Fecal incontinence and inflammatory bowel diseases
Thierry, Marie-Lise
Fecal incontinence and inflammatory bowel diseases - 2022.
67
The prevalence of fecal incontinence is high in patients with inflammatory bowel disease (IBD) (between 20 and 73% depending on the study). Diarrhea, lack of colorectal reservoir, rectal compliance disorder, or sphincter rupture can cause fecal incontinence in IBD. Specific risk factors of fecal incontinence in IBD are: activity and duration of the disease, stenosing phenotype, a history of luminal surgery for IBD, pouchitis, perianal Crohn’s disease or anal stenosis, and a history of proctologic surgery. Fecal incontinence and perianal Crohn’s disease affect a patient’s quality of life: it is more difficult to access paid employment and periods of work stoppage are more frequent. Active perianal Crohn’s disease increases thirteenfold the risk of sexual dysfunction in women. Treatment of fecal incontinence is based on controlling luminal inflammation and symptomatic treatment of transit disorders. Second-line treatments for fecal incontinence such as colonic irrigations or sacral nerve stimulation are reserved for IBD patients in endoscopic remission and after failure of symptomatic treatment and anorectal rehabilitation. To prevent fecal incontinence in IBD, it is necessary to screen for perianal Crohn’s disease and to treat it early, to control rectal inflammation, to treat anoperineal fistulas with surgical drainage in combination with medical treatment, and to prefer sphincter- saving/sparing techniques to fistulotomy. The permanent stoma remains the last-resort treatment for refractory fecal incontinence to improve the patient’s quality of life.
Fecal incontinence and inflammatory bowel diseases - 2022.
67
The prevalence of fecal incontinence is high in patients with inflammatory bowel disease (IBD) (between 20 and 73% depending on the study). Diarrhea, lack of colorectal reservoir, rectal compliance disorder, or sphincter rupture can cause fecal incontinence in IBD. Specific risk factors of fecal incontinence in IBD are: activity and duration of the disease, stenosing phenotype, a history of luminal surgery for IBD, pouchitis, perianal Crohn’s disease or anal stenosis, and a history of proctologic surgery. Fecal incontinence and perianal Crohn’s disease affect a patient’s quality of life: it is more difficult to access paid employment and periods of work stoppage are more frequent. Active perianal Crohn’s disease increases thirteenfold the risk of sexual dysfunction in women. Treatment of fecal incontinence is based on controlling luminal inflammation and symptomatic treatment of transit disorders. Second-line treatments for fecal incontinence such as colonic irrigations or sacral nerve stimulation are reserved for IBD patients in endoscopic remission and after failure of symptomatic treatment and anorectal rehabilitation. To prevent fecal incontinence in IBD, it is necessary to screen for perianal Crohn’s disease and to treat it early, to control rectal inflammation, to treat anoperineal fistulas with surgical drainage in combination with medical treatment, and to prefer sphincter- saving/sparing techniques to fistulotomy. The permanent stoma remains the last-resort treatment for refractory fecal incontinence to improve the patient’s quality of life.
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