[in Japanese]

View full abstract

In the last years several techniques have been developed to help patients with severe fecal incontinence. It is important to determine the severity of incontinence. Severity is determined by the frequency the volume and consistency of the faeces that is lost. Soiling or staining of the underwear is no real incontinence.
Real incontinence is uncontrolled loss of real faeces. The loss of solid faeces is seen as more severe in all grading systems, but for the patient the loss of diarrhea forms a bigger handicap.
In case of loss of diarrhea it is important first to treat the diarrhea before diagnostic tools are used to look at the sphincters, pelvic floor or rectal capacity. For the determination of the cause of incontinence, several diagnostic tools are used, like anamnesis, physical examination, anal manometry, defae-cography, endosonography, electrophysiology and sometimes MRI and endoscopy. These investiga-tions make clear whether the anal sphincter and pelvic floor are anatomically intact, whether they are functional and what the capacity of the rectum is. In case of an intact pelvic floor and sphincter many patients can be helped with biofeedback therapy. When the result is insufficient, sacral nerve stimulation can give a solution. Sacral Nerve Stimulation can be given first as a test with the help of percutaneous electrodes that are inserted through the foramina of S3 or S4. These electrodes are connected with an external stimulator. The correct location can be found by motoric signs like contraction of the pelvic floor and sphincter or a sensation of twinkling around the anus. When the patient becomes continent during the time of the test which is normally three weeks, the percutaneous electrodes can be removed and an operation will follow and a definite electrode is implanted and connected to an im-planted neurostimulator. The results of sacral nerve stimulation are 84% so far. In case of a rupture of the sphincter the first option remains an anal repair. In about 70% of the cases this will lead to continence. When the patient remains incontinent, there are two other options. An artificial bowel sphincter or a dynamic graciloplasty. An artificial bowel sphincter consists of a cuff placed around the anus with a pressure regulating balloon that keeps the cuff inflated by its own tension. To allow the patient to defecate, the fluid of the cuff can be pumped back to the balloon and the anal canal enwidens to allow defecation. A dynamic graciloplasty is a modification of the conventional graciloplasty. Electrodes are implanted in the muscle and connected to an electrical stimulator that keeps the muscle contracted. By switching the stimulator off, the muscle can relax and defaecation is possible. Success rates of ABS and DGP are 70-80%. When nothing seems to be successful, there always remains the possibility of a colostomy.

View full abstract

[in Japanese]

View full abstract

Mainly by combining T.C.M. with the western medicine. 22, 500 constipation out-patients, 1031 in-patients have been treated. Colo-Proctological dynamics examinations including 11032 defecographs, 5324 colon transmit tests, 652 anorectal manometry. 648 pelvic E.M.G in ten years. As to the kinds of diseases in the out-patients, it is difficult to exactly classify and count. The conditions of the 1031 in-patients are as follows.
Rectocele 404 patients were rectocele patients. Methods of treatment: (1) transrectum repairment; (2) transvagina repairment and (3) through biomechanic research, we recognized the pathophysiology of the bowel movement obstruction and the cause of the faces thinning in the rectocele. Anismus 374 patients were anismus. Methods of treatment: (1) biofeedback therapy; (2) medical herbs acupuncture; (3) incision and seton therapy
Prolapse of rectum 100 patients were prolapse of rectum. Methods of treatment: (1) medical herbs; (2) double layers injection with medical herbs solutions; (3) ligation therapy; (4) Dixon's operation (re-built pelvic floor)
Slow transmit colon 97 patients were slow transmit colon. Methods of treatment: (1) medical herbs and acupuncture; (2) Cisapride and fibre; (3) subtotal colonectomy
Rectal endometriosis 17 patients were rectal endometriosis. Methods of treatment: (1) medical herbs; (2) rectal surgery
Stricture of anal canal 16 patients were stricture of anal canal. Methods of treatment: (1) incision with seton and dilatation therapy; (2) V-Y plastica
Enterocele 10 patients were enterocele. Local large intestinectomy
Spastic internal sphincter 9 patients were spastic internal sphincter. Methods of treatment: (1) anal dilatation; (2) internal sphincteroctomy
Megacolon 4 patients were megacolon. Local large intestinectomy
Research orientation : Set the outlet obstruction constipation diagnosis standard and search after new non-operation therapy and microsurgery.

View full abstract