Résumé
Hormis le cas de l’incontinence anale active pour les selles solides, qui peut exceptionnellement être améliorée par un traitement symptomatique, un traitement symptomatique peut être proposé à un grand nombre de patients sans avoir recours aux examens spécialisés du périnée. Il est possible d’obtenir une vacuité rectale efficace chez les patients souffrant de difficultés d’exonération ou d’incontinence anale passive. En cas d’incontinence anale active pour les selles liquides, la plus grande efficacité pour améliorer les malades repose sur le traitement d’une diarrhée. En cas d’incontinence active pour les gaz, la prise en charge diététique est sans doute la solution la plus efficace. L’approche clinique est donc suffisante chez un très grand nombre de patients pour faire disparaître le symptôme sans avoir recours aux examens spécialisés pour explorer l’anatomie et la physiologie du périnée. Le traitement curatif d’une dyschésie ou d’une incontinence anale nécessite l’étude de l’anatomie et de la physiologie du périnée, car les causes de la dyschésie et de l’incontinence anale sont souvent multifactorielles et le choix du traitement doit donc tenir compte de l’intrication fréquente des anomalies anatomiques et fonctionnelles. Si l’examen clinique est dans certains cas supérieur aux examens complémentaires pour étudier ces mécanismes, il n’est pas suffisant pour affirmer l’absence de rupture sphinctérienne, de neuropathie, d’entérocèle ou de sigmoïdocèle. L’approche clinique n’est donc pas suffisante pour le traitement curatif d’une dyschésie ou d’une incontinence anale.
Abstract
Except for fecal incontinence involving solid stool, conservative measures, including bowel transit regulation and biofeedback, may be the first steps in treating most patients suffering from anorectal disorders before performing anorectal manometry, imaging, and neurophysiological testing. Enemas and laxatives are usually sufficient to obtain emptied rectal ampulla and resolve rectal emptying difficulties and passive anal incontinence. Diarrhoea treatment is the first step in cases of liquid stool incontinence. For gas incontinence, appropriate dietary intervention is probably the best treatment. Thus it seems possible to improve anorectal disorders in most patients without performing specialized tests. If conservative measures fail to improve anorectal disorders, surgery may be considered. In this case, specialized tests must be performed because anorectal disorders result from the interplay of multiple pathogenic mechanisms and are rarely attributable to a single factor. Sensory dysfunction, neuropathy, sphincter defects, enterocele, and sigmoidocele may interfere with surgical management and are best diagnosed through anorectal testing.
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Touchais, J.Y., Leroi, A.M. & Denis, P. L’approche clinique est-elle suffisante dans la prise en charge des troubles anorectaux de l’adulte?. Pelv Perineol 2, 360–365 (2007). https://doi.org/10.1007/s11608-007-0153-x
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DOI: https://doi.org/10.1007/s11608-007-0153-x