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Improved Outcomes in Colon and Rectal Surgery part 25

Improved Outcomes in Colon and Rectal Surgery part 25. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery will result in urge incontinence as well with stool clustering and increased frequency. Secondly the history should identify concomitant symptoms such as urinary incontinence and pelvic organ prolapse since FI is frequently only part of a more general pelvic floor dysfunction. Thirdly questions should elicit underlying risk factors particularly those that are readily corrected Table 22.1 . Emphasis must be given to a detailed obstetric history to identify surrogate markers of a traumatic childbirth instrumental delivery prolonged second stage of labor birth weight greater than 4 kg episiotomy 8 and to evaluate the presence of FI symptoms in the postpartum period. A careful assessment of stool consistency and defecation habits will help determine the potential benefits of a bowel regulating treatment. Finally a detailed history of FI will guide selection of appropriate investigations. Physical examination should identify possible causes effects and coexisting conditions of FI. Perineal scarring diminished perineal body or palpable sphincter defects will suggest obstetric trauma. A patulous anus is a sign of sphincter denervation. Dermatitis and excoriation result from prolonged exposure to feces and poor hygiene. Furthermore the clinician should actively look for any anorectal conditions causing pseudo-incontinence such as rectal prolapse or prolapsing hemorrhoids skin tags mucosal ectropion or fistula in-ano. Digital rectal examination provides gross information on sphincter bulk anal canal tone anal stenosis and presence of masses. A vaginal exam is essential to assess for coexisting conditions such as rectocele enterocele uterine or vaginal apex prolapse and cystocele. Additional studies The aim of additional studies is to identify the cause of FI and risk factors amenable to treatment. Endoscopic examination at least a flexible sigmoidoscopy if not a full colonoscopy should be performed to rule out conditions that .