Surgical Management Of Fecal Incontinence
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Surgical Management Of Fecal Incontinence
In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups. * Restoration and improvement of residual sphincter function ::::* sphincteroplasty (sphincter repair) ::::* Correction of anorectal deformities that may be contributing to FI ::::* Sacral nerve stimulation * Replacement / imitation of the sphincter or its function ::* ''Narrowing of anal canal to increase the outlet resistance without any dynamic component'' ::::* Anal encirclement (Thiersch procedure) ::::* Radiofrequency ablation ("Secca procedure") ::::* Nondynamic graciloplasty ("bio-Thiersch") ::::* Implantation/injection of microballoons, carbon-coated beads, autologous fat, silicone, collagen. ::* ''Dynamic sphincter replacement'' ::::* Implantation of artificial bowel sphincter (neosphincter) ::::* Dynamic graciloplasty * Antegrade continence enema (A ...
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Fecal Incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred to as anal incontinence. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from deficiency of multiple mechanisms. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions), altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn's disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence), and receptive anal sex. An estimated ...
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Sacral Spinal Nerve 3
The sacral spinal nerve 3 (S3) is a spinal nerve of the sacral segment.American Medical Association
Nervous System -- Groups of Nerves It originates from the spinal column from below the 3rd body of the sacrum.


Muscles

S3 supplies many muscles, either directly or through nerves originating from S3. They are not innervated with S3 as single origin, but partly by S3 and partly by other spinal nerves. The muscles are: *
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Randomized Control Trials
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical techniques, medical devices, diagnostic procedures or other medical treatments. Participants who enroll in RCTs differ from one another in known and unknown ways that can influence study outcomes, and yet cannot be directly controlled. By randomly allocating participants among compared treatments, an RCT enables ''statistical control'' over these influences. Provided it is designed well, conducted properly, and enrolls enough participants, an RCT may achieve sufficient control over these confounding factors to deliver a useful comparison of the treatments studied. Definition and examples An RCT in clinical research typically compares a proposed new treatment against an existing standard of care; these are then termed the 'experimental' ...
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Outpatient Surgery
Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay.The International Association for Ambulatory Surgery (IAAS) would not consider all of these terms synonymous. In a 2003 documen"Ambulatory (day) surgery: suggested international terminology and definitions" the IAAS recommends defining an "outpatient" procedure as one "carried out in the outpatient department of a hospital" and an "ambulatory" procedure as one "excluding an office/surgery or outpatient operation/procedure, where the patient is discharged on the same working day." That is, "ambulatory surgery" occurs in an "ambulatory surgery center." The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs. Outpatient surgery may occur in an inpatient fa ...
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Conscious Sedation
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own. Airway protective reflexes are not compromised by this process Walls, Ron M., MD; Hockberger, Robert S., MD; Gausche-Hill, Marianne, MD, FACEP, FAAP, FAEMS (2018). ''Rosen's Emergency Medicine: Concepts and Clinical Practice. Ninth Edition''. Elsevier. and therefore Tracheal intubation, endotracheal intubation is not required. PSA is commonly used in the emergency department, in addition to the operating room. Medical uses This technique is often used in the emergency department for the performance of painful or uncomfortable procedures. Common purposes include: * laceration repair * setting fractures * draining abscesses * reducing Joint disloca ...
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Local Anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. The following terms are often used interchangeably: * ''Local anesthesia'', in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin. * ''Regional anesthesia'' is aimed at anesthetizing a larger part of the body such as a leg or arm. * ''Conduction anesthesia'' encompasses a great variety of local and regional anesthetic techniques. Medical A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways (nerve block), effects such as ...
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Stenosis
A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' as a term is usually used when narrowing is caused by contraction of smooth muscle (e.g. achalasia, prinzmetal angina); ''stenosis'' is usually used when narrowing is caused by lesion that reduces the space of lumen (e.g. atherosclerosis). The term coarctation is another synonym, but is commonly used only in the context of aortic coarctation. Restenosis is the recurrence of stenosis after a procedure. Types The resulting syndrome depends on the structure affected. Examples of vascular stenotic lesions include: * Intermittent claudication (peripheral artery stenosis) * Angina ( coronary artery stenosis) * Carotid artery stenosis which predispose to (strokes and transient ischaemic episodes) * Renal artery stenosis The types of sten ...
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Rectal Prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be rectal discharge, mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence and obstructed defecation symptoms. Rectal prolapse is generally more common in elderly women, although it may occur at any age and in either sex. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Most external prolapse cases can be treated successfully, often with a surgical procedure. Internal prolapses are traditionally harder to treat and sur ...
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Scrotum
The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum contains the external spermatic fascia, testes, epididymis, and ductus deferens. It is a distention of the perineum and carries some abdominal tissues into its cavity including the testicular artery, testicular vein, and pampiniform plexus. The perineal raphe is a small, vertical, slightly raised ridge of scrotal skin under which is found the scrotal septum. It appears as a thin longitudinal line that runs front to back over the entire scrotum. In humans and some other mammals the scrotum becomes covered with pubic hair at puberty. The scrotum will usually tighten during penile erection and when exposed to cold temperatures. One testis is typically lower than the other to avoid compression in the event of an impact. The scrotum is biologicall ...
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Labia Majora
The labia majora (singular: ''labium majus'') are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia majora are homologous to the male scrotum. Etymology ''Labia majora'' is the Latin plural for big ("major") lips; the singular is ''labium majus.'' The Latin term ''labium/labia'' is used in anatomy for a number of usually paired parallel structures, but in English it is mostly applied to two pairs of parts of female external genitals (vulva)—labia majora and labia minora. Labia majora are commonly known as the outer lips, while labia minora (Latin for ''small lips''), which run alongside between them, are referred to as the inner lips. Traditionally, to avoid confusion with other lip-like structures of the body, the labia of female genitals were termed by anatomists in Latin as ''labia majora (''or ''minora) pudendi.'' Embryology Embryolo ...
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Perineum
The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. There is some variability in how the boundaries are defined. The perineal raphe is visible and pronounced to varying degrees. The perineum is an erogenous zone. The word perineum entered English from late Latin via Greek περίναιος ~ περίνεος ''perinaios, perineos'', itself from περίνεος, περίνεοι 'male genitals' and earlier περίς ''perís'' 'penis' through influence from πηρίς ''pērís'' 'scrotum'. The term was originally understood as a purely male body-part with the perineal raphe seen as a continuation of the scrotal septum since masculinization causes the development of a large anogenital distance in men, in comparison to the corresponding lack ...
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Obstructed Defecation
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Functional constipation is usually defined as infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal (unlike slow transit constipation). Definitions ODS is a loose term, consisting of a constellation of possible symptoms, caused by multiple, complex and poorly understood disorders which may include both functional and organic disorders. Furthermore, many different terms have been used, which appear to refer to the same clinical entity. However, the term does not appear in the ICD-11 and Rome-IV classifications, which both instead re ...
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