Conservative treatment of patients with faecal soi

Authors: S J van der Hagen P B Soeters C G Baeten W G van Gemert

Publish Date: 2011/07/01

Volume: 15, Issue: 3, Pages: 291-295

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Abstract

Between January 2010 and January 2011 50 consecutive patients of two different clinical centres with faecal soiling and normal anorectal function as assessed by endoanal ultrasound MRI and anal manometry were eligible for the purpose of this study All patients started the therapy by psyllium PS and a fibrerich diet daily after 2 months followed by rectal irrigation RI in case of incomplete response and after 4 months by 4 g colestyramine CO respectively The patients completed the Vaizey incontinence score and a 2week diary card All tests were performed repeated after 2 4 and 8 months respectivelyThe study group consisted of 41 men and 9 women and a mean age of 38 years 21–70 The soiling complaints resolved completely in 37 79 patients After treatment with PS RI and CO 12 24 patients 24 73 patients and 1 79 patient respectively resolved completely of faecal soiling Average weekly soiling frequency the amount of patients wearing pads daily and the Vaizey incontinence score diminished significantly after treatment with psyllium and after treatment with rectal irrigation P  0001Patients with faecal soiling suffer from anal dermatitis and itching mostly after defecation Faecal soiling is caused by insufficient clearing of the anal canal after normal defecation and the anorectal manometry is usually within the normal range 1 Faecal soiling occurs when sticky faeces stays behind in the anorectal canal and gives a local reaction at the anodermal skin which results in itching dermatitis and loss of small amounts of brown fluid The anorectal canal is sometimes anatomically disturbed but many patients with faecal soiling do not have an anal defect The anatomical disturbance is seen in patients with haemorrhoids anal fissures tumours fistulas etc or in patients who had anal surgery for these conditions resulting in scar tissue or keyhole defects About 30 per cent of the patients surgically treated for perianal fistulas suffer from soiling 2 3 4 5 6 7 Terms like passive incontinence and soiling are used mixed up for patients who suffer from anal leakageThere is no standardised adequate therapy for faecal soiling Most of the prescribed therapies consist of symptomatic conservative treatment formerly used for passive faecal incontinence Symptomatic treatment has focussed on the perianal dermatitis by application of dermatological creams by providing information regarding adequate anal hygiene wearing pads or bile acid binders In addition fibre including psyllium or bran is suggested for the treatment of soiling to enhance evacuation of stools 8 Evacuation of faeces by enemas of rectal irrigation after defecation is described in studies for soiling and retentive encopresis in children 9 10 Gosselink et al described retrograde colonic irrigation in patients with bowel disorders and faecal incontinence and soiling 11

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