Anale Inkontinenz

 

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Zusammenfassung

Aufgrund der höheren Lebenserwartung und eines gesteigerten Anspruchs an die Lebensqualität unserer Patienten, auch im Alter, rückt die anale Inkontinenz immer mehr in den Fokus der behandelnden Ärzte. Aufgrund der Beschwerden setzten sich verschiedene Fakultäten, wie Gynäkologen, Urologen, Chirurgen und Dermatologen, mit diesem Problem auseinander. Die Ursachen sind multifokal. Es handelt sich mehr um ein heterogenes Symptombild als um eine klar definierte Erkrankung. Betroffen sind überwiegend Frauen (5 : 1), insbesondere nach multiplen, schwierigen, prolongierten Geburten mit schweren Kindern. Aber auch chirurgische und gynäkologische Eingriffe, jahrelanges falsches Stuhlverhalten und der normale Alterungsprozess tragen zur Entstehung und Verschlechterung der analen Inkontinenz bei.

Ein therapeutischer Algorithmus hilft vom Einfachen zum Schweren hin zu behandeln. Zur Verbesserung der Situation sollte zunächst ein konservativer Therapieansatz gewählt werden. Zunächst sollte die Stuhlentleerung verbessert werden, um den Druck von dem eingeschränkt funktionsfähigen Verschlusssystem zu nehmen. Nachdem dieses erreicht ist, sollte versucht werden, mittels Beckenbodentraining und Biofeedbackübungen die Sensorik und Kontraktionsfähigkeit des Beckenbodens zu verbessern. Mit diesen einfachen Maßnahmen kann mehr als 80 % der Betroffenen geholfen werden. Die übrigen Patienten werden dann, wenn gewünscht, operativen Verfahren zugeführt. Es gilt hier zu entscheiden, ob eine Verbesserung oder Verstärkung des Schließmuskels im Vordergrund steht (Schließmuskelrekonstruktion/künstlicher Schließmuskel) oder eine neurogene Stimulation (SNS) zur Verbesserung des Halteapparates erfolgversprechender ist.

Abstract

Due to a higher life expectancy and an increased claim to the quality of life of our patients, also at a higher age, doctors focus more and more on anal incontinence. The causes for the incontinence are multifocal, therefore, different faculties, like gynecologists, urologists, surgeons and dermatologists work on this issue. It is rather a heterogeneous symptom picture than a clearly defined illness. Women (5 : 1) are concerned predominantly in particular after multiple, difficult, extended births with heavy children. But also surgical and gynecological interventions, many years of wrong stool behaviour and the normal ageing process contribute to the origin and deterioration of the anal incontinence.

A therapeutic algorithm leads from the easy to the severe. A conservative therapy beginning should be chosen. The stool emptying should be improved to take the pressure from the restrictedly functioning locking system. After this is reached, it should be tried to improve the sensory and contraction ability of the pelvic floor by means of pelvic floor training and biofeedback-exercises. With these easy measures more than 80 % of the affected patients can be helped. The remaining patients are supplied, if desired, to surgical procedures. The surgeon has to decide whether an improvement or strengthening of the sphincter is in the foreground (sphincter reconstruction/artificial bowl sphincter) or if a neurogenic stimulation (SNS) is the more promising procedure for the improvement of the pelvic floor.

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