Aim: The aim of this study was to elucidate the risk factors for fecal incontinence (FI) in women who have anal sphincter dysfunction.

Methods: The subjects of this study were women with anal sphincter dysfunction (maximum resting pressure: MRP < 45 mmHg and/or atmospheric maximum squeeze pressure: MSP < 130 mmHg) who visited Matsushima Hospital Coloproctology Center between January and April in 2019. They were divided into two groups: one with FI and one without, and independent risk factors for FI were retrospectively analyzed by comparing the two groups using multivariate analysis. In the FI group, changes in anal pressure and symptom score with treatment were also evaluated.

Results: The subjects were 221 women (median age: 75 years, interquartile range: 64-80 years), who were divided into the FI group (149 patients) and the No FI group (72 patients). There was no significant difference in MRP or MSP between the two groups. Bowel movements were more frequent, age was higher, and rectal prolapse & forceps delivery were more prevalent in the FI than in the No FI group, and these differences were all statistically significant. On multivariate analysis, bowel movements of twice or more per day and forceps delivery were identified as independent risk factors for FI. In 15 patients who were evaluated at 6-month follow-up, neither MRP nor MSP significantly changed following treatment, whilst symptom scores improved significantly.

Conclusion: In women with anal sphincter dysfunction, bowel movements of twice or more per day and forceps delivery were independent risk factors for FI.

Peristomal skin trouble, also called peristomal skin complications, is the most common stoma-related complication. Peristomal skin trouble not only makes stoma management difficult, causing symptoms such as itching and pain that impair patients’ quality of life, but also increases the financial burden due to the increased frequencies of ostomy appliance changes and readmissions. Without proper care in the early stages of peristomal skin trouble, it can easily become severe, not only causing physical pain, but often resulting in the inability to wear an ostomy appliance. Therefore, it is important to understand the risk factors for peristomal skin trouble and to detect it in the early stages to prevent its worsening. In addition, it is important to establish a stoma care and continuous follow-up system that provides reliable self-care guidance and social life-oriented stoma care. In this review article, we provide an overview of peristomal skin trouble, including its definition and pathophysiology, incidence and risk factors, appropriate stoma creation techniques for its prevention, assessment methods for its prevention and management, the effectiveness of assessment tools in the hospital setting, treatment options, and the importance of a team approach to care.

Background: Stoma prolapse is a common late complication of stomal construction. It is one of the most difficult complications to manage because it impairs a patient’s quality of life and rarely improves with conservative therapy. Surgical treatment is often required, but no standard treatment has been established to date. We report a case of loop transverse colon stoma prolapse repaired by a simple procedure.

Case: A 70-year-old man was referred to our department with rectal invasion and stenosis due to bladder cancer, and transverse loop colostomy was performed. Although stoma prolapse developed on the 5th day postoperatively, it was successfully repaired surgically with a modified Altemeier’s procedure, which is usually performed for rectal prolapse.

Discussion: This procedure can be performed from the original stoma hole as a simple, minimally invasive surgery. In addition, risk of intestinal necrosis and recurrence is considered low. Typically, the patient can resume stoma care soon after surgery.

Conclusion: This method should be considered as a useful treatment option for stomal prolapse.