进行大便失禁的检查以评估每个患者的状况。由于没有单一的方法可以完美地评估这种情况,有几个测试需要进行。这些如下:肛门测压,直肠肛门敏感性试验,阴部神经末梢运动潜伏期,肌电图,肛门超声检查,盆腔磁共振成像(MRI)扫描,和排粪造影。此外,在所有这些检查中,大多数患者所经历的精神和身体压力都需要考虑在内。虽然这些检查大多适用于便秘患者,我们在此描述这些测试作为评估大便失禁的工具。大便失禁的保守治疗包括饮食,生活方式,和排便习惯的改变,药物治疗,盆底肌肉训练,生物反馈治疗,肛门插入装置,经肛门灌洗,等等。这些干预措施已被确定,以改善大便失禁的症状,通过确定导致更硬的大便稠度的机制;加强盆底肌肉,包括肛门外括约肌;使直肠感觉正常化;或定期排空结肠和直肠。在这些干预措施中,饮食,生活方式,排便习惯的改变和药物治疗可以在一定程度的知识和经验下进行。这两种疗法,因此,可以由所有医生进行,包括全科医生和其他不擅长大便失禁的医生。然而,在这些初始治疗后仍未好转的大便失禁患者应转诊至专门机构.与最初的治疗相反,专门疗法,包括盆底肌肉训练,生物反馈治疗,肛门插入装置,经肛门冲洗,应在专门机构中进行,因为这些需要基于专业知识和经验的患者教育和指导。总的来说,对于大便失禁,应在手术前进行保守治疗,因为其病理生理主要归因于良性疾病。所有照顾大便失禁患者的日本医疗保健专业人员都希望了解每种保守治疗的特点,以便选择和执行适当的治疗方法。因此,在这一章中,描述了每种保守治疗大便失禁的特点。
Examination for fecal incontinence is performed in order to evaluate the condition of each patient. As there is no single method that perfectly assesses this condition, there are several tests that need to be conducted. These are as follows: anal manometry, recto anal sensitivity test, pudendal nerve terminal motor latency, electromyogram, anal endosonography, pelvic magnetic resonance imaging (MRI) scan, and defecography. In addition, the mental and physical stress most patients experience during all these examinations needs to be taken into consideration. Although some of these examinations mostly apply for patients with constipation, we hereby describe these tests as tools for the assessment of fecal incontinence. Conservative therapies for fecal incontinence include diet, lifestyle, and bowel habit modification, pharmacotherapy, pelvic floor muscle training, biofeedback therapy, anal insert device, trans anal irrigation, and so on. These interventions have been identified to improve the symptoms of fecal incontinence by determining the mechanisms resulting in firmer stool consistency; strengthening the pelvic floor muscles, including the external anal sphincter; normalizing the rectal sensation; or periodic emptying of the colon and rectum. Among these interventions, diet, lifestyle, and bowel habit modifications and pharmacotherapy can be performed with some degree of knowledge and experience. These two therapies, therefore, can be conducted by all physicians, including general practitioners and other physicians not specializing in fecal incontinence. However, patients with fecal incontinence who did not improve following these initial therapies should be referred to specialized institutions. Contrary to the initial therapies, specialized therapies, including pelvic floor muscle training, biofeedback therapy, anal insert device, and trans anal irrigation, should be conducted in specialized institutions as these require patient education and instructions based on expert knowledge and experience. In general, conservative therapies should be performed for fecal incontinence before surgery because its pathophysiologies are mostly attributed to benign conditions. All Japanese healthcare professionals who take care of patients with fecal incontinence are expected to understand the characteristics of each conservative therapy, so that appropriate therapies will be selected and performed. Therefore, in this chapter, the characteristics of each conservative therapy for fecal incontinence are described.