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Meta-Analysis
. 2013 Jul 2;2013(7):CD001757.
doi: 10.1002/14651858.CD001757.pub4.

Surgery for faecal incontinence in adults

Steven R Brown  1 , Himanshu Wadhawan, Richard L Nelson
Affiliations
Meta-Analysis

Surgery for faecal incontinence in adults

Steven R Brown et al. Cochrane Database Syst Rev. .

Abstract

Background: Faecal incontinence is a debilitating problem with significant medical, social and economic implications. Treatment options include conservative, non-operative interventions (for example pelvic floor muscle training, biofeedback, drugs) and surgical procedures. A surgical procedure may be aimed at correcting an obvious mechanical defect, or augmenting a functionally deficient but structurally intact sphincter complex.

Objectives: To assess the effects of surgical techniques for the treatment of faecal incontinence in adults who do not have rectal prolapse. Our aim was firstly to compare surgical management with non-surgical management and secondly, to compare the various surgical techniques.

Search methods: Electronic searches of the Cochrane Incontinence Group Specialised Register (searched 6 March 2013), the Cochrane Colorectal Cancer Group Specialised Register (searched 6 March 2013), CENTRAL (2013, issue 1) and EMBASE (1 January 1998 to 6 March 2013) were undertaken. The British Journal of Surgery (1 January 1995 to 6 March 2013), Colorectal Diseases (1 January 2000 to 6 March 2013) and the Diseases of the Colon and Rectum (1 January 1995 to 6 March 2013) were specifically handsearched. The proceedings of the Association of Coloproctology of Great Britain and Ireland annual meetings held from 1999 to 2012 were perused. Reference lists of all relevant articles were searched for further trials.

Selection criteria: All randomised or quasi-randomised trials of surgery in the management of adult faecal incontinence (other than surgery for rectal prolapse).

Data collection and analysis: Three review authors independently selected studies from the literature, assessed the methodological quality of eligible trials and extracted data. The three primary outcome measures were change or deterioration in incontinence, failure to achieve full continence, and the presence of faecal urgency.

Main results: Nine trials were included with a total sample size of 264 participants. Two trials included a group managed non-surgically. One trial compared levatorplasty with anal plug electrostimulation and one compared an artificial bowel sphincter with best supportive care. The artificial bowel sphincter resulted in significant improvements in at least one primary outcome but the numbers were small. The other trial showed no difference in the primary outcome measures.Seven trials compared different surgical interventions. These included anterior levatorplasty versus postanal repair, anterior levatorplasty versus total pelvic floor repair, total pelvic floor versus postanal repair, end to end versus overlap sphincter repair, overlap repair with or without a defunctioning stoma or with or without biofeedback, and total pelvic floor repair versus repair plus internal sphincter plication and neosphincter formation versus total pelvic floor repair. Sacral nerve stimulation and injectables are considered in separate Cochrane reviews. Only one comparison had more than one trial (total pelvic floor versus postanal repair, 44 participants) and no trial showed any difference in primary outcome measures.

Authors' conclusions: The review is striking for the lack of high quality randomised controlled trials on faecal incontinence surgery that have been carried out in the last 10 years. Those trials that have been carried out have focused on sacral neuromodulation and injectable bulking agents, both reported in separate reviews. The continued small number of relevant trials identified together with their small sample sizes and other methodological weaknesses limit the usefulness of this review for guiding practice. It was impossible to identify or refute clinically important differences between the alternative surgical procedures. Larger rigorous trials are still needed. However, it should be recognised that the optimal treatment regime may be a complex combination of various surgical and non-surgical therapies.

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Conflict of interest statement

None

Figures

1
1
PRISMA study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Anterior levatorplasty versus anal plug electrostimulation, Outcome 1 Number of patients with no change in incontinence.
1.4
1.4. Analysis
Comparison 1 Anterior levatorplasty versus anal plug electrostimulation, Outcome 4 Number of patients using pads.
1.5
1.5. Analysis
Comparison 1 Anterior levatorplasty versus anal plug electrostimulation, Outcome 5 Number of patients with complications.
1.6
1.6. Analysis
Comparison 1 Anterior levatorplasty versus anal plug electrostimulation, Outcome 6 Patient assessment of physical handicap (yes/no).
1.7
1.7. Analysis
Comparison 1 Anterior levatorplasty versus anal plug electrostimulation, Outcome 7 Patient assessment of social handicap (yes/no).
2.1
2.1. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 1 Number of patients with no change in incontinence.
2.4
2.4. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 4 Cleveland Clinic Continence Score.
2.5
2.5. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 5 Quality of life score.
2.6
2.6. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 6 Physical assessment (SF‐36).
2.7
2.7. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 7 Mental assessment (SF‐36).
2.8
2.8. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 8 Beck depression score.
2.9
2.9. Analysis
Comparison 2 Artificial bowel sphincter versus best supportive care, Outcome 9 Number of patients with complications.
3.2
3.2. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 2 Number of patients failing to achieve full continence.
3.4
3.4. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 4 Number of patients with dyspareunia.
3.5
3.5. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 5 Maximum resting anal pressure (cm/water).
3.6
3.6. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 6 Maximum squeeze pressure (cm/water).
3.7
3.7. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 7 Number of patients with no improvement in anal canal sensation (mA).
3.8
3.8. Analysis
Comparison 3 Anterior levatorplasty versus postanal repair, Outcome 8 Functional length of anal canal (cm).
4.2
4.2. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 2 Number of patients failing to achieve full continence.
4.4
4.4. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 4 Number of patients with dyspareunia.
4.5
4.5. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 5 Maximum resting anal pressure (cm/water).
4.6
4.6. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 6 Maximum squeeze pressure (cm/water).
4.7
4.7. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 7 Number of patients with no improvement in anal canal sensation (mA).
4.8
4.8. Analysis
Comparison 4 Total pelvic floor repair versus anterior levatorplasty, Outcome 8 Functional length of anal canal (cm).
5.1
5.1. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 1 Number of patients with no change in incontinence.
5.2
5.2. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 2 Number of patients failing to achieve full continence.
5.4
5.4. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 4 Number of patients with adverse functional effects.
5.5
5.5. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 5 Maximum resting anal pressure (cm/water).
5.6
5.6. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 6 Maximum squeeze pressure.
5.7
5.7. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 7 Number of patients with no improvement in anal canal sensation (mA).
5.8
5.8. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 8 Functional length of anal canal (cm).
5.9
5.9. Analysis
Comparison 5 Total pelvic floor repair (TPFR) versus postanal repair (PAR), Outcome 9 Number of patients with a decrease in maximum squeeze pressure.
6.1
6.1. Analysis
Comparison 6 Overlap sphincter repair versus end to end repair, Outcome 1 Number of patients with no change in incontinence.
6.4
6.4. Analysis
Comparison 6 Overlap sphincter repair versus end to end repair, Outcome 4 Number of patients having to use imodium.
6.5
6.5. Analysis
Comparison 6 Overlap sphincter repair versus end to end repair, Outcome 5 Number of patients with difficulty evacuating.
6.6
6.6. Analysis
Comparison 6 Overlap sphincter repair versus end to end repair, Outcome 6 Complications.
7.4
7.4. Analysis
Comparison 7 Overlap sphincter repair versus repair and defunctioning, Outcome 4 Cleveland Clinic Continence Score.
7.5
7.5. Analysis
Comparison 7 Overlap sphincter repair versus repair and defunctioning, Outcome 5 Maximum resting pressure.
7.6
7.6. Analysis
Comparison 7 Overlap sphincter repair versus repair and defunctioning, Outcome 6 Maximum squeeze pressure (cm water).
7.7
7.7. Analysis
Comparison 7 Overlap sphincter repair versus repair and defunctioning, Outcome 7 Number of sphincter related complications.
7.8
7.8. Analysis
Comparison 7 Overlap sphincter repair versus repair and defunctioning, Outcome 8 Hospital stay (days).
8.1
8.1. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 1 Number of patients with no change in incontinence.
8.2
8.2. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 2 Number of patients failing to achieve full continence.
8.4
8.4. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 4 Continence grading scale score at 12 months.
8.5
8.5. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 5 Patient satisfaction score (VAS) at 12 months.
8.6
8.6. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 6 Quality of life score ‐ lifestyle at 12 months.
8.7
8.7. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 7 Quality of life score ‐ Coping at 12 months.
8.8
8.8. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 8 Quality of life score ‐ (less) depression at 12 months.
8.9
8.9. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 9 Quality of life score ‐ embarrassment at 12 months.
8.10
8.10. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 10 Mean resting pressures (cm water) at 3 months.
8.11
8.11. Analysis
Comparison 8 Overlap sphincter repair versus repair and biofeedback, Outcome 11 Mean squeeze pressures (cm water) at 3 months.
9.4
9.4. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 4 Incontinence score.
9.5
9.5. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 5 Maximum resting anal pressure (cm/water).
9.6
9.6. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 6 Improvement in mucosal electrosensitivity (mA).
9.7
9.7. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 7 Rectal capacity (ml).
9.8
9.8. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 8 Number of patients with no improvement in functional length of anal canal.
9.9
9.9. Analysis
Comparison 9 Total pelvic floor repair with internal sphincter plication versus total pelvic floor repair, Outcome 9 Number of patients with post‐operative complications.
10.2
10.2. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 2 Number of patients failing to achieve full continence.
10.3
10.3. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 3 Number of patients with no improvement in faecal urgency.
10.4
10.4. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 4 Incontinence score.
10.5
10.5. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 5 Number of patients with post‐operative complications.
10.6
10.6. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 6 Number of patients with adverse effects.
10.7
10.7. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 7 Maximum resting anal pressure (cm/water).
10.8
10.8. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 8 Mucosal electrosensitivity (mA).
10.9
10.9. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 9 Maximum squeeze pressure (cm/water).
10.10
10.10. Analysis
Comparison 10 Gluteus maximus transposition (adynamic) versus total pelvic floor repair, Outcome 10 Length of high pressure zone (cm).
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References

References to studies included in this review

Davis 2004 {published data only}
    1. Davis KJ, Kumar D, Poloniecki J. Adjuvant biofeedback following anal sphincter repair: a randomized study. Alimentary Pharmacology & Therapy 2004;20:539‐49. - PubMed
Deen 1993 {published data only}
    1. Deen KI, Oya M, Oritz J, Keighley MRB. Randomized trial comparing three forms of pelvic floor repair for neuropathic faecal incontinence. British Journal of Surgery 1993;80:794‐8. - PubMed
Deen 1995 {published data only}
    1. Deen KI, Kumar D, Williams JG, Grant EA, Keighley MRB. Randomized trial of internal anal sphincter plication with pelvic floor repair for neuropathic fecal incontinence. Diseases of the Colon and Rectum 1995;38(1):14‐8. - PubMed
Hasegawa 2000 {published data only}
    1. Hasegawa H, Yoshioka K, Keighley MRB. Randomized trial of fecal diversion for sphincter repair. Disease of the Colon and Rectum 2000;43:961‐5. - PubMed
O'Brien 2004 {published data only}
    1. O'Brien PE, Dixon JB, Skinner S, Laurie C, Khera A, Fonda D. A prospective randomized controlled clinical trial of placement of the artificial bowel sphincter (Acticon neosphincter) for the control of fecal incontinence. Disease of the Colon and Rectum 2004;47:1852‐60. - PubMed
Osterberg 2004 {published data only}
    1. Osterberg A, Edebol Eeg‐Olofsson K, Hallden M, Graf W. Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence. British Journal of Surgery 2004;91:1131‐7. - PubMed
Tjandra 2003 {published data only}
    1. Tjandra JJ, Han WR, Goh J, Carey M, Dwyer P. Direct repair versus overlapping sphincter repair. A randomised controlled trial. Diseases of the Colon and Rectum 2003;46:937‐43. - PubMed
van Tets 1998 {published data only}
    1. Tets WF, Kuijpers JHC. Pelvic floor procedures produce no consistent changes in anatomy or physiology. Diseases of the Colon and Rectum 1998;41(3):365‐9. - PubMed
Yoshioka 1999 {published data only}
    1. Yoshioka K, Ogunbiyi OA, Keighley MRB. Pilot study of total pelvic floor repair or Gluteus Maximus transposition for postobstetric neuropathic fecal incontinence. Diseases of the Colon and Rectum 1999;42(2):252‐7. - PubMed

References to studies excluded from this review

Dehli 2013 {published data only}
    1. Delhi T, Stordahl A, Vatten LJ, Romundstad PR, Mevik K, Sahlin Y, et al. Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomised controlled trial. Scandinavian Journal of Gastroenterology 2013;48(3):302‐10. - PubMed
Farrell 2010 {published data only}
    1. Farrell SA, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, Flowerdew G, Fanning CA. Overlapping compared with end‐to‐end repair of third‐ and fourth‐degree obstetric anal sphincter tears: a randomised controlled trial. Obstetrics and Gynecology 2010;116(1):16‐24. - PubMed
Farrell 2012 {published data only}
    1. Farrell SA, Flowerdew G, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, Fanning CA. Overlapping compared with end‐to‐end repair of complete third‐degree or fourth‐degree obstetric tears: three‐year follow up of a randomised controlled trial.. Obstetrics and Gynecology 2012;120(4):803‐8. - PubMed
Fernando 2006a {published data only}
    1. Fernando R, Sultan AH, Kettle C, Radley S, Jones P, O'Brien S. A randomised trial of overlap vs end‐to‐end primary repair of the anal sphincter (abstract). Neurourology and Urodynamics 2004;23(5/6):411‐2.
    1. Fernando RJ, Sultan AH, Kettle C, Radley S, Jones P, O'Brien PM. Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial. Obstetrics and Gynecology 2006;107(6):1261‐8. - PubMed
Fitzpatrick 2000 {published data only}
    1. Fitzpatrick M, Behan M, O'Connell R, O'Herlihy C. A randomised clinical trial comparing primary overlap with approximation repair of third‐degree tears. American Journal of Obstetrics and Gynecology 2000;183:1220‐4. - PubMed
    1. Fitzpatrick M, Cassidy M, Behan M, O'Herlihy C, O'Connell PR. Primary anal sphincter repair: influence of technique of repair (abstract). Colorectal Disease 1999;1 Suppl 1:10.
Garcia V 2005 {published data only}
    1. Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer‐Doak DN. Primary repair of obstetric anal sphincter laceration: A randomised trial of two surgical techniques. American Journal of Obstetrics and Gynecology 2005;192:1697‐701. - PubMed
Graf 2011 {published data only}
    1. Graf W, Mellgren A, Matzel KE, Hull T, Johansson C, Bernstein M, NASHA Dx Study Group. Efficacy of dextranomer in stabilised hyaluronic acid for the treatment of faecal incontinence: a randomised, sham‐controlled trial. Lancet 2011;377(9770):997‐1003. - PubMed
Leroi 2005 {published data only}
    1. Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, et al. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double‐blind crossover study. Annals of Surgery 2005;242(5):662‐9. [MEDLINE: ] - PMC - PubMed
Loder 1993 {published data only}
    1. Loder PB, Phillips RK. Randomized trial comparing three forms of pelvic floor repair for neuropathic faecal incontinence. British Journal of Surgery 1993;80(10):1352. - PubMed
Maeda 2007 {published data only}
    1. Maeda Y, Vaisey CJ, Kamm MA. Pilot study of two new injectable bulking agents for the treatment of faecal incontinence. Colorectal Disease 2007;10(3):268‐72. - PubMed
Michelsen 2008 {published data only}
    1. Michelsen HB, Krogh K, Buntzen S, Laurberg S. A prospective randomised study: switch off the sacral nerve stimulator during the night?. Diseases of the Colon and Rectum 2008;51(5):538‐40. - PubMed
Nordenstam 2008 {published data only}
    1. Nordenstam J, Mellgren A, Altman D, López A, Johansson C, Anzén B, et al. Immediate or delayed repair of obstetric anal sphincter tears ‐ a randomised controlled trial. BJOG 2008;115(7):857‐65. - PubMed
Rygh 2010 {published data only}
    1. Rygh AB, Korner H. The overlap technique versus end‐to‐end approximation technique for primary repair of obstetric anal sphincter rupture: a randomised controlled study. Acta Obstetricia et Gynecologica Scandinavica 2010;89(10):1256‐62. - PubMed
Siphrouis 2004 {published data only}
    1. Siproudhis L, Morcet J, Laine F. Elastomer implants in faecal incontinence: a blind, randomised placebo‐controlled study. Alimentary Pharmacology and Therapeutics 2007;25(9):1125‐32. - PubMed
Tjandra 2004 {published data only}
    1. Tjandra JJ, Lim JF, Hiscock R, Rajendra P. Injectable silicone biomaterial for faecal incontinence caused by internal anal sphincter dysfunction is effective. Diseases of the Colon and Rectum 2004;47(12):2138‐46. - PubMed
Tjandra 2008 {published data only}
    1. Tjandra JJ, Chan MK, Yeh CH, Murray‐Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe faecal incontinence: a randomised controlled trial. Diseases of the Colon and Rectum 2008;51(5):494‐502. - PubMed
Tjandra 2009 {published data only}
    1. Tjandra JJ, Chan MK, Yeh HC. Injectable silicone biomaterial (PTQ) is more effective than carbon‐coated beads (Durasphere) in treating passive faecal incontinence ‐ a randomized controlled trial. Colorectal Disease 2009;11(4):382‐9. - PubMed
Vaizey 1999 {published data only}
    1. Vaizey CJ, Kamm MA, Roy AJ, Nicholls RJ. Double blind crossover study of sacral nerve stimulation for fecal incontinence. Diseases of the Colon and Rectum 1999;43:298‐302. - PubMed
Williams 2004 {published data only}
    1. Williams A, Adams E, Tincello D, Alfirevic Z, Richmond D. Randomised controlled trial of third degree perineal tear: medium term outcome (abstract). Proceedings of the International Continence Society UK 11th annual scientific meeting. 2004:33‐4. [17174]

Additional references

Andrews 1964
    1. Andrews J, Nathan P. Lesions of the anterior frontal lobes and disturbances of micturition and defecation. Brain 1964;87:233‐62. - PubMed
Burnstock 1990
    1. Burnstock G. Innervation of bladder and bowel. Ciba Foundation Symposium 1990;151:2‐18, 18‐26. - PubMed
Byar 1976
    1. Byar DP, Simon RM, Friedewald WT, Schlesselman JJ, DeMets DL, Ellenberg JH, et al. Randomized clinical trials. Perspectives on some recent ideas. New England Journal of Medicine 1976;295(2):74‐80. - PubMed
Chen 1998
    1. Chen ASH, Luchtefeld MA, Senagore AJ, Mackeigan JM, Hoyt C. Pudendal nerve latency. Does it predict outcome of anal sphincter repair. Diseases of the Colon and Rectum 1998;41(8):1005‐9. - PubMed
Counihan 2005
    1. Counihan TC, Madoff RD. Faecal incontinence. In: Fazio VW, Church JM, Delaney CP editor(s). Current therapy in Colon and Rectal Surgery. 2nd Edition. Philadelphia: Elsevier Mosby, 2005:105‐12.
de Groat 1990
    1. Groat WC. Central neural control of the lower urinary tract. Ciba Foundation Symposium 1990;151:27‐44, 44‐56. - PubMed
EUCTR 2010
    1. Anonymous. Skeletal muscle‐derived cell implantation for the treatment of fecal incontinence: a multicentre, randomized, double‐blind, placebo controlled, parallel, dose‐finding clinical study . EU Clinical Trials Register 2011. [EUCTR2010‐021463‐32‐AT]
Felt‐Bersma 1997
    1. Felt‐Bersma RJF, Poen AC, Cuesta MA, Meuwissen SGM. Anal sensitivity test; what does it measure and do we need it. Cause or derivative of anorectal complaints. Diseases of the Colon and Rectum 1997;40(7):811‐6. - PubMed
Fernando 2006b
    1. Fernando RJ, Sultan AHH, Kettle C, Thakar R, Radley S. Methods of repair for obstetric anal sphincter injury. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD002866.pub2] - DOI - PubMed
Ghahramani 2013
    1. Ghahramani. Evaluation of efficacy of preoperative biofeedback therapy before sphincteroplasty ‐ levatorplasty for fecal incontinence management due to obstetric trauma. Iranian Registry of Clinical Trials 2013.
Guttierez 2004
    1. Guttierez AB, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long‐term results of anterior sphincteroplasty. Disease of the Colon and Rectum 2004;47:727‐32. - PubMed
Halverson 2002
    1. Halverson AJ, Hull TL. Long‐term outcome of overlapping anal sphincter repair. Diseases of the Colon and Rectum 2002;45:345‐8. - PubMed
Higgins 2008
    1. Higgins JPT, Green S. [Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008].]. In: Higgins JPT, Green S editor(s). The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org. Oxford: Update Software, 2008.
Integrated continence service 2000
    1. Bladder and Bowel Foundation. Making the case for an integrated continence service. Bladder and Bowel Foundation 2000.
ISRCTN88559475
    1. Horrocks E, Knowles C. Control of faecal incontinence using distal neuromodulation. ISRCTN Register 2011. [ISRCTN8855975]
Johanson 1996
    1. Johanson JF, Lafferty J. Epidemiology of faecal incontinence: the silent affliction. American Journal of Gastroenterology 1996;91(1):33‐6. - PubMed
Kalantar 2002
    1. Kalantar JS, Howell S, Talley NJ. Prevalence of faecal incontinence and associated risk factors; an under‐diagnosed problem in the Australian community?. Medical Journal of Australia 2002;176:54‐7. - PubMed
Kamm 1998
    1. Kamm MA. Faecal incontinence. BMJ 1998;316(7130):528‐32. - PMC - PubMed
Keating 1997
    1. Keating JP, Stewart PJ, Eyers AA, Warner D, Bokey EL. Are special investigations of value in the management of patients with fecal incontinence?. Diseases of the Colon and Rectum 1997;40(8):896‐901. - PubMed
Lam 1999
    1. Lam TCF, Kennedy ML, Chen FC, et al. Prevalence of Faecal incontinence: obstetric and constipation‐related risk factors; a population‐based study. Colorectal Disease 1999;1:197‐203. - PubMed
MacArthur 1997
    1. MacArthur C, Bick DE, Keighley MR. Faecal incontinence after childbirth. British Journal of Obstetrics and Gynaecology 1997;104:46‐50. - PubMed
Maeda 2009
    1. Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD007959.pub3] - DOI - PMC - PubMed
Malouf 2000
    1. Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long‐term results of overlapping anterior anal‐sphincter repair for obstetrical trauma. Lancet 2000;355:260‐5. - PubMed
Mellgren 1999
    1. Mellgren A, Jenson LL, et al. Long‐term cost of fecal incontinence secondary to obstetric injuries. Diseases of the Colon and Rectum 1999;42(7):857‐65. - PubMed
Michot 2012
    1. Michot F. Myoblast for anal incontinence. ClinicalTrials.gov 2012. [NCT01523522]
Mowatt 2007
    1. Mowatt G, Glazener CMA, Jarrett M. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD004464.pub2] - DOI - PubMed
Nakayama 1997
    1. Nakayama H, Jorgensen HS, Pederson PM, Raaschou HO, Olsen TS. Prevalence and risk factors of Incontinence after stroke. The Copenhagen stroke study. Stroke 1997;28(1):58‐62. - PubMed
NCT01044589 2010
    1. Anonymous. Comparison of the efficacy of a biological implant to reinforce overlapping sphincter repair versus overlapping sphincter repair alone. ClinicalTrials.gov 2010. [NCT01044589]
Nelson 1995
    1. Nelson R, Norton N, Cautley E, Furner F. Community‐based prevalence of anal incontinence. JAMA 1995;274(7):559‐61. - PubMed
Norderval 2012
    1. Norderval S, Rydningen M. A blinded randomized controlled clinical trial comparing sacral nerve modulation and anal bulking injections as treatment for fecal incontinence after obstetric anal sphincter injuries (OASIS). ClinicalTrials.gov 2012. [NCT01528995]
Parellada 1998
    1. Parellada CM, Miller AS, Williamson MER, Johnston D. Paradoxical high anal resting pressures in men with idiopathic fecal seepage. Diseases of the Colon and Rectum 1998;41(5):593‐7. - PubMed
Parks 1975
    1. Parks AG. Anorectal incontinence. Proceedings of the Royal Society of Medicine 1975;68:681‐90. - PMC - PubMed
Perry 2002
    1. Perry S, Shaw C, Varma MG, et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002;50:480‐4. - PMC - PubMed
Pescatori 2004
    1. Pescatori M. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. British Journal of Surgery 2004;91:1559‐69. - PubMed
Pfeifer 1997
    1. Pfeifer J, Salanga VD, Agachan F, Weiss EG, Wexner SD. Variation in pudendal nerve terminal motor latency according to disease. Diseases of the Colon and Rectum 1997;40(1):79‐83. - PubMed
Rainey 1990
    1. Rainey JB, Donaldson DR, Thompson JPS. Postanal repair: which patients derive most benefit?. Journal of the Royal College of Surgeons of Edinburgh 1990;35:101‐5. - PubMed
Rockwood 2000
    1. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrontonis SC, Thorson AG, et al. Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Diseases of the Colon and Rectum 2000;43:9‐16. - PubMed
Ryhammer 1997
    1. Ryhammer AM, Laurberg S, Hermann AP. Test‐retest repeatability of anorectal physiology tests in healthy volunteers. Diseases of the Colon and Rectum 1997;40(3):287‐92. - PubMed
Setti Carraro 1994
    1. Setti Carraro P, Kamm MA, Nicholls RJ. Long‐term results of postanal repair of neurogenic faecal incontinence. British Journal of Surgery 1994;81(1):140‐4. - PubMed
Siproudhis 2006
    1. Siproudhis L, Pigot F, Godeberge P, et al. Defecation disorders: A French population survey. Diseases of the Colon and Rectum 2006;49:219‐27. - PubMed
Sun 1990
    1. Sun WM, Read NW, Miner PB. Relation between rectal sensation and anal function in normal subjects and patients with fecal incontinence. Gut 1990;31(9):1056‐61. - PMC - PubMed
Takahashi 2002
    1. Takahashi T, Garcia‐Osogobio S, Valdovinos MA, Mass W, Jimenez R, Jauregui LA, et al. Radio‐frequency energy delivery to the anal canal for the treatment of fecal incontinence. Diseases of the Colon and Rectum 2002;45:915‐22. - PubMed
Tou 2008
    1. Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD001758.pub2] - DOI - PubMed
Turnberg 1995
    1. Turnberg L, Brocklehurst J, Fowler C, Borzyskowski M, Cardozo L, Chellingsworth M, et al. Incontinence. Causes, management and provision of services. May. London: The Royal College of Physicians, 1995.
Uher 1998
    1. Uher EM, Swash M. Sacral reflexes physiology and clinical application. Diseases of the Colon and Rectum 1998;41(9):1165‐77. - PubMed
Vaizey 1998
    1. Vaizey CJ, Kamm MA, Nicholls RJ. Recent advances in the surgical treatment of faecal incontinence. British Journal of Surgery 85;5:596‐603. - PubMed
Ware 1993
    1. Ware JE, Snow KK, Kosinski M, Gandek B. SF‐36 Health Survey Manual and Interpretation Guide. Boston: New England Medical Centre, 1993.
Whitehead 2009
    1. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009;137(2):512‐7. - PMC - PubMed
Wong 2011
    1. Wong MTC, Meurette G, Stanherlin P, Lehur PA. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence . Diseases of the Colon and Rectum 2011;54:773‐9. - PubMed
Zigmond 1983
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983;67:361‐70. - PubMed

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