Skip to main content
SpringerLink
Log in

Traitement médical des dysfonctionnements des sphincters anaux

  • Chapter
Les fonctions sphinctériennes

  • 364 Accesses

Abstrait

Ľincontinence anorectale est un symptôme invalidant et rarement rapporté spontanément par le patient (1). La prévalence de ce symptôme est donc difficile à évaluer et se base souvent sur des collectifs particuliers, tels que les patients institutionnalisés chez lesquels la prévalence atteint 50% (2). Dans la population générale, on estime qu’environ 2,2% de personnes souffrent ďincontinence aux selles (3) mais ce taux atteint 11% des personnes après 45 ans selon une étude française pratiquée dans la population générale (4). Ce symptôme affecte de manière importante la qualité de vie des patients (5) et devrait donc ître abordé par le médecin traitant, surtout lors ďanamnèse à risques. Le traitement chirurgical des déchirures sphinctériennes consiste à suturer en paletot le sphincter anal externe. Malheureusement, les résultats à long terme de cette chirurgie sont décevants (6, 7). Diverses modalités thérapeutiques conservatrices ou peu invasives sont disponibles et devraient être tentées avant une intervention chirurgicale. La physiothérapie par biofeedback, les mesures diététiques associées ou non à un traitement médicamenteux sont les mesures de première intention. La neuromodulation sacrée et ďaugmentation de volume sphinctérien par injection locale sont des traitements peu invasifs qui occupent une place grandissante dans le traitement de ďincontinence anorectale (IAR).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. Leigh RJ, Turnberg LA (1982) Faecal incontinence: the unvoiced symptom. Lancet 1(8285): 1349–51

    Article  PubMed  CAS  Google Scholar 

  2. Nelson RL (2004) Epidemiology of fecal incontinence. Gastroenterology 126(1 Suppl 1): S3–7

    Article  PubMed  Google Scholar 

  3. Nelson R et al. (1995) Community-based prevalence of anal incontinence. JAMA 274: 559–61

    Article  PubMed  CAS  Google Scholar 

  4. Denis P et al. (1992) Prevalence of anal incontinence in adults. Gastroenterol Clin Biol 16: 344–50

    PubMed  CAS  Google Scholar 

  5. Rockwood TH et al. (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43: 9–16; discussion 16–7

    Article  PubMed  CAS  Google Scholar 

  6. Bravo Gutierrez A et al. (2004) Long-term results of anterior sphincteroplasty. Dis Colon Rectum 47: 727–31; discussion 731–2

    Article  PubMed  Google Scholar 

  7. Malouf AJ et al. (2000) Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet 355(9200): 260–5

    Article  PubMed  CAS  Google Scholar 

  8. Bliss DZ et al. (2001) Supplementation with dietary fiber improves fecal incontinence. Nurs Res 50: 50: 203–13

    Article  PubMed  CAS  Google Scholar 

  9. Bergman L, Djarv L (1981) A comparative study of lopéramide and diphénoxylate in the treatment of chronic diarrhoea caused by intestinal resection. Ann Clin Res 13: 402–5

    PubMed  CAS  Google Scholar 

  10. Read M et al. (1982) Effects of lopéramide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 27: 807–14

    Article  PubMed  CAS  Google Scholar 

  11. Palmer KR, Corbett CL, Holdsworth CD (1980) Double-blind cross-over study comparing lopéramide, codeine and diphénoxylate in the treatment of chronic diarrhea. Gastroenterology 79: 1272–5

    PubMed  CAS  Google Scholar 

  12. Carapeti EA et al. (2000) Randomized, controlled trial of topical phenylephrine for fecal incontinence in patients after ileoanal pouch construction. Dis Colon Rectum 43(8): 1059–63

    Article  PubMed  CAS  Google Scholar 

  13. Cheetham MJ, Kamm MA, Phillips RK (2001) Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut 48: 356–9

    Article  PubMed  CAS  Google Scholar 

  14. van Ophoven A et al. (2004) A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol 172: 533–6

    Article  PubMed  Google Scholar 

  15. Hanno PM, Buehler J, Wein AJ (1989) Use of amitriptyline in the treatment of interstitial cystitis. J Urol 141: 846–8

    PubMed  CAS  Google Scholar 

  16. Santoro GA et al. (2000) Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 43: 1676–81; discussion 1681–2

    Article  PubMed  CAS  Google Scholar 

  17. Ryan D et al. (1994) The reduction of faecal incontinence by the use of «Duphalac»in geriatric patients. Curr Med Res Opin 2: 329–33

    Google Scholar 

  18. Chiarioni G et al. (2002) Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Am J Gastroenterol 97: 109–17

    Article  PubMed  CAS  Google Scholar 

  19. Fernandez-Fraga X et al. (2003) Predictors of response to biofeedback treatment in anal incontinence. Dis Colon Rectum 46: 1218–25

    Article  PubMed  Google Scholar 

  20. Ryn AK et al. (2000) Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum 43: 1262–6

    Article  PubMed  CAS  Google Scholar 

  21. Pager CK et al. (2002) Long-term outcomes of pelvic floor exercise and biofeedback treatment for patients with fecal incontinence. Dis Colon Rectum 45: 997–1003

    Article  PubMed  Google Scholar 

  22. Ferrara A et al. (2001) Time-related decay of the benefits of biofeedback therapy. Tech Coloproctol 5: 131–5

    Article  PubMed  CAS  Google Scholar 

  23. Matzel K et al. (1995) Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346(8983): 1124–7

    Article  PubMed  CAS  Google Scholar 

  24. Kenefick NJ et al. (2003) Effect of sacral nerve stimulation on autonomic nerve function. Brit J Surg 90: 1256–60

    Article  PubMed  CAS  Google Scholar 

  25. Vaizey CJ et al. (1999) Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut 44: 407–12

    Article  PubMed  CAS  Google Scholar 

  26. Rosen HR et al. (2001) Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterol 121: 536–41

    Article  CAS  Google Scholar 

  27. Jarrett ME et al. (2004) Sacral nerve stimulation for faecal incontinence in the UK. Brit J Surg 91: 755–61

    Article  PubMed  CAS  Google Scholar 

  28. Leroi AM et al. (2001) Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis Colon Rectum 44: 779–89

    Article  PubMed  CAS  Google Scholar 

  29. Uludag O et al. (2004) Sacral neuromodulation in patients with fecal incontinence: a single-center study. Dis Colon Rectum 47: 1350–7

    Article  PubMed  Google Scholar 

  30. Matzel KE et al. (2004) Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 363(9417): 1270–6

    Article  PubMed  Google Scholar 

  31. Altomare DF et al. (2004) Permanent sacral nerve modulation for fecal incontinence and associated urinary disturbances. Int J Colorectal Dis 19: 203–9

    Article  PubMed  Google Scholar 

  32. Shafik A (1995) Perianal injection of autologous fat for treatment of sphincteric incontinence. Dis Colon Rectum 38: 583–7

    Article  PubMed  CAS  Google Scholar 

  33. Shafik A (1993) Polytetrafluoroethylene injection for the treatment of partial fecal incontinence. Int Surg 78: 159–61

    PubMed  CAS  Google Scholar 

  34. Kumar D, Benson JT, Bland J (1998) Glutaraldehyde cross-linked collagen in the treatment of faecal in continence. Brit J Surg 85: 978–9

    Article  PubMed  CAS  Google Scholar 

  35. Malouf AJ et al. (2001) Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial. Dis Colon Rectum 44: 595–600

    Article  PubMed  CAS  Google Scholar 

  36. Kenefick NJ et al. (2002) Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction. Gut 51: 225–8

    Article  PubMed  CAS  Google Scholar 

  37. Tjandra JJ et al. (2004) Injectable silicone biomaterial for fecal incontinence caused by internal anal sphincter dysfunction is effective. Dis Colon Rectum 47: 2138–46

    Article  PubMed  CAS  Google Scholar 

  38. Kenefick NJ et al. (2002) Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Brit J Surg 89: 896–901

    Article  PubMed  CAS  Google Scholar 

  39. Ganio E et al. (2001) Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience. Dis Colon Rectum 44: 965–70

    Article  PubMed  CAS  Google Scholar 

  40. Malouf AJ et al. (2000) Permanent sacral nerve stimulation for fecal incontinence. Ann Surg 232: 143–8

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. C. Achtari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag France

About this chapter

Cite this chapter

Achtari, C., Meyer, S. (2006). Traitement médical des dysfonctionnements des sphincters anaux. In: Les fonctions sphinctériennes. Collection de L’Académie Européenne de Médecine de Réadaptation. Springer, Paris. https://doi.org/10.1007/978-2-287-37362-6_24

Download citation

  • DOI: https://doi.org/10.1007/978-2-287-37362-6_24

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-25167-2

  • Online ISBN: 978-2-287-37362-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation