UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

成人大便失禁

Authors
Kristen M Robson, MD, MBA, FACG
Anthony J Lembo, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF
Translators
王琨, 主治医师

引言

大便失禁是最严重的身体缺陷之一，因其会影响患者自信和个人形象，并可导致社交孤立[1-4]。虽然难以计算其经济影响，但据1988年的估计，美国仅成人尿布的花费每年就超过4亿美元[5]。而且，大便失禁还是患者入住疗养院的第二大原因。

各项报道对大便失禁的定义存在差异。一份共识声明对大便失禁的定义是：3岁以上个体、至少持续1个月存在连续性或复发性不受控制的排便(>10mL)[6,7]。美国精神病学会也提出了一个相似定义，不过其将年龄设置为4岁以上[8]。

鉴于各研究使用的定义，将大便失禁分为重度和轻度较为合理：

●轻度大便失禁是指无意识排气或部分内裤沾染液状便。

●重度大便失禁是指不自主排便。

                                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-08-10.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA 1995; 274:559.
  2. Sangwan YP, Coller JA. Fecal incontinence. Surg Clin North Am 1994; 74:1377.
  3. Rothbarth J, Bemelman WA, Meijerink WJ, et al. What is the impact of fecal incontinence on quality of life? Dis Colon Rectum 2001; 44:67.
  4. Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008; 148:449.
  5. Lahr CJ. Evaluation and treatment of incontinence. Pract Gastroenterol 1988; 12:27.
  6. Drossman DA, Funch-Jensen P, Janssens J, et al. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int 1990; 3:159.
  7. Thompson WG, Creed F, Drossman DA, et al. Functional bowel disease and functional abdominal pain. Gastroenterol Int 1992; 5:75.
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  9. Rao SS, American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 2004; 99:1585.
  10. Macmillan AK, Merrie AE, Marshall RJ, Parry BR. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum 2004; 47:1341.
  11. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38:1569.
  12. Varma MG, Brown JS, Creasman JM, et al. Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum 2006; 49:841.
  13. Perry S, Shaw C, McGrother C, et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002; 50:480.
  14. Talley NJ, O'Keefe EA, Zinsmeister AR, Melton LJ 3rd. Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology 1992; 102:895.
  15. Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum 1998; 41:1226.
  16. Bharucha AE, Zinsmeister AR, Locke GR, et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology 2005; 129:42.
  17. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137:512.
  18. Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc 2010; 58:1341.
  19. Halland M, Koloski NA, Jones M, et al. Prevalence correlates and impact of fecal incontinence among older women. Dis Colon Rectum 2013; 56:1080.
  20. Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal, or dual incontinence in the Nurses' Health Study. Obstet Gynecol 2013; 122:539.
  21. Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 1996; 91:33.
  22. Sagar PM, Pemberton JH. Anorectal and pelvic floor function. Relevance of continence, incontinence, and constipation. Gastroenterol Clin North Am 1996; 25:163.
  23. Shafik A, Shafik AA, El Sibai O, et al. Role of the rectosigmoidal junction in fecal continence: concept of the primary continent mechanism. Arch Surg 2006; 141:23.
  24. Taylor BM, Beart RW Jr, Dozois RR, et al. The endorectal ileal pouch-anal anastomosis. Current clinical results. Dis Colon Rectum 1984; 27:347.
  25. Sun WM, Read NW, Miner PB. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut 1990; 31:1056.
  26. Fernández-Fraga X, Azpiroz F, Malagelada JR. Significance of pelvic floor muscles in anal incontinence. Gastroenterology 2002; 123:1441.
  27. Oberwalder M, Connor J, Wexner SD. Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 2003; 90:1333.
  28. Bharucha AE, Zinsmeister AR, Locke GR, et al. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol 2006; 101:1305.
  29. Sultan AH, Kamm MA, Hudson CN, et al. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993; 329:1905.
  30. Fynes M, Donnelly V, Behan M, et al. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet 1999; 354:983.
  31. Faltin DL, Sangalli MR, Roche B, et al. Does a second delivery increase the risk of anal incontinence? BJOG 2001; 108:684.
  32. Sze EH. Prevalence and severity of anal incontinence in women with and without additional vaginal deliveries after a fourth-degree perineal laceration. Dis Colon Rectum 2005; 48:66.
  33. Mahony R, Behan M, O'Connell PR, O'Herlihy C. Effect of second vaginal delivery on anal function in patients at risk of occult anal sphincter injury after first forceps delivery. Dis Colon Rectum 2008; 51:1361.
  34. Wattchow DA, Rieger N. Faecal incontinence after vaginal delivery. Lancet 1999; 354:965.
  35. McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol 2003; 189:1251.
  36. Abramov Y, Sand PK, Botros SM, et al. Risk factors for female anal incontinence: new insight through the Evanston-Northwestern twin sisters study. Obstet Gynecol 2005; 106:726.
  37. Kamm MA. Faecal incontinence. BMJ 1998; 316:528.
  38. Malouf AJ, Norton CS, Engel AF, et al. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 2000; 355:260.
  39. Walker WA, Rothenberger DA, Goldberg SM. Morbidity of internal sphincterotomy for anal fissure and stenosis. Dis Colon Rectum 1985; 28:832.
  40. Brisinda G, Maria G, Bentivoglio AR, et al. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 1999; 341:65.
  41. Rao SS, Read NW, Davison PA, et al. Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology 1987; 93:1270.
  42. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984; 2:546.
  43. Bharucha AE, Fletcher JG, Harper CM, et al. Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 2005; 54:546.
  44. Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med 1992; 326:1002.
  45. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987; 16:17.
  46. Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum 2010; 53:1656.
  47. Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association. Gastroenterology 1999; 116:732.
  48. Wald A. Colonic and anorectal motility testing in clinical practice. Am J Gastroenterol 1994; 89:2109.
  49. Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 2007; 102:850.
  50. Diamant NE, Kamm MA, Wald A, Whitehead WE. AGA technical review on anorectal testing techniques. Gastroenterology 1999; 116:735.
  51. Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997; 92:469.
  52. Sajid MS, Khatri K, Siddiqui MR, Baig MK. Endo-anal ultrasound versus endo-anal magnetic resonance imaging for the depiction of external anal sphincter pathology in patients with faecal incontinence: a systematic review. Magy Seb 2010; 63:9.
  53. Saclarides TJ. Endorectal ultrasound. Surg Clin North Am 1998; 78:237.
  54. Falk PM, Blatchford GJ, Cali RL, et al. Transanal ultrasound and manometry in the evaluation of fecal incontinence. Dis Colon Rectum 1994; 37:468.
  55. Stoker J. Magnetic resonance imaging in fecal incontinence. Semin Ultrasound CT MR 2008; 29:409.
  56. Lockhart ME, Fielding JR, Richter HE, et al. Reproducibility of dynamic MR imaging pelvic measurements: a multi-institutional study. Radiology 2008; 249:534.
  57. Keating JP, Stewart PJ, Eyers AA, et al. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum 1997; 40:896.
  58. Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2013; :CD002116.
  59. Bharucha AE, Fletcher JG, Camilleri M, et al. Effects of clonidine in women with fecal incontinence. Clin Gastroenterol Hepatol 2014; 12:843.
  60. Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 1980; 79:1272.
  61. Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 1982; 27:807.
  62. Wrenn K. Fecal impaction. N Engl J Med 1989; 321:658.
  63. Santoro GA, Eitan BZ, Pryde A, Bartolo DC. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 2000; 43:1676.
  64. Cheetham MJ, Kamm MA, Phillips RK. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut 2001; 48:356.
  65. Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence. N Engl J Med 1974; 290:646.
  66. Ko CY, Tong J, Lehman RE, et al. Biofeedback is effective therapy for fecal incontinence and constipation. Arch Surg 1997; 132:829.
  67. Ryn AK, Morren GL, Hallböök O, Sjödahl R. Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum 2000; 43:1262.
  68. Guillemot F, Bouche B, Gower-Rousseau C, et al. Biofeedback for the treatment of fecal incontinence. Long-term clinical results. Dis Colon Rectum 1995; 38:393.
  69. MacLeod JH. Management of anal incontinence by biofeedback. Gastroenterology 1987; 93:291.
  70. Byrne CM, Solomon MJ, Young JM, et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum 2007; 50:417.
  71. Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet 2004; 364:621.
  72. Norton C, Hosker G, Brazzelli M. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev 2000; :CD002111.
  73. Norton C, Chelvanayagam S. Methodology of biofeedback for adults with fecal incontinence: a program of care. J Wound Ostomy Continence Nurs 2001; 28:156.
  74. Norton C, Chelvanayagam S, Wilson-Barnett J, et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 2003; 125:1320.
  75. Christiansen J. Modern surgical treatment of anal incontinence. Ann Med 1998; 30:273.
  76. Madoff RD, Rosen HR, Baeten CG, et al. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial. Gastroenterology 1999; 116:549.
  77. Brown SR, Wadhawan H, Nelson RL. Surgery for faecal incontinence in adults. Cochrane Database Syst Rev 2010; :CD001757.
  78. Grey BR, Sheldon RR, Telford KJ, Kiff ES. Anterior anal sphincter repair can be of long term benefit: a 12-year case cohort from a single surgeon. BMC Surg 2007; 7:1.
  79. Khaikin M, Wexner SD. Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol 2006; 12:3168.
  80. Baeten CG, Geerdes BP, Adang EM, et al. Anal dynamic graciloplasty in the treatment of intractable fecal incontinence. N Engl J Med 1995; 332:1600.
  81. Rongen MJ, Uludag O, El Naggar K, et al. Long-term follow-up of dynamic graciloplasty for fecal incontinence. Dis Colon Rectum 2003; 46:716.
  82. Murphy J, Chan CL, Scott SM, et al. Rectal augmentation: short- and mid-term evaluation of a novel procedure for severe fecal urgency with associated incontinence. Ann Surg 2008; 247:421.
  83. Vaizey CJ, Kamm MA, Gold DM, et al. Clinical, physiological, and radiological study of a new purpose-designed artificial bowel sphincter. Lancet 1998; 352:105.
  84. Wong MT, Meurette G, Stangherlin P, Lehur PA. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence. Dis Colon Rectum 2011; 54:773.
  85. Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum 2007; 50:1950.
  86. Gourcerol G, Gallas S, Michot F, et al. Sacral nerve stimulation in fecal incontinence: are there factors associated with success? Dis Colon Rectum 2007; 50:3.
  87. Hetzer FH, Bieler A, Hahnloser D, et al. Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 2006; 93:1411.
  88. Tjandra JJ, Chan MK, Yeh CH, Murray-Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 2008; 51:494.
  89. Leroi AM, Parc Y, Lehur PA, et al. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 2005; 242:662.
  90. Rosen HR, Urbarz C, Holzer B, et al. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology 2001; 121:536.
  91. Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev 2007; :CD004464.
  92. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 1995; 346:1124.
  93. Jarrett ME, Matzel KE, Christiansen J, et al. Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse. Br J Surg 2005; 92:734.
  94. Uludağ O, Koch SM, van Gemert WG, et al. Sacral neuromodulation in patients with fecal incontinence: a single-center study. Dis Colon Rectum 2004; 47:1350.
  95. Matzel KE, Kamm MA, Stösser M, et al. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004; 363:1270.
  96. Rasmussen OO, Buntzen S, Sørensen M, et al. Sacral nerve stimulation in fecal incontinence. Dis Colon Rectum 2004; 47:1158.
  97. Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA. Permanent sacral nerve stimulation for treatment of idiopathic constipation. Br J Surg 2002; 89:882.
  98. Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg 2010; 251:441.
  99. Boyle DJ, Knowles CH, Lunniss PJ, et al. Efficacy of sacral nerve stimulation for fecal incontinence in patients with anal sphincter defects. Dis Colon Rectum 2009; 52:1234.
  100. Faucheron JL, Voirin D, Badic B. Sacral nerve stimulation for fecal incontinence: causes of surgical revision from a series of 87 consecutive patients operated on in a single institution. Dis Colon Rectum 2010; 53:1501.
  101. George AT, Kalmar K, Sala S, et al. Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg 2013; 100:330.
  102. Shafik A, Ahmed I, El-Sibai O, Mostafa RM. Percutaneous peripheral neuromodulation in the treatment of fecal incontinence. Eur Surg Res 2003; 35:103.
  103. Queralto M, Portier G, Cabarrot PH, et al. Preliminary results of peripheral transcutaneous neuromodulation in the treatment of idiopathic fecal incontinence. Int J Colorectal Dis 2006; 21:670.
  104. Govaert B, Pares D, Delgado-Aros S, et al. A prospective multicentre study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 2010; 12:1236.
  105. Vitton V, Damon H, Roman S, et al. Transcutaneous posterior tibial nerve stimulation for fecal incontinence in inflammatory bowel disease patients: a therapeutic option? Inflamm Bowel Dis 2009; 15:402.
  106. de la Portilla F, Rada R, Vega J, et al. Evaluation of the use of posterior tibial nerve stimulation for the treatment of fecal incontinence: preliminary results of a prospective study. Dis Colon Rectum 2009; 52:1427.
  107. Takahashi T, Garcia-Osogobio S, Valdovinos MA, et al. Radio-frequency energy delivery to the anal canal for the treatment of fecal incontinence. Dis Colon Rectum 2002; 45:915.
  108. Takahashi-Monroy T, Morales M, Garcia-Osogobio S, et al. SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up. Dis Colon Rectum 2008; 51:355.
  109. Ruiz D, Pinto RA, Hull TL, et al. Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up? Dis Colon Rectum 2010; 53:1041.
  110. Efron JE, Corman ML, Fleshman J, et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence. Dis Colon Rectum 2003; 46:1606.
  111. Kim DW, Yoon HM, Park JS, et al. Radiofrequency energy delivery to the anal canal: is it a promising new approach to the treatment of fecal incontinence? Am J Surg 2009; 197:14.
  112. Norton C, Gibbs A, Kamm MA. Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 2006; 49:190.
  113. Wong WD, Congliosi SM, Spencer MP, et al. The safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study. Dis Colon Rectum 2002; 45:1139.
  114. O'Brien PE, Dixon JB, Skinner S, et al. A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence. Dis Colon Rectum 2004; 47:1852.
  115. Wong MT, Meurette G, Wyart V, et al. The artificial bowel sphincter: a single institution experience over a decade. Ann Surg 2011; 254:951.
  116. Giamundo P, Welber A, Weiss EG, et al. The procon incontinence device: a new nonsurgical approach to preventing episodes of fecal incontinence. Am J Gastroenterol 2002; 97:2328.
  117. Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev 2013; :CD007959.
  118. Tjandra JJ, Lim JF, Hiscock R, Rajendra P. Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum 2004; 47:2138.
  119. Stojkovic SG, Lim M, Burke D, et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg 2006; 93:1514.
  120. Altomare DF, La Torre F, Rinaldi M, et al. Carbon-coated microbeads anal injection in outpatient treatment of minor fecal incontinence. Dis Colon Rectum 2008; 51:432.
  121. Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, sham-controlled trial. Lancet 2011; 377:997.
  122. La Torre F, de la Portilla F. Long-term efficacy of dextranomer in stabilized hyaluronic acid (NASHA/Dx) for treatment of faecal incontinence. Colorectal Dis 2013; 15:569.
  123. Bond C, Youngson G, MacPherson I, et al. Anal plugs for the management of fecal incontinence in children and adults: a randomized control trial. J Clin Gastroenterol 2007; 41:45.
  124. Norton C, Kamm MA. Anal plug for faecal incontinence. Colorectal Dis 2001; 3:323.
  125. Pfrommer W, Holschneider AM, Löffler N, et al. A new polyurethane anal plug in the treatment of incontinence after anal atresia repair. Eur J Pediatr Surg 2000; 10:186.
  126. Van Winckel M, Van Biervliet S, Van Laecke E, Hoebeke P. Is an anal plug useful in the treatment of fecal incontinence in children with spina bifida or anal atresia? J Urol 2006; 176:342.
  127. Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev 2012; :CD005086.