was repaired with a XenoDerm patch (LifeCell Corp., Woodlands, TX). After surgery, there was improved motor and sphincter function. However, there was continued sensory disturbance. CONCLUSION: ISCH is rare cause of thoracic cord dysfunction. Despite prolonged diagnostic delay, significant clinical improvement may be obtained with ISCH reduction and anterior dural repair.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
2/131. Successfully managing incontinence-related irritant dermatitis across the lifespan.The management of irritant dermatitis caused by incontinence is not always an easy patient care problem to solve. A brief review of the literature demonstrated that irritant dermatitis from body fluids is either not an issue in the healthcare arena or that only a few individuals have recognized it as a healthcare concern. Many products are used to treat this type of dermatitis, yet this can be a very challenging problem for the clinician and painful problem for the patient. It is imperative for healthcare providers to be aware of the effects of stool and urine on the skin, how products interact with body waste, and how to manage this problem properly.- - - - - - - - - - ranking = 5keywords = incontinence (Clic here for more details about this article) |
3/131. fecal incontinence and the menstrual cycle: a case report.urinary tract dysfunction influenced by the menstrual cycle has been described. This case demonstrates mensturation-influenced fecal incontinence. The patient had difficulty with stool control and rectal hygiene only during the week prior to her period. These symptoms had been present since she had discontinued oral birth control. Progestin levels and anal manometry were obtained during the secretory and luteal phases of her cycle and demonstrated a difference in resting anal tone between phases. Progestin smooth muscle relaxation is presumed to have uncovered an already weakened anal continence mechanism. With reinstitution of oral contraceptive pills the patient's cyclic fecal incontinence resolved.- - - - - - - - - - ranking = 6keywords = incontinence (Clic here for more details about this article) |
4/131. Implementing an incontinence program in long-term care settings. A multidisciplinary approach.urinary incontinence is a prevalent and costly problem in long-term care settings. Impaired bladder function can cause many physical and social problems, such as impaired skin integrity, falls, and altered psychological well-being. Fortunately, there are several low-risk interventions that can cure or improve continence status in many individuals, regardless of cognitive status. Basic assessment of medical and environmental status, as outlined in this article, can assist staff in determining transient conditions which often alter bladder control. Because many interventions are dependent on mobility, dexterity, and diet, an interdisciplinary approach is ideal.- - - - - - - - - - ranking = 5keywords = incontinence (Clic here for more details about this article) |
5/131. Pneumatosis coli: an uncommon but treatable cause of faecal incontinence.Pneumatosis intestinalis is defined as the presence of gas within the bowel wall. Small bowel pneumatosis is less commonly reported and more severe than colonic disease in adults. Pneumatosis coli is characterised by multiple collections of encysted gas occurring within the sub-mucosa and subserosa of the colon and rectum. It is an uncommon condition which typically presents in late middle age and has been associated with a number of gastrointestinal (e.g. pyloric stenosis, sigmoid volvulus and ischaemic bowel) and non-gastrointestinal (e.g. chronic obstructive pulmonary disease, depression and multiple sclerosis) diseases. Some cases, however, are idiopathic or primary. Symptoms can include diarrhoea, constipation, mucus per rectum, bleeding, flatus, abdominal pain and, rarely, faecal incontinence. We report on two patients, one of whom presented with faecal incontinence, the other who had troublesome lower gastrointestinal symptoms including faecal incontinence. Both responded well to continuous oxygen therapy.- - - - - - - - - - ranking = 7keywords = incontinence (Clic here for more details about this article) |
6/131. Incontinence and constipation after low anorectal malformations in a boy.BACKGROUND: Low anorectal malformations are considered to be a benign type of anorectal malformations. Their treatment is simple in the neonatal period and gives good results as far continence is concerned. methods: We studied a group of 55 boys with low anorectal malformations which had been surgically treated between the 1st January 1975 and the 31st December 1992. We studied the initial treatment and the associated anomalies, 5 patients have died. 27 were seen for an interview and a clinical examination. Extra investigations (anorectal manometry or electromyography of external sphincter) were only offered to consenting patients with an ongoing problem. RESULTS: 3 to 20 years had passed since their operations. Associated anomalies had been found in 11 children. The initial treatment was a perineal procedure in 20 cases and a colostomy in 8 cases. Dilatations were carried out on 11 children. Faecal and urinary continence had been acquired before 30 months of age. 13 children (48%) had problems of soiling and/or chronic constipation. There was no difference between these children and the 14 continent ones regarding the type of malformation, the initial treatment and the follow-up. Anorectal manometry (performed on 9 cases) showed 4 anorectal dyssynergies. It was normal in 3 cases. The Recto Anal Inhibitory reflex was always present. CONCLUSION: Problems of continence are not rare in the evolution of low anorectal malformations. We suggest therefore a long-term clinical follow-up for those children, with one anorectal manometry control being performed after continence is acquired.- - - - - - - - - - ranking = 1.9998507147389E-5keywords = urinary (Clic here for more details about this article) |
7/131. Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury.OBJECTIVE: To describe the effects of an antegrade continence enema stoma formed in a paraplegic man with intractable constipation and fecal incontinence. DESIGN: Case report. SETTING: spinal cord injury unit, veterans Affairs hospital. PARTICIPANTS: spinal cord injury (SCI) patient with T12 paraplegia. INTERVENTION: Surgical formation of antegrade continence enema stoma. MAIN OUTCOME MEASURES: time of bowel program care, ease of fecal elimination, safety of procedure. RESULTS: Bowel care time was decreased from 2 hours to 50 minutes daily; 6 bowel medications were discontinued; fecal incontinence was eliminated; and no surgical or medical side effects noted after the procedure. CONCLUSION: The antegrade continence enema procedure is a safe and effective means of treating intractable constipation and fecal incontinence in the adult SCI patient. This option should be considered for those persons in whom medical management of bowel care has been unsuccessful.- - - - - - - - - - ranking = 7keywords = incontinence (Clic here for more details about this article) |
8/131. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study.PURPOSE: Anal incontinence affects approximately 10 percent of adult females. Damage to the anal sphincters has been considered as the cause of anal incontinence after childbirth in the sole prospective study so far available. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth and their relationship with obstetric parameters. methods: We studied 259 consecutive females six weeks before and eight weeks after delivery. They were asked to fill in a questionnaire assessing fecal incontinence. Anal endosonography (7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. RESULTS: A total of 233 patients (90 percent) were assessed, of whom 31 had cesarean section. De novo sphincter defects were observed in 16.7 percent (14 percent external, 1.7 percent internal, and 1 percent both) in the postpartum period only after vaginal delivery. These disruptions occurred with the same incidence after the first and the second childbirth. Independent risk factors (odds ratio; 95 percent confidence interval) for sphincter defect were forceps (12; 4-20), perineal tears (16; 9-25), episiotomy (6.6; 5-17), and parity (8.8; 4-19) as revealed by multivariate analyses. The overall rate of anal incontinence was 9 percent and independent risk factors (odds ratio; 95 percent confidence interval) involved forceps (4.5; 1.5-13), perineal tears (3.9; 1.4-10.9), sphincter defect (5.5; 5-15), and prolonged labor (3.4; 1-11). Among these patients only 45 percent had sphincter defects. CONCLUSION: Anal incontinence after delivery is multifactorial, and anal sphincter defects account for only 45 percent of them. Primiparous and secundiparous patients have the same risk factors for sphincter disruption and anal incontinence. Because external anal sphincter disruptions are more frequent than internal anal sphincter damage, surgical repair should be discussed in symptomatic patients.- - - - - - - - - - ranking = 11keywords = incontinence (Clic here for more details about this article) |
9/131. Laparoscopic cecostomy for anterior ectopic anus with constipation: a new and technical proposal.A female patient of 26 years of age with faecal incontinence is presented. The anal opening was anteriorly located just posterior to the vagina. This had resulted in overflow faecal incontinence due to severe chronic constipation. NMR showed a normal musculature of the pelvic floor and sphincter. Since the patient did not agree to surgery, laparoscopic cecostomy was performed for the first time for antegrade rinsing.- - - - - - - - - - ranking = 2keywords = incontinence (Clic here for more details about this article) |
10/131. Intermittent falls and fecal incontinence as a manifestation of epileptic negative myoclonus in idiopathic partial epilepsy of childhood.We report two children, suffering from idiopathic partial epilepsy, who started to present, in the same period of time, with epileptic negative myoclonus (ENM) in one lower limb and fecal incontinence (FI). Polygraphic recordings showed that ENM was associated with paroxysmal activities distributed over the vertex region. Both ENM and FI disappeared when ethosuximide treatment was started. We hypothesize that, in our patients, ENM in one lower limb and FI depended on a transitory impairment, caused by epileptic activity that altered the functionality of nearby cortical areas, located in fronto-mesial regions, involved in the control of the muscular tone of the lower limbs and of the pelvic floor muscles.- - - - - - - - - - ranking = 5keywords = incontinence (Clic here for more details about this article) |
| | Next -> |