Fecal Incontinence and Encopresis
There are three logical elements in any clinical program. Furthermore, these elements are equally operative whether the program is medical or behavioral. The elements are (1) diagnosis, (2) mechanism or process, and (3) intervention. Diagnosis means the determination of the signs and symptoms by which one assigns a probability that a specific clinical state is present, or that it is likely to occur. Diagnostic indices have two attributes: sensitivity and specificity. Sensitivity means that the index is an attribute of the disease—that is, the index is a positive sign; and specificity means that the index discriminates the absence of the disease from the presence of the disease—that is, the index also is a negative sign. Most indices meet one or the other criterion but not both. Mechanism or process refers to the factors which are responsible for the etiology or course of the disease. Clearly, the mechanisms associated with the etiology of a disease need not be the same as the mechanisms which mediate its course. For example, the mechanisms associated with the etiology of diverticulosis (herniation of the colonic mucosa between the fibers of the inner, circular muscles) undoubtedly are different from those which mediate the natural history of that disorder (elaboration of the diverticula, often accompanied by inflammation and occasional rupture of a diverticulum). Finally, intervention refers to the process by which one tries to disrupt the natural history of the disease. Interventions could be preventive, therapeutic, or rehabilitative.
KeywordsFecal Incontinence Spina Bifida External Anal Sphincter Behavioral Analysis Anorectal Manometry
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