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Stuhlinkontinenz: Therapieoptionen

Fecal incontinence

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Zusammenfassung

Diagnose und Behandlungskonzept der analen Inkontinenz setzen eine exakte Kenntnis der Anatomie und Pathophysiologie des Kontinenzorgans voraus und bedürfen einer methodischen abgestuften Vorgehensweise. Trotz der potenziellen Möglichkeit chirurgischer Maßnahmen können eine Reihe der Patienten durch vergleichsweise einfache, nicht invasive Maßnahmen therapiert werden. Grundsätzlich sollte immer ein konservativer Therapieversuch mit Biofeedback und Stuhlregulation unternommen werden. Bei fortgeschrittener Beckenbodendenervation sind anhaltend befriedigende Behandlungsergebnisse unter diesen Maßnahmen nur selten zu erwarten. Manifeste Sphinkterläsionen und Versagen konservativer Maßnahmen bedürfen einer chirurgischen Intervention. Die meisten Verletzungen lassen sich durch eine Sphinkternaht behandeln. Bei idiopathischer Inkontinenz und morphologisch intaktem Schließmuskel kann durch eine Sphinkterraffung, Radiofrequenzapplikation oder permanente Sakralnervenstimulation in vielen Fällen eine Besserung der Kontinenz erreicht werden. Patienten mit komplexen neurologischen Störungen des Beckenbodens, ausgedehnten Sphinkter- und Beckenbodendefekten oder Patienten nach frustranen lokalen operativen Therapieversuchen lassen sich nur durch einen Sphinkterersatz mit dynamischer Grazilisplastik oder einen künstlichen Analsphinkter erfolgreich behandeln.

Abstract

Diagnosis and management of fecal incontinence requires exact understanding of the anatomic and pathophysiologic principles involved and demands a methodical, stepwise approach. Despite the potential appeal of surgical intervention, a considerable number of patients can be helped by comparatively simple, noninvasive measures. Initial treatment should be medical, including biofeedback in combination with a bowel management program. In the presence of a severely denervated pelvic floor, physiotherapeutic techniques rarely give rise to a satisfactory and long-lasting response. Obvious external sphincter defects and patients who failed medical management are treated surgically. Many injuries of the external sphincter can be treated by direct sphincter repair. If patients with intact external sphincters are unresponsive to medical measures, descending perineum and resultant idiopathic fecal incontinence will improve by radio-frequency delivery, sacral nerve stimulation, or postanal plication. Patients with complex neurologic disorders or extensive sphincter defects or who have undergone previous unsuccessful attempts at repair of the puborectalis itself should be considered for dynamic gracilis plastic or an artificial sphincter.

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  1. Chirurgische Klinik, Rotes Kreuz Krankenhaus Bremen

    J. Braun

  2. Chirurgische Klinik, RWTH Aachen

    S. Willis

  3. Chirurgische Klinik, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199 , Bremen

    J. Braun

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  2. S. Willis
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Correspondence to J. Braun.

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Braun, J., Willis, S. Stuhlinkontinenz: Therapieoptionen. Chirurg 75, 871–881 (2004). https://doi.org/10.1007/s00104-004-0923-8

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