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Tarlov, or perineural cysts, are lesions of the nerve root usually located at the sacral level of the spine. Their cause is unclear. These cysts are generally identified as an incidental finding and are usually asymptomatic. Symptomatic cysts are infrequent, with symptoms usually consisting of pain, radiculopathy and, less frequently, bladder, bowel and sexual dysfunction. We report the case of a 70-year-old woman with Tarlov cyst, provoking faecal incontinence, and review the aetiology, pathophysiology and management of this particular case., (Copyright © 2019 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The main aim of this study was to assess the efficacy of percutaneous posterior tibial nerve electrostimulation (P-PTNS) in urge urinary incontinence (UUI) and faecal incontinence (FI) refractory to first-line treatment. A secondary aim was to identify predictors of treatment response. To do this, we performed a 2-year analytical, longitudinal and prospective study in patients with UUI and FI treated with P-PTNS., Material and Methods: We included patients with UUI and FI who were treated with P-PTNS and who completed the bladder/faecal incontinence diary and severity and quality of life questionnaires. We excluded patients with neurogenic UUI and those who abandoned treatment or did not complete the questionnaires. We assessed demographic and clinical variables (micturition/defecation habits pre- and postreatment), severity scales before and after treatment (ICIQ-SF, Sandvick and Wexner), subjective improvement and quality of life (IQOL and FIQL pre- and postreatment). The statistical analysis was conducted using SPSS v19., Results: The sample consisted of 21 patients divided into 2 groups: -UUI group, 9 patients. After P-PTNS, there was a statistically significant improvement in diurnal (p=.018) and nocturnal (p=.016) urinary frequency, urgencies/day (p=.018), urine leakage/day (p=.027), ICIQ-SF and Sandvick (p=.018), and IQOL (p=.012). This improvement was related to exercise (p=.039) and prolapse (p=.05). -Group FI, 12 patients. After P-PTNS, there was a statistically significant improvement in defecation frequency (p=.027), incontinence (p=.012), Wexner scale (p=.007), and FIQL in its 4 dimensions (lifestyle, behaviour, embarrassment p=.005; and depression p=.008). This improvement was related to age (p=.048), time since onset (p=.044) and prolapse (p=.026)., Conclusions: The P-PTNS is effective in UUI and FI refractory to conventional treatment. Treatment response is affected by several factors., (Copyright © 2019 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI)., Materials and Methods: Children with functional constipation, aged 4 to 17years, that underwent ARM were included in the study., Results: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135ml of air as the maximum tolerance sensation for distinguishing children with RFI., Conclusions: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation., (Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Introduction and Aims: Fecal incontinence is a disabling condition with devastating consequences for the patients. Medical and surgical options are not very satisfactory, reason by which regenerative medicine has been considered in this field. In the present research, we analyzed functional and histologic effects after implanting pluripotent stem cells (PSCs) in a murine model with sphincterotomy., Materials and Methods: Female Wistar rats were subjected to sphincterotomy and divided into three groups. Group 1 (control group) was treated with 300μL of balanced saline solution and group 2 (late treatment) and group 3 (early treatment) received 50,000 PSCs resuspended in 300μL of balanced saline solution. All animals were evaluated through high-resolution anorectal manometry 24hours before and after sphincterotomy and every month for three months. Finally, the rats were euthanized and histopathologic sections from the anal canal were obtained., Results: All groups showed a decrease in resting anal pressure and squeeze anal pressure 24hours after sphincterotomy. At the third month, higher anal pressures in the groups treated with PSCs were detected. Regarding the histologic effects, the microscopic architecture was restored and there was a significant decrease in the inflammatory response in the groups treated with PSCs., Conclusion: PSCs implantation improves anal tone, as well as histologic structure, presenting better regenerative results when implanted as early treatment., (Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Background: Fecal incontinence is defined as an involuntary bowel movement through the anal canal in inadequate time and place. There are different types of therapies for the management of fecal incontinence, being biofeedback therapy one of the most effective techniques. The aim of this study was to evaluate the necessary number of sessions of biofeedback electromyographyc therapy to achieve the maximum sphincteric complex contraction., Methods: Descriptive, retrospective and longitudinal study. 65 patients with fecal incontinence were included. Weekly electromyographyc biofeedback therapies were applied, with a maximum of 6, in which the sphincteric complex contraction was measured. A two ways Friedman analysis was made to determine the significant differences between the sessions., Results: A total of 65 patients were evaluated for fecal incontinence. The values for pelvic floor contraction were significantly higher in the third session, and did not show any significant difference in posterior sessions., Conclusion: The maximum contraction of the sphicnteric complex was achieved in the third weekly biofeedback session, without any significant differences in the posterior sessions.

Objective: to evaluate the average resulting area from the Pressure x Time curves resulting from the manometric anorectal exam and compare it with the support capacity of voluntary squeeze., Materials and Methods: the data set was represented by data from 11 exams from continent patients and eight exams from patients with grade III fecal incontinence. The manometric curves were delineated, and the areas and support capacity of voluntary squeeze calculated, by means of the R computer language and the algorithm developed., Results: the resulting averages for support capacity of voluntary squeeze in continent patients and patients with grade III fecal incontinence were 33.07 seconds and 30.76 seconds (p>0.05) and the averages for area were 2362.04 mmHg x second and 947.92 mmHg x second (p<0.05), respectively., Conclusion: the average resulting area is able to differentiate continent patients from incontinent and is shown to be a possible parameter in the analysis of biomechanical behavior related to the mechanisms of anorectal continence.

Introduction: Fecal incontinence is a complex disease that affects the quality of life of patients suffering from it. Anorectal manometry and endoanal ultrasound 360 grades are included among the studies used. There are no clear agreement about the relevance and usefulness of this studies and their role as apart of diagnostic procedures., Objective: To describe the relationship between the clinical severity score in patients with fecal incontinence and the findings of anorectal manometry and endoanal ultrasound. Another objective of this study is to describe the degree of agreement of both methods of study., Material and Methods: The study population includes 74 patients who underwent endoanal ultrasonography and anorectal manometry for fecal incontinence. The presence or absence of ultrasound injury, the pressures obtained by anorectal manometry and its relationship with clinical severity of patients were described. An analysis of the degree of agreement between both methods was performed., Results: The mean age of patients was 53 years old (range 19-84 years). Pressures of anorectal manometry were reduced in 59 patients (79.7%) and normal in 15 (20.3%). The assessment of the degree of agreement or concordance between ultrasound and anorectal manometry yielded a kappa coefficient of 0.25 (acceptable) (P = 0.0001)., Conclusion: There is a level of acceptable agreement between endoanal ultrasound findings and anorectal manometry when patients with fecal incontinence are evaluated.

Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009., (Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.)

Purpose: To describe the findings obtained with magnetic resonance imaging (MRI) in patients with ano-rectal atresia, after treatment by posterior sagittal anorectoplasty (PSARP), who have fecal incontinence and to describe its usefulness in the evaluation of causes of incontinence., Subject and Methods: Twelve patients, 9 men and 3 women, with anorectal atresia were examined with 0.5T MRI after performing PSARP for imperforate anus. The study included T1-weighted, T2-weighted and proton-density, axial, sagittal and coronal planes. The location of descended neorectus and the degree of development of pelvic musculature were evaluated., Results: Normal development of anus levator muscles and sphincterian complex were observed in six patients, with correct situation of neorectus between anus levator muscles and sphincterian complex in five of them and eccentric in the other one. Diverse grades of striate muscular complex underdevelopment were showed in the other six cases, moderate grade in four of them and severe hypoplasia in the other two. Spinal and urogenital congenital anomalies were found in these patients. Sagittal and coronal T1-weighted MR images were the most useful planes in evaluating the relationship between anus levator muscles and sphincterian complex and axial T1-weighted MR images in the evaluation of the level of development of striated muscle complex in the evaluation of patients., Conclusions: MRI is useful in the evaluation of patients with fecal incontinence after performing PSARP for anorectal atresia. Unsuitable neorectus position or striated muscle complex hypoplasia are causes of postoperative incontinence in these patients.

Fecal incontinence (FI), defined as the recurrent uncontrolled passage of fecal material due to the inability to control bowel discharge is a common and devastating condition. According to previous studies, at least 1 in 10 adult women have FI. This disorder poses a significant economic burden and has a negative impact on patient's lifestyle, leads to a loss of self-confidence, social isolation and a diminished quality of life. Three subgroups of FI are recognized: a) passive incontinence: the involuntary discharge of stool or gas without awareness; b) urge incontinence: the discharge of fecal matter in spite of active attempts to retain bowel contents, and c) fecal seepage: the involuntary leakage of small volumes of stool after normal evacuation. Disruption of the normal structure or function of the anorectal unit leads to FI and is often due to multiple mechanisms. A detailed history and examination including digital rectal examination facilitates diagnosis. Anorectal physiological tests provide useful information regarding functional abnormalities and anal endosonography regarding sphincter defects. These tests provide insights regarding pathophysiology and can guide further management. Behavioral therapy is successful in most patients and should be offered first. Surgical treatment should be considered in cases who fail medical treatment or with sphincter defects. Several experimental approaches, including bulking of the anal sphincter, sacral nerve stimulation and the delivery of radiofrequency energy to the anal canal are under investigation.

Objective: to demonstrate the role of the clinical, anorectal manometry and surface electromyography in the assessment of patients with fecal incontinence., Patients and Methods: ninety-three patients with fecal incontinence are retrospectively reviewed and the data obtained from the directed clinical history, physical examination of the anal region, digital rectal examination, anorectal manometry and surface electromyography are analyzed. A treatment was administered in accordance with the alterations encountered and the results evaluated at 3 and 12 months., Results: fecal incontinence was predominant (91.4%) in women age 59.7+/-11. A background of obstetric risks (48.2%) was frequent in women. Also, 73.1% of the patients presented diarrhea. The anorectal manometry (ARM) demonstrated some alterations in 90.3% of the patients, whereas a hypotonic sphincter was the most common finding (85.7%). Rectal sensitivity or distensibility alterations were present in the rest of the patients. In 79.2% ofthe cases, hypotonic sphincter was associated with rectal sensitivity or distensibility alterations. In 65.2% of patients with hypotonic external anal sphincter, damage of the pudendal nerve was found and therefore biofeedback was indicated in 41.9% of them., Conclusions: the clinical study of the patients, together with the anorectal manometry and surface electromyography enables the identification of the cause of FI and its treatment. These studies demonstrate that in most cases the origin of the incontinence is due to multiple etiologies, however the treatment of some of the factors involved frequently improves the symptomatology.

Miction and defecation disturbances are very frequent in the general population and far more so among neurological patients. It is essential to know the physiopathology of these disorders in clinical practice. The neurological control of these functions is carried out by automatisms that are regulated in the nuclei of the brain stem through somatic and vegetative peripheral structures that act simultaneously. The cortical, hypothalamic and reticular levels play a part in the activation or inhibition of the pontine nuclei. Continence depends on the integrity of the anatomical structures and the sensory, pressure and mechanical systems that enable the automatisms to develop. Neurological examination must be combined with studies conducted by other specialists on patients in which no neurological illness is known, but who have this kind of dysfunction. Adding a neurophysiological examination allows us to complete the clinical study and to check objectively for the existence of external anal sphincter denervation or disorders involving the exteroceptive reflexes of the sacrum. The recent appearance of techniques for treating incontinence that make use of the repeated and continuous stimulation of the sacral roots has revolutionised the way these patients are treated and calls for greater involvement of neurologists in dealing with these problems.

Aims: A study is made of the alterations in anorectal physiology among rectal prolapse patients, evaluating the differences between fecal continent and incontinent individuals., Patients and Methods: Eighteen patients with complete rectal prolapse were divided into two groups: Group A (8 continent individuals) and Group B (10 incontinent women), while 22 healthy women were used as controls (Group C). Clinical exploration and perineal level measurements were performed, along with anorectal manometry, electrophysiology, and anorectal sensitivity to electrical stimuli., Results: The main antecedents of the continent subjects were excess straining efforts, while the incontinent women presented excess straining and complex deliveries. Pathological perineal descent was a frequent finding in both groups, with a hypotonic anal canal at rest (p < 0.001 vs controls) and at voluntary squeezing (p < 0.001 vs controls). In turn, the incontinent patients exhibited a significantly lower anal canal pressure at rest than the continent women (p < 0.05). There were no significant differences between Groups A and C in terms of pudendal motor latency, though latency was significantly longer in Group B than in the controls (p < 0.01). Moreover, pudendal neuropathy was more common, severe and often bilateral in Group B. There were no differences in rectal sensation to distention or in terms of the volumes required to relax the internal anal sphincter. In turn, both prolapse groups exhibited diminished anal canal and rectal sensitivity to electrical stimuli., Conclusions: Patients with rectal prolapse exhibit a hypotonic anal canal at rest, regardless of whether they are continent to feces or not. Continent patients have less pudendal neuropathy and therefore less pressure alterations at voluntary sphincter squeeze than incontinent individuals.

Objective: Classically, clinical assessment of faecal incontinence is supported by anal manometry and electromyography. Recently, anal endosonography has appeared to be the ideal method evaluating anatomically both the internal and external anal sphincter. In this paper, our experience in evaluating faecal incontinence by anal endosonography is presented., Patients: 34 patients (26 female, 4 male; mean age, 40) complaining of faecal incontinence were analysed by traditional anorectal physiologic tests as well as by anal endosonography. Previously, patients were clinically grouped in: group 1, post-delivery, 18 cases; group 2, post-surgery, 6 cases; group 3, "idiopathic", 10 cases., Results: Results of anal physiologic test showed significant differences between group 1 and the rest of patients. All patients complaining of post-surgery incontinence were found to have sphincter disruptions. 2 out of 10 patients from group 3 presented unsuspected lesions. Nearly 40% of women with post-delivery incontinence had normal anal muscles., Conclusions: Anal endosonography is a imaging technique that permits fully vision of the sphincters. It showed to be a great help in cases of faecal incontinence particularly in the decision-making of surgical approach.

Four hundred and thirty seven consecutive patients with problems of motility were referred to, and examined at our third-level unit from 1987 to 1993. Forty seven (mean age 36.3 +/- 3.8, range 5-76 years; 25 females) fulfilled the established criteria for fecal incontinence. The mean period of total incontinence was 55.4 +/- 7.6 months (range 6 months to 21 years), with episodes of incontinence of 2.4 +/- 0.2 (range 1-7 a day). All patients were asked to complete a questionnaire in order to validate the incontinence diagnosis. A complete clinical history was obtained from each patient, and they were given laboratory tests, barium enema, recto-sigmoidoscopy, rectal sensitivity tests, recto-anal manometry, and biofeedback without electronic equipment. Twenty one normal subjects were used as a control group. Patients with fecal incontinence showed less rectal sensitivity (P < 0.01). The spontaneous recto-anal inhibitory reflex was not present in all forty seven. All the patients that completed their treatment were completely cured in a period of 4 +/- 0.5 months (range 16 days to 15 months), and follow-up continued for one to eight years. To sum up, this new therapeutic approach is beneficial independent of age, duration and cause of incontinence. The treatment is patient-friendly and economical. Doctors have changed their attitudes, and the quality of life of the patient has improved dramatically, thus providing clinical signification, and proof of the validity and applicability of this treatment: using biofeedback without electronic equipment in the treatment of fecal incontinence.

The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.