Fecal Incontinence - Diagnosis and Treatment - C. Ratto, G. Dogglietto (Springer, 2007) WW.pdf

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Fecal Incontinence
Diagnosis and Treatment
Carlo Ratto • Giovanni B.Doglietto
Fecal Incontinence
Diagnosis and Treatment
Forewords by
A.C. Lowry
•
L. Påhlman
•
G. Romano
E
DITORS
C
ARLO
R
ATTO
Department of Surgical Sciences
Division of Digestive Surgery
Catholic University
Rome, Italy
G
IOVANNI
B
.
D
OGLIETTO
Department of Surgical Sciences
Division of Digestive Surgery
Catholic University
Rome, Italy
Library of Congress Control Number:
2007925057
ISBN
978-88-470-0637-9 Springer Milan Berlin Heidelberg New York
This work is subject to copyright. All rights are reserved, whether the whole or part of the material
is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
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of this publication or parts thereof is permitted only under the provisions of the Italian Copyright
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are liable to prosecution under the Italian Copyright Law.
Springer is a part of Springer Science+Business Media
springer.com
© Springer-Verlag Italia
2007
Printed in Italy
The use of general descriptive names, registered names, trademarks, etc. in this publication does
not imply, even in the absence of a specific statement, that such names are exempt from the relevant
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Product liability: The publishers cannot guarantee the accuracy of any information about dosage
and application contained in this book. In every individual case the user must check such
information by consulting the relevant literature.
Cover image: Simona Colombo, Milan, Italy
Typesetting: Compostudio, Cernusco s/N, Italy
Printing: Arti Grafiche Nidasio, Assago, Italy
Springer-Verlag Italia S.r.l., Via Decembrio
28,
I-20137 Milan, Italy
Foreword
by Ann C. Lowry
Several years ago, the American media presented urinary incontinence as the “last clos-
et issue”. Arguably, that designation really belongs to fecal incontinence. Even today, on-
ly a third of patients suffering with the condition discuss it with their physicians. This is
particularly unfortunate, as the condition affects a significant portion of the population
and is a significant burden to patients, their families, and society.
This situation exists for a number of reasons. The social stigma of incontinence of
stool is the primary reason. Early on, children are taught to avoid “bathroom talk”, and
that admonishment continues into adulthood. However, there are other reasons as well.
Continence of flatus and stool is an extremely complex process involving feces consis-
tency and transit time, the sensory capability of the rectum, and the neurological and
muscular function of the sphincter muscle. Despite years of research on the pathophys-
iology, it is hard to explain how a patient with an intact sphincter has daily episodes of
incontinence while a patient with a cloaca has none. Inconsistent presentations of the
condition make it baffling to health care providers. Partially because of the complexity of
the condition, a number of different providers are interested in fecal incontinence. Each
specialty focuses upon a different aspect of the disorder. For instance, pediatricians fo-
cus largely on congenital abnormalities associated with incontinence and treatment op-
tions applicable to children. Gerontologists concern themselves with the opposite age
spectrum, where the etiology and appropriate treatment options are different. In most
institutions, there is little communication among specialties about the disorder, which
limits progress in diagnosis and treatment. Finally, incontinence is not a life-threatening
process; there is thus less pressure to overcome the natural tendency of patients and
providers to avoid discussing the situation.
In view of all of the above, this book,
Fecal Incontinence: Diagnosis and Treatment,
is
a significant contribution to the medical profession. Discussion of all aspects of incon-
tinence is presented in a clear, concise manner. The contributors represent distinguished
experts from multiple disciplines and continents; these authors are the leaders and in-
novators in their fields. The book is especially timely, as understanding of the disorder
and treatment options have progressed significantly within the past few years.
In this one volume, the reader will find information about all elements of the inconti-
nence of stool, starting with the current understanding of continence and the patho-
physiology of incontinence. The burden of the illness on patients and their families, in-
cluding its economic and psychological consequences, is empathetically covered. Ap-
propriate diagnosis and evaluation is thoroughly reviewed. Traditional medical and sur-
gical treatment alternatives as well as innovative treatment options and their outcomes

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