Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Causes | Clinical | Tests | Management |
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Weakness of the Anal Sphincter |
- Common after childbirth (especially with traumatic vaginal delivery). - Anal surgery (e.g., hemorrhoidectomy, fistula surgery). - Neurological conditions affecting sphincter control (e.g., spinal cord injury, multiple sclerosis). |
- Anorectal Manometry: Assesses the strength of the anal sphincter muscles.
- Endoanal Ultrasound: Visualizes the integrity of the sphincter muscles. - Pudendal Nerve Testing: Evaluates nerve function to the anal sphincter. |
- Pelvic floor exercises (Kegels) to strengthen sphincter muscles.
- Biofeedback therapy to improve sphincter control. - Surgical repair of sphincter damage (e.g., sphincteroplasty). - Sacral nerve stimulation for refractory cases. |
Diarrhoea |
- Acute or chronic diarrhoea can overwhelm sphincter control. - Common in conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or infectious gastroenteritis. |
- Stool Cultures: To rule out infectious causes of diarrhoea.
- Colonoscopy or Sigmoidoscopy: To assess for IBD or other structural causes of diarrhoea. - Fecal Fat Testing: To assess for malabsorption. |
- Treat underlying cause of diarrhoea (e.g., antibiotics for infection, anti-inflammatory medication for IBD).
- Anti-diarrhoeal medications (e.g., loperamide) to reduce stool frequency. - Dietary changes (e.g., avoiding trigger foods like lactose or gluten in intolerances). |
Chronic Constipation with Overflow Incontinence |
- Severe constipation can lead to fecal impaction, causing overflow incontinence as liquid stool leaks around the impaction. |
- Abdominal X-ray: May show fecal impaction or large bowel distension.
- Digital Rectal Examination (DRE): To assess for impacted stool. - Colonic Transit Study: To assess for slow transit constipation. |
- Bowel regimen including stool softeners and laxatives (e.g., polyethylene glycol).
- Manual disimpaction if stool impaction is present. - Increase fiber and fluid intake to prevent recurrence. |
Neurological Disorders |
- Conditions like multiple sclerosis, stroke, or spinal cord injury can impair sphincter control or cause loss of rectal sensation. |
- MRI of the Spine or Brain: To assess for spinal cord lesions or stroke.
- Anorectal Manometry: To evaluate sphincter function and rectal sensation. - Pudendal Nerve Terminal Motor Latency Test: To assess nerve function. |
- Treat underlying neurological condition (e.g., rehabilitation for stroke).
- Pelvic floor muscle training and biofeedback to improve sphincter control. - Sacral nerve stimulation or colostomy in severe cases. |
Rectal Prolapse |
- Prolapse of the rectum through the anus can weaken sphincter control and lead to faecal incontinence. |
- Physical Examination: Visualization of the prolapse during straining.
- Defecography: Imaging to assess the extent of the prolapse. - Anorectal Manometry: To evaluate sphincter function. |
- Surgical repair of rectal prolapse (e.g., rectopexy).
- Pelvic floor exercises to prevent recurrence. - Biofeedback to improve rectal sensation and control. |
Age-Related Changes |
- Ageing leads to decreased anal sphincter strength and reduced rectal sensation, contributing to faecal incontinence. |
- Anorectal Manometry: To assess anal sphincter pressure and rectal sensation.
- Endoanal Ultrasound: To evaluate sphincter integrity. |
- Pelvic floor exercises to strengthen sphincter muscles.
- Biofeedback therapy to improve bowel control. - Dietary modifications and stool consistency management. |