Pathy's Principles and Practice of Geriatric Medicine. Группа авторов
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CHAPTER 19 Faecal incontinence
William Gibson
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
Introduction
Faecal incontinence (FI),* the involuntary loss of liquid or solid stool,1 is a common but under‐reported problem in older adults. Accurate estimates of the prevalence of FI are challenging due to under‐reporting,2 and prevalence estimates for FI in older adults are highly variable, from 2.2–25% in the general population, to 9–30% in community‐dwelling older adults, and up to 50% in institutionalized older people.3,4 Faecal incontinence is a highly stigmatizing symptom5 and is associated with shame and embarrassment6 and social isolation,7 and it has been reported to increase institutionalization8 and mortality.9
The physiology of defecation
Much like urination, defecation is a learned skill under conscious control and should only occur at the time and place of one’s choosing. The control of defecation and, therefore, the maintenance of faecal continence rely on many interconnected systems, including the alimentary canal, anus, pelvic floor, and peripheral and central nervous systems. Fundamentally, faecal continence is maintained as long as the pressure in the rectum is lower than the pressure generated by the anus.
Anatomy of the lower alimentary canal
The rectum forms the final part of the alimentary tract. It is a tubular structure 12–15 cm in length, extending the sigmoid colon to the anal canal, which extends around 4 cm from the anal verge to the anorectal ring. The rectum follows the shape of the sacrum and, unlike the rest of the colon, lacks teniae