Anal Incontinence

Front matter

Updates in sual

Ludovico Docimo Luigi Brusciano Editors

Anal Incontinence

Foreword

Fecal incontinence is still today an important and underestimated disability that affects a portion of the general population and is caused by many different conditions, including also iatrogenic conditions. The topic is of major interest for surgeons and many different medical specialists because this disease requires a multidisciplinary approach and an integration of competences.

This volume examines in depth all the pathophysiological aspects of fecal incontinence and the role of surgeons in preventing and treating this complex disease. The authors are very accurate in clarifying to the reader some nebulous aspects of fecal incontinence, leaving open, at the same time, some still important questions. All the recent advancements in the diagnostic flowchart, fine differential etiopathogenetic diagnosis, and tailored choice of therapeutic strategies are, in the present book, well presented with remarkable illustrations.

All aspects such as treatments, rehabilitation, dietary regimen, social costs, and even DRG-related issues are very clearly and cleverly addressed, giving this book the value of an exhaustive guide and very up-to-date reference. For all the abovementioned reasons, Id like to express my gratitude to Professors Ludovico Docimo and Luigi Brusciano and to all the authors involved in this work for having successfully completed such a marvelous scientific endeavor, upholding, once again, the great tradition of Italian Society of Surgery.

Catania, Italy Francesco Basile September 2022 Italian Society of Surgery

Preface

Although benign, anal incontinence is a highly invalidating condition causing an important impairment to the patients’ quality of life. Its related social stigma concurs in the underestimation of its prevalence. Nowadays, a high number of patients still tend to avoid seeking medical care or even talking about the condition, which is why it is reasonably thought to be more common than known.

Stool consistency, the efficiency of the rectum as a reservoir, the sphincter structures, and the innervation of the anatomic area of the perineum are all involved in the continence process. This book describes the multiple aspects of continence ranging from anatomical details to recent pathophysiological findings and nutritional profiles. A spotlight has been turned on the innovative and technologic diagnostic tools such as the 3D reconstruction of the whole sphincteric complex using endoanal ultrasound or the detailed evaluation of sphincter tone utilizing high-resolution manometry. Also addressed are the surgical procedures, from the most common ones performed in every operating room to the more complex approaches reserved for highly specialized centers and not neglecting the latest surgical options, such as sphincteroplasty by crossing puborectalis flaps.

The several nutritional and rehabilitation profiles are also discussed in detail. The complex interplay of the perineum itself with the diaphragm, the vertebral column, and the abdominal wall leads to a delicate equilibrium of what has been configured as the “imaginary cuboid”, whose functional integrity is of utmost importance in the continence process. This partially explains why assessment of the integrity of the sphincter structures is not in itself enough to guarantee an appropriate diagnostic approach to anal incontinence.

A number of physicians with different expertise and specialties have given their contribution to the topic, providing a comprehensive expert discussion of anal incontinence that spans from its pathophysiology to the most innovative views on the diagnostic approach, including the need to analyze physiatric parameters as an estimate of the wellness of the “imaginary cuboid”. The older and more traditional treatments are here tightly interwoven with the most recent therapeutic approaches, vii viii Preface with attention also being paid to the functional treatment of pelvic floor rehabilitation. Objective data supporting the outcomes are also presented so the reader is provided with a clear and concise review of the literature on the subject.

Naples, Italy Ludovico Docimo Naples, Italy Luigi Brusciano September 2022

Contents

PartI Overview

Corrado Rispoli and Gennaro Rispoli

2 Epidemiology, Anorectal Anatomy, Physiology and Gaetano Gallo, Alberto Realis Luc, and Mario Trompetto