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Anal and Perineal Injuries.

Arjun N Jeganathan1, Jeremy W Cannon2, Joshua I S Bleier3

  • 1Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Clinics in Colon and Rectal Surgery
|January 31, 2018
PubMed
Summary
This summary is machine-generated.

Explosive devices cause severe anal trauma and fecal incontinence. Survivors benefit from therapies ranging from medication and biofeedback to advanced surgical options and nerve stimulation for improved bowel continence.

Keywords:
anal and perineal traumaanosphincteric complexfecal incontinence

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Area of Science:

  • Colorectal Surgery
  • Trauma Surgery
  • Gastroenterology

Background:

  • Increased use of explosive devices in warfare leads to complex pelviperineal injuries.
  • Survivors of such trauma often experience disabling fecal incontinence due to anosphincteric complex damage.

Purpose of the Study:

  • To review the evaluation and management of fecal incontinence following severe anal trauma.
  • To discuss current and emerging therapeutic options for restoring bowel continence.

Main Methods:

  • Initial evaluation includes physical examination, rigid proctoscopy, flexible sigmoidoscopy, anal manometry, and endoanal ultrasound.
  • Therapeutic strategies encompass conservative measures, surgical repairs, and innovative treatments.

Main Results:

  • First-line therapy involves bulking agents, antidiarrheals, and biofeedback.
  • Surgical interventions yield variable results, while sacral nerve stimulation and magnetic anal sphincters show promise.
  • Permanent fecal diversion is a viable option for severe, intractable cases.

Conclusions:

  • Effective management of fecal incontinence after anal trauma requires a comprehensive approach.
  • A range of treatments, from conservative to surgical and neuromodulatory, can improve outcomes.
  • Patient satisfaction is high even with permanent fecal diversion when other options fail.