GENERAL SURGERY

 

The dynamic continence challenge - a simple test to predict faecal continence before colostomy closure

 

 

M Brand^I; G J Oettle^II

^IMB ChB, FCS (SA), MRCS, MMed (Surg). Department of Surgery, University of the Witwatersrand, Johannesburg
^IIMB BCh, FRCS (Edin). Department of Surgery, University of the Witwatersrand, Johannesburg

Correspondence

 

 

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ABSTRACT

BACKGROUND: A common problem in clinical practice is predicting whether a patient will be continent after treatment of a severe perineal injury. Several tests have been described. Anal manometry is unreliable; continence can be normal with low pressures, and poor with high or normal pressures. Endo-anal ultrasound only illustrates anatomical sphincter integrity. The saline continence test involves the quite unphysiological instilling of saline into the rectum, and assessing seepage. What is needed in the prediction of continence is a normal stool simulator.
METHOD: We propose the use of powdered instant mashed potato reconstituted with water to the consistency of faeces. About 100 - 150 ml is introduced into the rectum using a catheter-tipped syringe. The patient is instructed to walk around for half an hour. On return the underwear is examined for any soiling. If there is no leakage the colostomy may be reversed.
RESULTS: Over the past 15 years, 53 patients have undergone this test. In 47 patients there was no leakage, all had their stomas reversed, and none was incontinent during follow-up.
CONCLUSION: The dynamic continence challenge is an accurate physiological test that allows clinicians to simulate the effects of colostomy reversal and assess a patient's continence before actually proceeding to the reversal.

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REFERENCES

1. Cummings JH, Bingham SA, Heaton KW, Eastwood MA. Fecal weight, colon cancer risk, and dietary intake of nonstarch polysaccharides (dietary fiber). Gastroenterology 1992;103(6):1783-1789.         [ Links ]

2. Oettle GJ, Segal I. Bowel function in an urban black African population. Dis Colon Rectum 1985;28(10):717-720.         [ Links ]

3. Burkitt DP, Walker ARP, Painter NP. Effect of dietary fibre on stools and transit times, and its role in causation of disease. Lancet 1972;2(7792):1408-1412.         [ Links ]

4. Parés D, Duncan J, Dudding T, Phillips RKS, Norton C. Investigation to predict faecal continence in patients undergoing reversal of a defunctioning stoma (porridge enema test). Colorectal Dis 2008;10(4):379-385.         [ Links ]

5. Read NW, Harford WV, Schmulen AC, Read MG, Santa Ana C, Fordtran JS. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 1979;76(4):747-756.         [ Links ]

6. Matheson DM, Keighley MR. Manometric evaluation of rectal prolapse and faecal incontinence. Gut 1981;22(2):126-129.         [ Links ]

7. Hallan RI, Marzouk DEMM, Waldron DJ, Womack NR, Williams NS. Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 1989;78:973-975.         [ Links ]

8. O'Kelly TJ, Mortensen NJ. Tests of anorectal function. Br J Surg 1992;76(9):988-989.         [ Links ]

9. Hill J, Corson RJ, Brandon H, Redford J, Faragher EB, Kiff E. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum 1994;37(5):473-477.         [ Links ]

10. Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Eur J Surg 1994;160(3):167-174.         [ Links ]

11. Williams N, Barlow J, Hobson A, Scott N, Irving M. Manometric asymmetry in the anal canal in controls and patients with fecal incontinence. Dis Colon Rectum 1995;38(12):1275-1280.         [ Links ]

12. Roberts PL, Coller JA, Schoetz DJ, Veidenheimer MC. Manometric assessment of patients with obstetric injuries and fecal incontinence. Dis Colon Rectum 1990;33(1):16-20.         [ Links ]

13. Bartram CI, Frudinger A. Handbook of Anal Endosonography. Petersfield, Hants: Wrightson Biomedical Publishers, 1997.         [ Links ]

14. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993;329(26):1905-1911. [http://dx.doi.org/10.1056/NEJM199312233292601]        [ Links ]

15. Bharucha AE. Update of tests of colon and rectal structure and function. J Clin Gastroenterol 2006;40(2):96-103.         [ Links ]

16. Terra MP, Stoker J. The current role of imaging techniques in faecal incontinence. Eur Radiol 2006;16(8):1727-1736.         [ Links ]

17. Henry MM, Swash M. Coloproctology and the Pelvic Floor. London: Butterworth, 1989.         [ Links ]

 

 

Correspondence:
M Brand
(martinbrand78@gmail.com)