The 2002 Official Patient's Sourcebook on Fecal Incontinence: A Revised and Updated Directory for the Internet Age

THE 2002 OFFICIAL PATIENT’S SOURCEBOOK

on

FECAL

INCONTINENCE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Fecal Incontinence: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83268-4 1. Fecal Incontinence-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of fecal incontinence.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to the study of fecal incontinence. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to fecal incontinence, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Appendicitis

·

The Official Patient's Sourcebook on Autoimmune Hepatitis

·

The Official Patient's Sourcebook on Bacteria and Foorborne Illness

·

The Official Patient's Sourcebook on Barrett's Esophagus

·

The Official Patient's Sourcebook on Celiac Disease

·

The Official Patient's Sourcebook on Cirrhosis of the Liver

·

The Official Patient's Sourcebook on Constipation

·

The Official Patient's Sourcebook on Crohn Disease

·

The Official Patient's Sourcebook on Cyclic Vomiting Syndrome

·

The Official Patient's Sourcebook on Diarrhea

·

The Official Patient's Sourcebook on Diverticular Disease

·

The Official Patient's Sourcebook on Gallstones

·

The Official Patient's Sourcebook on Gas

·

The Official Patient's Sourcebook on Gastritis

·

The Official Patient's Sourcebook on Gastroparesis

·

The Official Patient's Sourcebook on Hemolytic Uremic Syndrome

·

The Official Patient's Sourcebook on Hemorrhoids

·

The Official Patient's Sourcebook on Hepatitis a

·

The Official Patient's Sourcebook on Hepatitis B

·

The Official Patient's Sourcebook on Hepatitis C

·

The Official Patient's Sourcebook on Hiatal Hernia

·

The Official Patient's Sourcebook on Hirschsprung

·

The Official Patient's Sourcebook on Indigestion

·

The Official Patient's Sourcebook on Inguinal Hernia

·

The Official Patient's Sourcebook on Intestinal Pseudo-obstruction

·

The Official Patient's Sourcebook on Irritable Bowel Syndrome

·

The Official Patient's Sourcebook on Lactose Intolerance

·

The Official Patient's Sourcebook on Ménétrier

·

The Official Patient's Sourcebook on Pancreatitis

·

The Official Patient's Sourcebook on Peptic Ulcer

·

The Official Patient's Sourcebook on Porphyria

·

The Official Patient's Sourcebook on Primary Biliary Cirrhosis

·

The Official Patient's Sourcebook on Primary Sclerosing Cholangitis

·

The Official Patient's Sourcebook on Proctitis

·

The Official Patient's Sourcebook on Rapid Gastric Emptying

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·

The Official Patient's Sourcebook on Short Bowel Syndrome

·

The Official Patient's Sourcebook on Ulcerative Colitis

·

The Official Patient's Sourcebook on Whipple Disease

·

The Official Patient's Sourcebook on Wilson's Disease

·

The Official Patient's Sourcebook on Zollinger-ellison Syndrome

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents

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Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON FECAL INCONTINENCE: GUIDELINES ......................................... 9 Overview ....................................................................................................................................... 9 What Is Fecal Incontinence? ....................................................................................................... 11 Causes.......................................................................................................................................... 12 Diagnosis ..................................................................................................................................... 14 Treatment .................................................................................................................................... 14 What to Do about Anal Discomfort............................................................................................. 18 Emotional Considerations ........................................................................................................... 18 Everyday Practical Tips .............................................................................................................. 19 Fecal Incontinence in Children.................................................................................................... 19 Hope through Research................................................................................................................ 21 For More Information.................................................................................................................. 21 More Guideline Sources .............................................................................................................. 21 Vocabulary Builder...................................................................................................................... 28 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 33 Overview ..................................................................................................................................... 33 Associations and Fecal Incontinence ........................................................................................... 33 Finding More Associations ......................................................................................................... 35 Finding Doctors........................................................................................................................... 37 Selecting Your Doctor ................................................................................................................. 38 Working with Your Doctor ......................................................................................................... 39 Broader Health-Related Resources .............................................................................................. 40 Vocabulary Builder...................................................................................................................... 41 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 43 CHAPTER 3. STUDIES ON FECAL INCONTINENCE........................................................................... 45 Overview ..................................................................................................................................... 45 The Combined Health Information Database .............................................................................. 45 Federally-Funded Research on Fecal Incontinence...................................................................... 52 E-Journals: PubMed Central ....................................................................................................... 64 The National Library of Medicine: PubMed................................................................................ 65 Vocabulary Builder...................................................................................................................... 69 CHAPTER 4. PATENTS ON FECAL INCONTINENCE ......................................................................... 77 Overview ..................................................................................................................................... 77 Patents on Fecal Incontinence ..................................................................................................... 78 Patent Applications on Fecal Incontinence ................................................................................. 83 Keeping Current .......................................................................................................................... 84 Vocabulary Builder...................................................................................................................... 85 CHAPTER 5. BOOKS ON FECAL INCONTINENCE ............................................................................. 87 Overview ..................................................................................................................................... 87 Book Summaries: Federal Agencies ............................................................................................. 87 Book Summaries: Online Booksellers .......................................................................................... 89 The National Library of Medicine Book Index............................................................................. 93 Chapters on Fecal Incontinence................................................................................................... 96

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Contents Directories ................................................................................................................................. 100 General Home References .......................................................................................................... 101 Vocabulary Builder.................................................................................................................... 102 CHAPTER 6. MULTIMEDIA ON FECAL INCONTINENCE ................................................................ 107 Overview ................................................................................................................................... 107 Video Recordings....................................................................................................................... 107 Bibliography: Multimedia on Fecal Incontinence...................................................................... 109 Vocabulary Builder.................................................................................................................... 111 CHAPTER 7. PERIODICALS AND NEWS ON FECAL INCONTINENCE ............................................. 113 Overview ................................................................................................................................... 113 News Services & Press Releases ................................................................................................ 113 Newsletter Articles .................................................................................................................... 117 Academic Periodicals covering Fecal Incontinence ................................................................... 121 Vocabulary Builder.................................................................................................................... 124 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 125 Overview ................................................................................................................................... 125 NIH Guidelines ......................................................................................................................... 125 NIH Databases .......................................................................................................................... 126 Other Commercial Databases .................................................................................................... 129 The Genome Project and Fecal Incontinence ............................................................................. 130 Specialized References ............................................................................................................... 135 Vocabulary Builder.................................................................................................................... 135

PART III. APPENDICES .............................................................................................................. 137 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 139 Overview ................................................................................................................................... 139 Your Medications: The Basics ................................................................................................... 139 Learning More about Your Medications ................................................................................... 141 Commercial Databases............................................................................................................... 142 Contraindications and Interactions (Hidden Dangers)............................................................. 143 A Final Warning ....................................................................................................................... 144 General References..................................................................................................................... 145 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 147 Overview ................................................................................................................................... 147 What Is CAM? .......................................................................................................................... 147 What Are the Domains of Alternative Medicine? ..................................................................... 148 Can Alternatives Affect My Treatment?................................................................................... 151 Finding CAM References on Fecal Incontinence ...................................................................... 152 Additional Web Resources......................................................................................................... 162 General References..................................................................................................................... 163 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 165 Overview ................................................................................................................................... 165 Food and Nutrition: General Principles .................................................................................... 165 Finding Studies on Fecal Incontinence ..................................................................................... 170 Federal Resources on Nutrition................................................................................................. 173 Additional Web Resources......................................................................................................... 173 Vocabulary Builder.................................................................................................................... 174 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 177 Overview ................................................................................................................................... 177 Preparation ................................................................................................................................ 177 Finding a Local Medical Library ............................................................................................... 178 Medical Libraries Open to the Public ........................................................................................ 178 APPENDIX E. YOUR RIGHTS AND INSURANCE ............................................................................. 185 Overview ................................................................................................................................... 185

Contents

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Your Rights as a Patient............................................................................................................ 185 Patient Responsibilities ............................................................................................................. 189 Choosing an Insurance Plan...................................................................................................... 190 Medicare and Medicaid ............................................................................................................. 192 NORD’s Medication Assistance Programs............................................................................... 195 Additional Resources................................................................................................................. 196 ONLINE GLOSSARIES ............................................................................................................... 197 Online Dictionary Directories................................................................................................... 198 FECAL INCONTINENCE GLOSSARY..................................................................................... 199 General Dictionaries and Glossaries ......................................................................................... 214 INDEX.............................................................................................................................................. 216

Introduction

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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Fecal Incontinence

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Fecal Incontinence has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to fecal incontinence, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on fecal incontinence. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on fecal incontinence should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate

Introduction

3

options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching fecal incontinence (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to fecal incontinence. It also gives you sources of information that can help you find a doctor in your local area specializing in diagnosing and treating fecal incontinence. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with fecal incontinence. Part II moves on to advanced research dedicated to fecal incontinence. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on fecal incontinence. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with fecal incontinence or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with fecal incontinence. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with fecal incontinence.

Scope While this sourcebook covers fecal incontinence, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that fecal incontinence is often considered a synonym or a condition closely related to the following: ·

Functional Incontinence of Stool

·

Soiling

4

Fecal Incontinence

·

Stool Incontinence

In addition to synonyms and related conditions, physicians may refer to fecal incontinence using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for fecal incontinence:4 ·

307.7 encopresis

·

787.6 incontinence of feces

·

788.3 incontinence

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to fecal incontinence. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses and conditions. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.

4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

Introduction

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Why “Internet age”? All too often, patients with fecal incontinence will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with fecal incontinence is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of fecal incontinence, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on fecal incontinence. The essentials of a symptom typically include the definition or description of the symptom, a discussion of who it affects, the diseases that are associated with a given symptom, tests or diagnostic procedures that might be specific to the symptom, and treatments for the symptom. Your doctor or healthcare provider may have already explained the essentials of fecal incontinence to you or even given you a pamphlet or brochure describing fecal incontinence. Now you are searching for more indepth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

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CHAPTER 1. THE ESSENTIALS ON FECAL INCONTINENCE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on fecal incontinence. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on fecal incontinence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on fecal incontinence. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Fecal Incontinence

There is no guarantee that any one Institute will have a guideline on a specific condition or disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare conditions and disorders. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with fecal incontinence and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·

Division of Diabetes, Endocrinology, and Metabolic Diseases

·

Division of Digestive Diseases and Nutrition

·

Division of Kidney, Urologic, and Hematologic Diseases

The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6

Guidelines 11

Institute supports basic and clinical research through investigator-initiated grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on fecal incontinence.

What Is Fecal Incontinence?7 Fecal incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you can get to a toilet. Or stool may leak from the rectum unexpectedly. More than 6.5 million Americans have fecal incontinence. It affects people of all ages--children as well as adults. Fecal incontinence is more common in women than in men and more common in older adults than in younger ones. It is not, however, a normal part of aging. Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed, or humiliated. Some don’t want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced because treatment can improve bowel control and make incontinence easier to manage.

Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/fecalincon/fecalincon.htm. 7

12 Fecal Incontinence

Anatomy of the rectum and anus.

Causes Fecal incontinence can have several causes: ·

Damage to the anal sphincter muscles

·

Damage to the nerves of the anal sphincter muscles or the rectum

·

Loss of storage capacity in the rectum

·

Diarrhea

·

Pelvic floor dysfunction

Muscle Damage Fecal incontinence is most often caused by injury to one or both of the ringlike muscles at the end of the rectum called the anal internal and/or external sphincters. The sphincters keep stool inside. When damaged, the muscles aren’t strong enough to do their job, and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if the doctor uses forceps to help deliver the baby or does an episiotomy, which is a cut in the vaginal area to prevent it from tearing during birth. Hemorrhoid surgery can damage the sphincters as well.

Guidelines 13

Nerve Damage Fecal incontinence can also be caused by damage to the nerves that control the anal sphincters or to the nerves that sense stool in the rectum. If the nerves that control the sphincters are injured, the muscle doesn’t work properly and incontinence can occur. If the sensory nerves are damaged, they don’t sense that stool is in the rectum. You then won’t feel the need to use the bathroom until stool has leaked out. Nerve damage can be caused by childbirth, a long-term habit of straining to pass stool, stroke, and diseases that affect the nerves, such as diabetes and multiple sclerosis.

Loss of Storage Capacity Normally, the rectum stretches to hold stool until you can get to a bathroom. But rectal surgery, radiation treatment, and inflammatory bowel disease can cause scarring that makes the walls of the rectum stiff and less elastic. The rectum then can’t stretch as much and can’t hold stool, and fecal incontinence results. Inflammatory bowel disease also can make rectal walls very irritated and thereby unable to contain stool. Diarrhea Diarrhea, or loose stool, is more difficult to control than solid stool that is formed. Even people who don’t have fecal incontinence can have an accident when they have diarrhea.

Pelvic Floor Dysfunction Abnormalities of the pelvic floor can lead to fecal incontinence. Examples of some abnormalities are decreased perception of rectal sensation, decreased anal canal pressures, decreased squeeze pressure of the anal canal, impaired anal sensation, a dropping down of the rectum (rectal prolapse), protrusion of the rectum through the vagina (rectocele), and/or generalized weakness and sagging of the pelvic floor. Often the cause of pelvic floor dysfunction is childbirth, and incontinence doesn’t show up until the midforties or later.

14 Fecal Incontinence

Diagnosis The doctor will ask health-related questions and do a physical exam and possibly other medical tests. ·

Anal manometry checks the tightness of the anal sphincter and its ability to respond to signals, as well as the sensitivity and function of the rectum.

·

Anorectal ultrasonography evaluates the structure of the anal sphincters.

·

Proctography, also known as defecography, shows how much stool the rectum can hold, how well the rectum holds it, and how well the rectum can evacuate the stool.

·

Proctosigmoidoscopy allows doctors to look inside the rectum for signs of disease or other problems that could cause fecal incontinence, such as inflammation, tumors, or scar tissue.

·

Anal electromyography tests for nerve damage, which is often associated with obstetric injury.

Treatment Treatment depends on the cause and severity of fecal incontinence; it may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary for successful control since continence is a complicated chain of events.

Dietary Changes Food affects the consistency of stool and how quickly it passes through the digestive system. One way to help control fecal incontinence in some persons is to eat foods that add bulk to stool, making it less watery and easier to control. Also, avoid foods that contribute to the problem. They include foods and drinks containing caffeine, like coffee, tea, and chocolate, which relax the internal anal sphincter muscle. Another approach is to eat foods low in fiber to decrease the work of the anal sphincters. Fruit can act as a natural laxative and should be eaten sparingly. You can adjust what and how you eat to help manage fecal incontinence.

Guidelines 15

Keep a food diary. List what you eat, how much you eat, and when you have an incontinent episode. After a few days, you may begin to see a pattern between certain foods and incontinence. After you identify foods that seem to cause problems, cut back on them and see whether incontinence improves. Foods that typically cause diarrhea, and so should probably be avoided, include ·

Caffeine

·

Cured or smoked meat like sausage, ham, or turkey

·

Spicy foods

·

Alcohol

·

Dairy products like milk, cheese, and ice cream

·

Fruits like apples, peaches, or pears

·

Fatty and greasy foods

·

Sweeteners, like sorbitol, xylitol, mannitol, and fructose, which are found in diet drinks, sugarless gum and candy, chocolate, and fruit juices

Eat smaller meals more frequently. In some people, large meals cause bowel contractions that lead to diarrhea. You can still eat the same amount of food in a day, but space it out by eating several small meals. Eat and drink at different times. Liquid helps move food through the digestive system. So if you want to slow things down, drink something half an hour before or after meals, but not with the meals. Eat more fiber. Fiber makes stool soft, formed, and easier to control. Fiber is found in fruits, vegetables, and grains, like those listed below. You’ll need to eat 20 to 30 grams of fiber a day, but add it to your diet slowly so your body can adjust. Too much fiber all at once can cause bloating, gas, or even diarrhea. Also, too much insoluble, or undigestible, fiber can contribute to diarrhea. So if you find that eating more fiber makes your diarrhea worse, try cutting back to two servings each of fruits and vegetables and removing skins and seeds from your food. Eat foods that make stool bulkier. Foods that contain soluble, or digestible, fiber slow the emptying of the bowels. Examples are bananas, rice, tapioca, bread, potatoes, applesauce, cheese, smooth peanut butter, yogurt, pasta, and oatmeal.

16 Fecal Incontinence

Get plenty to drink. You need to drink eight 8-ounce glasses of liquid a day to help prevent dehydration and to keep stool soft and formed. Water is a good choice, but avoid drinks with caffeine, alcohol, milk, or carbonation if you find that they trigger diarrhea. Over time, diarrhea can rob you of vitamins and minerals. Ask your doctor if you need a vitamin supplement. What Foods Have Fiber?8 Breads, Cereals, and Beans 1/2 cup of black-eyed peas, cooked

4 grams

1/2 cup of kidney beans, cooked

5.5 grams

1/2 cup of lima beans, cooked

4.5 grams

Whole-Grain Cereal, Cold 1/2 cup of All-Bran

10 grams

3/4 cup of Total

3 grams

3/4 cup of Post Bran Flakes

5 grams

1 packet of whole-grain cereal, hot (oatmeal, Wheatena)

3 grams

1 slice of whole-wheat or multigrain bread

3 grams

Fruits 1 medium apple

4 grams

1 medium peach

2 grams

1/2 cup of raspberries

4 grams

1 medium tangerine

3 grams

Vegetables

8

1 cup of acorn squash, raw

2 grams

1 medium stalk of broccoli, raw

4 grams

5 brussels sprouts, raw

3 grams

1 cup of cabbage, raw

2 grams

1 medium carrot, raw

2 grams

1 cup of cauliflower, raw

2 grams

1 cup of spinach, cooked

2 grams

1 cup of zucchini, raw

2 grams

Source: USDA/ARS Nutrient Data Laboratory

Guidelines 17

Medication If diarrhea is causing the incontinence, medication may help. Sometimes doctors recommend using bulk laxatives to help people develop a more regular bowel pattern. Or the doctor may prescribe antidiarrheal medicines such as loperamide or diphenoxylate to slow down the bowel and help control the problem.

Bowel Training Bowel training helps some people relearn how to control their bowels. In some cases, it involves strengthening muscles; in others, it means training the bowels to empty at a specific time of day. ·

Use biofeedback. Biofeedback is a way to strengthen and coordinate the muscles and has helped some people. Special computer equipment measures muscle contractions as you do exercises--called Kegel exercises-to strengthen the rectum. These exercises work muscles in the pelvic floor, including those involved in controlling stool. Computer feedback about how the muscles are working shows whether you’re doing the exercises correctly and whether the muscles are getting stronger. Whether biofeedback will work for you depends on the cause of your fecal incontinence, how severe the muscle damage is, and your ability to do the exercises.

·

Develop a regular pattern of bowel movements. Some people-particularly those whose fecal incontinence is caused by constipation-achieve bowel control by training themselves to have bowel movements at specific times during the day, such as after every meal. The key to this approach is persistence--it may take a while to develop a regular pattern. Try not to get frustrated or give up if it doesn’t work right away.

Surgery Surgery may be an option for people whose fecal incontinence is caused by injury to the pelvic floor, anal canal, or anal sphincter. Various procedures can be done, from simple ones like repairing damaged areas, to complex ones like attaching an artificial anal sphincter or replacing anal muscle with muscle from the leg or forearm. People who have severe fecal incontinence that doesn’t respond to other treatments may decide to have a colostomy, which involves removing a portion of the bowel. The remaining part is then either attached to the anus if it still works properly, or to a hole in the

18 Fecal Incontinence

abdomen called a stoma, through which stool leaves the body and is collected in a pouch.

What to Do about Anal Discomfort The skin around the anus is delicate and sensitive. Constipation and diarrhea or contact between skin and stool can cause pain or itching. Here’s what you can do to relieve discomfort: ·

Wash the area with water, but not soap, after a bowel movement. Soap can dry out the skin, making discomfort worse. If possible, wash in the shower with lukewarm water or use a sitz bath. Or try a no-rinse skin cleanser. Try not to use toilet paper to clean up--rubbing with dry toilet paper will only irritate the skin more. Premoistened, alcohol-free towelettes are a better choice.

·

Let the area air dry after washing. If you don’t have time, gently pat yourself dry with a lint-free cloth.

·

Use a moisture barrier cream, which is a protective cream to help prevent skin irritation from direct contact with stool. However, talk to your health care professional before you try anal ointments and creams because some have ingredients that can be irritating. Also, you should clean the area well first to avoid trapping bacteria that could cause further problems. Your health care professional can recommend an appropriate cream or ointment.

·

Try using nonmedicated talcum powder or corn starch to relieve anal discomfort.

·

Wear cotton underwear and loose clothes that “breathe.” Tight clothes that block air can worsen anal problems. Change soiled underwear as soon as possible.

·

If you use pads or diapers, make sure they have an absorbent wicking layer on top. Products with a wicking layer protect the skin by pulling stool and moisture away from the skin and into the pad.

Emotional Considerations Because fecal incontinence can cause distress in the form of embarrassment, fear, and loneliness, taking steps to deal with it is important. Treatment can help improve your life and help you feel better about yourself. If you haven’t

Guidelines 19

been to a doctor yet, make an appointment. Also, consider contacting the organizations listed at the end of this fact sheet. Such groups can help you find information and support and, in some cases, referrals to doctors who specialize in treating fecal incontinence.

Everyday Practical Tips ·

Take a backpack or tote bag containing cleanup supplies and a change of clothing with you everywhere.

·

Locate public restrooms before you need them so you know where to go.

·

Use the toilet before heading out.

·

If you think an episode is likely, wear disposable undergarments or sanitary pads.

·

If episodes are frequent, use oral fecal deodorants to add to your comfort level.

Fecal Incontinence in Children If your child has fecal incontinence, you need to see a doctor to determine the cause and treatment. Fecal incontinence can occur in children because of a birth defect or disease, but in most cases it’s because of chronic constipation. Potty-trained children often get constipated simply because they refuse to go to the bathroom. The problem might stem from embarrassment over using a public toilet or unwillingness to stop playing and go to the bathroom. But if the child continues to hold in stool, the feces will accumulate and harden in the rectum. The child might have a stomachache and not eat much, despite being hungry. And when he or she eventually does pass the stool, it can be painful, which can lead to fear of having a bowel movement. A child who is constipated may soil his or her underpants. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out. Soiling is a sign of fecal incontinence. Try to remember that your child did not do this on purpose. He or she cannot control the liquid stool and may not even know it has passed.

20 Fecal Incontinence

The first step in treating the problem is passing the built-up stool. The doctor may prescribe one or more enemas or a drink that helps clean out the bowel, like magnesium citrate, mineral oil, or polyethylene glycol. The next step is preventing future constipation. You will play a big role in this part of your child’s treatment. You may need to teach your child bowel habits, which means training your child to have regular bowel movements. Experts recommend that parents of children with poor bowel habits encourage their child to sit on the toilet four times each day (after meals and at bedtime) for 5 minutes. Give rewards for bowel movements and remember that it is important not to punish your child for incontinent episodes. Some changes in eating habits may be necessary too. Your child should eat more high-fiber foods to soften stool, avoid dairy products if they cause constipation, and drink plenty of fluids every day, including water and juices like prune, grape, or apricot, which help prevent constipation. If necessary, the doctor may prescribe laxatives. It may take several months to break the pattern of withholding stool and constipation. And episodes may occur again in the future. The key is to pay close attention to your child’s bowel habits. Some warning signs to watch for include ·

Pain with bowel movements

·

Hard stool

·

Constipation

·

Refusal to go to the bathroom

·

Soiled underpants

·

Signs of holding back a bowel movement, like squatting, crossing the legs, or rocking back and forth

Why Children Get Constipated ·

They were potty-trained too early.

·

They refuse to have a bowel movement (because of painful ones in the past, embarrassment, stubbornness, or even a dislike of public bathrooms).

·

They are in an unfamiliar place.

Guidelines 21

·

They are reacting to family stress like a new sibling or their parents’ divorce.

·

They can’t get to a bathroom when they need to go so they hold it. As the rectum fills with stool, the child may lose the urge to go and become constipated as the stool dries and hardens.

Hope through Research The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research into many kinds of digestive disorders, including fecal incontinence. In addition, researchers throughout the country are working hard to find possible solutions to the problem of fecal incontinence. Some studies address fecal incontinence due to anal sphincter damage and combine surgical procedures with electrical stimulation.

For More Information You can get information about fecal incontinence, as well as support, from American Academy of Family Physicians 11400 Tomahawk Creek Parkway Leawood, KS 66211-2672 Phone: (913) 906-6000 Email: [email protected] Internet: www.aafp.org International Foundation for Functional Gastrointestinal Disorders P.O. Box 17864 Milwaukee, WI 53217 Phone: 1-888-964-2001 or (414) 964-1799 Fax: (414) 964-7176 Email: [email protected] Internet: www.iffgd.org

More Guideline Sources The guideline above on fecal incontinence is only one example of the kind of material that you can find online and free of charge. The remainder of this

22 Fecal Incontinence

chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to fecal incontinence. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with fecal incontinence. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following: http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on fecal incontinence and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive:

Guidelines 23

·

Restoring Control: Proven Solutions for Bladder and Bowel Control Problems Source: Redmond, WA: SRS Medical Systems, Inc. 1997. [2 p.]. Contact: Available from SRS Medical Systems, Inc. 14950 NE 95th Street, Redmond WA 98052. (800) 345-5642 or (425) 882-1101. PRICE: $40.00 for a package of 100; for health professionals only. Also available at www.srsmedical.com. Summary: Pelvic muscle dysfunction (PMD) includes urinary and fecal incontinence, chronic constipation, pelvic pain, and related disorders. This brochure discusses PMD and the use of a biofeedback system of muscle reeducation as treatment for PMD. The brochure first outlines the types and causes of incontinence, encouraging readers to obtain appropriate assessment and diagnosis from a health care provider. The brochure then describes the use of the Orion Continence System, a combination of computerized biofeedback, patented electromyographic sensors, and home training. The program begins with a thorough evaluation and physical examination, then explains pelvic floor muscles and how to do Kegel exercises. These muscle strengthening exercises help control the leakage of urine and feces. How much each person improves depends on how much time is devoted to the exercises, how properly they are done, and what each person's individual physical condition is. The Orion Continence System is designed to help patients ensure that they are doing the pelvic muscle exercises properly. The system uses a small patented Perry sensor (which is inserted vaginally or rectally like a tampon or suppository); the sensor is attached to an Orion computerized biofeedback instrument with a color monitor. This allows both the health care provider and the patient to see and measure even tiny changes in pelvic muscle activity. Other components of the program include keeping records of bladder and bowel activity, teaching skills that can help improve control, and learning how diet can affect bladder and bowel problems. The brochure notes that it usually takes three to six weekly office visits and 8 weeks of home training to realize a reduction of 70 to 100 percent in the most common types of incontinence. One sidebar lists the addresses and telephone numbers for government agencies and other organizations through which readers can get more information. 3 figures.

·

All About Maintaining Bowel Control: Information on Faecal Incontinence Source: London, England: British Digestive Foundation. 1993. 3 p. Contact: Available from British Digestive Foundation. 7 Chandos Street, London W1A 2LN England. PRICE: Single copy free.

24 Fecal Incontinence

Summary: This patient education brochure provides basic information about fecal incontinence. Written in a question-and-answer format, the brochure includes a definition of fecal incontinence and information about the Continence Foundation Helpline. It addresses normal bowel anatomy and function; causes of incontinence; tests of sphincter function; treatment, including drug therapy or surgery. The brochure also outlines the need for more research on this area and asks readers to support research with financial assistance. The brochure includes an insert summarizing guidelines for the early diagnosis of digestive disorders. This insert, entitled 'When Should I See My Doctor' lists symptoms that suggest a health care provider should be consulted. The brochure concludes with a brief description of the activities of the British Digestive Foundation. ·

Ano-Rectal Testing Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. [2 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-1170. Fax (717) 7610216. PRICE: $22.00 per pack of 50 brochures; 3 pack minimum. Summary: This brochure describes four types of anorectal testing: manometry, anal sphincter EMG, pudendal nerve stimulation, and defecography. The brochure defines the terminology used for each type of test: the anus is the opening at the end of the intestinal tract; the rectum is the short portion of the colon just above the anus; manometry is the recording of muscle pressures within an organ; a sphincter is a specialized ring shaped muscles that surrounds an opening in the body; and EMG is electromyography, an electrical recording of muscle activity. The brochure notes the reasons that may indicate the use of these tests: constipation, fecal incontinence or accidents (involuntary loss of feces or stool), rectal pouch problems, rectal surgery, Hirschsprung disease, and an infection called Chaga's disease. The brochure reviews the general preparation that the patient can expect to undergo, then describes each procedure in detail. A final section describes the types of results that may be obtained and how those results will assist the physician in making the diagnosis and determining appropriate treatment strategies. 2 figures.

·

Solutions for Common Bladder Problems Source: Zetland, New South Wales, Australia: Multicultural Health Communication Service. 1998. (web brochure). Contact: Available from Multicultural Health Communication Service. Royal South Sydney Community Health Complex, Joynton Avenue,

Guidelines 25

Zetland, New South Wales, Australia 2107. (02) 9382 8111. E-mail: [email protected]. Website: mhcs.health.nsw.gov.au/. Item is available only through the website and can be found under Diseases and Conditions. Summary: This brochure, available online through the Multicultural Health Communication Service, is one in a series of health information publications available in languages other than English. The Service facilitates the communication of quality information about health issues and health services to people of non-English speaking backgrounds. This brochure discusses common problems with urinary incontinence (leaking urine involuntarily), stressing that all problems with incontinence can be improved and many can be cured. The brochure describes stress incontinence, urge incontinence, overflow incontinence, reflex incontinence, fecal incontinence, and bedwetting in children. The author reiterates that most problems can be treated with simple strategies (such as bladder retraining or Kegel exercises for the pelvic floor muscles). The brochure is not illustrated and written in straightforward, nontechnical language. Contact information for the Continence Foundation of Australia is provided. ·

Female Urinary and Bowel Incontinence: How to Choose a Doctor and Hospital for Your Treatment Source: Cleveland, OH: Cleveland Clinic Foundation. 1998. 22 p. Contact: Available from Cleveland Clinic Foundation. Department of Nutrition Services, One Clinic Center, 9500 Euclid Avenue, Cleveland, OH 44195. (216) 444-8950. PRICE: Single copy free. Summary: Selecting a doctor and hospital for treatment of incontinence involves making some difficult and important decisions. Patients must carefully consider where to go and what physicians and surgeons are the most qualified to treat incontinence. This brochure offers information for patients with urinary or fecal incontinence (involuntary loss of urine or stool), focusing on choosing a doctor and hospital for treatment. The brochure describes the different types of incontinence, how incontinence is diagnosed, treatment options (including nonsurgical therapies and surgical procedures), and six points that indicate quality. The six points that patients should consider are credentials, experience, range of services, participation in research and education, patient satisfaction, and outcome indicators. In each area, the brochure offers suggested questions for patients to ask of their health care providers and facilities. Specific procedures discussed include laparoscopic bladder neck suspension, sling procedure, percutaneous bladder neck stabilization, and laparoscopic rectopexy; these minimally invasive surgeries are being

26 Fecal Incontinence

performed as alternatives to traditional open surgery. The brochure also provides information about the Cleveland Clinic Foundation, which produced the brochure and provides treatment of urologic, gynecologic, and colorectal disorders.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “fecal incontinence” or synonyms. The following was recently posted: ·

Idiopathic constipation and soiling in children. Source: University of Michigan Health System.; 1997 September; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1011&sSearch_string=fecal+incontinence Healthfinder™

Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Bowel Incontinence Summary: Basic consumer health information about this bowel disorder (also called fecal incontinence) -- include causes and treatment options. Source: American Society of Colon and Rectal Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2580

Guidelines 27

·

Fecal Incontinence Summary: This consumer health information brochure presents a general overview of fecal incontinence (also called bowel incontinence) that includes causes and treatment options. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2579

The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to fecal incontinence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific conditions or disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

28 Fecal Incontinence

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Pertaining to the abdomen. [EU] Anal: Pertaining to the anus. [EU] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Chronic: Persisting over a long period of time. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Defecography: Radiographic examination of the process of defecation after the instillation of a contrast media into the rectum. [NIH] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH]

Guidelines 29

Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enema: A clyster or injection; a liquid injected or to be injected into the rectum. [EU] Episiotomy: Surgical incision into the perineum and vagina to prevent traumatic tearing during delivery. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control

30 Fecal Incontinence

osmolarity. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU]

Guidelines 31

Stabilization: The creation of a stable state. [EU] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]

Seeking Guidance 33

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with fecal incontinence. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with fecal incontinence. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Fecal Incontinence As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of a condition or disorder can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9

34 Fecal Incontinence

condition can all influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

Continence Foundation (UK) Address: Continence Foundation (UK) 307 Hatton Square, 16 Baldwins Gardens, London, EC1N 7RJ, United Kingdom Telephone: 0171 404 6875 Fax: 0171 404 6876 Email: [email protected] Web Site: http://www.vois.org.uk/cf Background: The Continence Foundation is a not-for-profit organization in the United Kingdom dedicated to offering information and support to individuals affected by an inability to control urination (urinary incontinence) or defecation (fecal incontinence). The Foundation is also committed to providing educational publications to health care professionals, engaging in advocacy efforts, and increasing public awareness of bladder and bowel problems that may be associated with incontinence. The Foundation provides a variety of services including offering a telephone helpline for affected individuals and family members, maintaining a web site on the Internet, and providing a range of educational materials for patients and health care professionals including leaflets, booklets, fact sheets, reports, directories, and reading lists. In addition, a support group for affected individuals and their caregivers was established in 1989 in affiliation with the Continence Foundation. Known as 'Incontact,' the group functions as a national charity that works with and for people with bladder and bowel disorders associated with urinary or fecal incontinence. Incontact is dedicated to providing information and support to affected individuals and family members and lobbying for improved patient services. The group also offers a pen pals program, enabling members to exchange mutual support, information, and resources; works to raise awareness to increase

Seeking Guidance 35

public understanding and encourage people with bladder and bowel problems to seek help; and produces a quarterly newsletter. ·

Intestinal Disease Foundation Address: Intestinal Disease Foundation 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219 Telephone: (412) 261-5888 Fax: (412) 471-272 Background: The Intestinal Disease Foundation (IDF) is an international not- for-profit organization dedicated to providing information, assistance, and mutual support to individuals with chronic intestinal illnesses including irritable bowel syndrome, diverticular disease, ulcerative colitis, Crohn's disease, and short-bowel syndrome. Established in 1986 and consisting of 1,400 members in the United States and abroad, IDF promotes healing by encouraging individuals to assume an active role in their own treatment through a positive mental attitude founded on shared experiences. This is facilitated by a telephone network of individuals with intestinal illnesses who provide support, encouragement, and information. The Foundation publishes a quarterly newsletter entitled 'Intestinal Fortitude' as well as a variety of informational brochures and educational materials on chronic intestinal diseases and conditions. Relevant area(s) of interest: Diarrhea, Diverticular Disease, Irritable Bowel Syndrome, Lactose Intolerance, Proctitis, Short Bowel Syndrome

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about fecal incontinence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

36 Fecal Incontinence

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “fecal incontinence” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “fecal incontinence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “fecal incontinence” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with fecal incontinence. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific conditions and diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “fecal incontinence” (or a synonym) in the search box.

Seeking Guidance 37

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. ·

Simon Foundation for Incontinence www.simonfoundation.org

Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with fecal incontinence must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·

If you are in a managed care plan, check the plan’s list of doctors first.

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

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Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

11

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

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·

The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 12 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.

If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare conditions and diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about fecal incontinence?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12

Seeking Guidance 39

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for fecal incontinence?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

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Tell your doctor about any natural or alternative medicines you are taking.

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Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

14

40 Fecal Incontinence

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

15

Seeking Guidance 41

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Colitis: Inflammation of the colon. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Proctitis: Inflammation of the rectum. [EU]

43

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on fecal incontinence. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on fecal incontinence. In Part II, as in Part I, our objective is not to interpret the latest advances on fecal incontinence or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with fecal incontinence is suggested.

Studies 45

CHAPTER 3. STUDIES ON FECAL INCONTINENCE Overview Every year, academic studies are published on fecal incontinence or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on fecal incontinence. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on fecal incontinence and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and fecal incontinence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the

46 Fecal Incontinence

format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “fecal incontinence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Fecal Incontinence Source: Gastroenterology Clinics of North America. 30(1): 115-130. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: The ability to store feces until a socially acceptable time and to void under conscious control is a fundamental social and physiologic process. Loss of the mechanisms controlling fecal continence can be devastating. This article explores the anatomy and physiology of fecal continence, and outlines the patient care management of these patients. The authors note that fecal incontinence is common, but only a few patients with fecal incontinence present to medical practitioners. Investigative techniques have improved, and it is possible now to define and diagnose accurately either functional or anatomic problems. There are many factors that can result in fecal incontinence; obstetric trauma (during childbirth) is one of the most common factors. Iatrogenic (caused by a medical procedure or treatment) incontinence may result from anorectal surgery, in particular hemorrhoid, fistula, and fissure surgery. Anorectal manometry provides an objective assessment of sphincter function by measuring resting anal pressure (largely a function of the internal anal sphincter) and voluntary squeeze anal pressure (reflecting external sphincter function). Careful planning of treatment with the possibility of using a variety of treatment modalities is essential. Many patients already have learned behavioral coping strategies by the time they seek medical advice, including modification and reduction of food intake, remaining in close proximity to toilet facilities, and the use of sanitary or incontinence pads. The authors note that all of these coping strategies may have a negative impact on quality of life. Patients may be managed medically with drug therapy, suppositories or enemas, or biofeedback; surgery is indicated in many case. The authors conclude by describing novel conservative and surgical techniques that have the potential to improve the outcome for patients with fecal incontinence. An

Studies 47

algorithm of suggested patient care management is provided. 1 figure. 4 tables. 64 references. ·

Surgical Treatment of Constipation and Fecal Incontinence Source: Gastroenterology Clinics of North America. 30(1): 131-166. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This lengthy article reviews the surgical treatment of constipation and fecal incontinence. The authors emphasize that success in the management of constipation depends on an accurate determination of the cause. Because there are many extracolonic causes that can produce constipation, a detailed clinical history should be taken. Before physiologic investigation, patients must discontinue the use of medications that may cause or exacerbate their symptoms. A proper diet should be maintained, and patients must be supervised by a dietitian or a physician for a minimum of 3 to 6 months before any extensive physiologic evaluation is undertaken and before any surgery is considered. Diagnostic tests may include anorectal examination, colonic transit study, proctography and cinedefecography, electromyography, manometry, small bowel transit study, Minnesota Multiphasic Personality Inventory, and rectal biopsy. Surgery for constipation is reserved for a highly select group of patients; the authors review the indications for patients with pelvic outlet obstruction, with colonic inertia (slow transit throughout the colon), and with combined outlet obstruction and colonic inertia. The authors then discuss fecal incontinence, noting that obstetric injury (during childbirth) is a major cause and one amenable to surgical correction. Diagnostic tests can include physical examination, manometry, electromyography, pudendal nerve terminal motor latency, anal ultrasonography, and magnetic resonance imaging (MRI). The treatment of fecal incontinence should always be directed to the cause; many individuals can be managed adequately by noninvasive means. Surgical treatment can include sphincter repair, muscle transplant, the use of synthetic material, and diversion (the creation of a stoma). 4 figures. 9 tables. 297 references.

·

Methodology of Biofeedback for Adults with Fecal Incontinence: A Program of Care Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 28(3): 156-168. May 2001.

48 Fecal Incontinence

Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: In a previous article, the authors described a nursing assessment protocol for adults with fecal incontinence (involuntary loss of stool, feces). This article outlines in detail the subsequent program of care that would be implemented after the assessment was complete. The patient care program is tailored to an individual's assessed needs and is based on the nurse-led biofeedback service for fecal incontinence at St. Mark's Hospital in England. The aim of biofeedback is to provide immediate and accurate visual or auditory feedback on bodily functions not normally consciously appreciated or controlled, with the aim of teaching or enhancing performance of those functions. The biofeedback service described incorporates eight components: diary and symptom questionnaire (printed as a figure in the article) sent with appointment; first biofeedback session, focusing on patient education; biofeedback sessions, including anal sphincter exercises and balloon distension; urge resistance program for those with urgency; lifestyle modifications, in the areas of diet, fluids, smoking, medication, general fitness and weight; management of fecal incontinence, including produce advice, skin care, and odor control; emotional support and encouragement; and access to other members of the multidisciplinary team as necessary. A recent evaluation of this program found that two thirds of patients reported improved fecal continence after receiving care from this service. 5 figures. 63 references. ·

Constipation and Fecal Incontinence in the Elderly Source: Gastroenterology Clinics of North America. 30(2): 497-515. June 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Continence and defecation are complex functions that require the interaction of visceral and pelvic muscles and the nerves that regulate their activity. These activities may be abnormal in elderly patients and can produce symptoms, such as chronic constipation or fecal incontinence (involuntary loss of stool). This article, from a special issue on gastrointestinal (GI) disorders in the elderly, addresses constipation and fecal incontinence in this population. The author emphasizes that, contrary to widespread opinion, much can be done to improve constipation and incontinence in the elderly and relieve a considerable burden in these patients. Relatively little research has been done to differentiate physiologic changes in rectoanal function resulting from aging and pathologic changes resulting from diseases occurring as

Studies 49

patients age. Treatment includes identification and treatment of the underlying disease, if possible, protective skin care, continence aids, psychologic support, drug therapy (for stimulation of defecation at intervals, antidiarrheal drugs), biofeedback, and surgical therapy. Results of therapy often can be good, leading to alleviation of suffering and the ability to lead a fuller life. 1 figure. 4 tables. 92 references. ·

Comparison of the Nutritional Composition of Diets of Persons with Fecal Incontinence and That of Age-and Gender-Matched Controls Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(2): 90-97. March 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: In clinical and research experience, persons with fecal incontinence (involuntary loss of stool) anecdotally report altered diet intake to avoid incontinence. This article reports on a study undertaken to compare the dietary intake of 39 persons with fecal incontinence living in the community with that of age and gender matched control subjects who had normal bowel function. The diets of both groups were compared with recommended dietary allowances (RDAs) for their constituent nutrients. Subjects prospectively recorded the type, amount, and method of preparing all foods and beverages ingested for 8 consecutive days; diet records were analyzed using a nutrition software program. There were no significant differences in the intake of total kilocalories, protein, fat, dietary fiber, caffeine, or lactose by the fecal incontinence and control groups. The fecal incontinence group had a greater intake of carbohydrates, manganese, and vitamin B1 compared with the control group. Diets of both groups exceeded 100 percent of the RDA for protein, phosphorus, iron, sodium, potassium, Vitamins B1, B2, B3, B12 and C, and folate. Diets of both groups had less than 50 percent of the RDA for biotin, chromium, copper, and manganese but did not differ significantly. The authors conclude that the diets of persons with fecal incontinence were similar to those of control subjects with normal bowel function. Both the fecal incontinence and control groups may improve their nutritional patterns by lowering sodium and protein intake and increasing dietary fiber and monounsaturated fat intake. Calcium and vitamin D supplementation may improve dietary deficiencies and lower disease risks. Including a nutritional assessment and consultation in the care of persons with fecal incontinence to improve their general health and prevent disease is recommended, but consideration must be given to altered diet patterns perceived by the patient to prevent fecal incontinence. 4 tables. 36 references.

50 Fecal Incontinence

·

Constipation in Imperforate Anus Source: Pull-Thru Network News. 8(1): 1-2. February 1999. Contact: Available from Pull-Thru Network. 4 Woody Lane, Westport, CT 06880. Summary: Most of the patients who are born with imperforate anus and undergo a repair that preserves their rectum will be constipation. This newsletter article reviews the problem, which seems to be the clinical manifestation of a hypomotility disorder of the rectosigmoid colon. After colostomy closure, proper treatment of the constipation is imperative. When it is not treated properly (meaning that the rectum is emptied every day), the megasigmoid worsens. The author notes that constipation can be a serious problem because it eventually provokes fecal incontinence, even in patients who were born with a potential for bowel control. The author also discusses the diagnosis of Hirschsprung's disease and imperforate anus, stressing that this condition is overdiagnosed. Patients with poor potential for bowel control and constipation should be treated with an enema every day, with close monitoring until the regimen is established. Patients with a good potential for bowel control and constipation should be treated with laxatives; however, it is important to establish the proper amount of laxatives for the individual patient. The author concludes with a brief discussion of the complication of tethered cord.

·

American Gastroenterological Association Medical Position Statement on Anorectal Testing Techniques Source: Gastroenterology. 116(3): 732-760. March 1999. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: This article presents the American Gastroenterological Association (AGA) Medical Position Statement on Anorectal Testing Techniques and the AGA Technical Review on Anorectal Testing Techniques; both are based on a comprehensive literature assessment. The various tests assess different aspects of the mechanisms of defecation and continence and of the sensory mechanisms involved with symptom production. Although some of the tests are available in a hospital or clinic setting, others are found only in special facilities, and most require some degree of experience for both appropriate ordering of tests and application of test results. The position statement offers comments, recommendations, and guidelines for endoscopy; imaging techniques, including barium enema, evacuation proctography (defography), anal ultrasonography, magnetic resonance imaging and computed

Studies 51

tomographic (CT) scanning, and colon transit studies; anorectal manometry; sensory testing, including rectal sensation, anal canal sensation, and sensory evoked potentials; muscle tone, compliance, and wall tension measurements; electromyography; nerve latency measurements; and other functional tests, including balloon expulsion, saline infusion, and rectal motor response to distention of fluid infusion. The statement also covers tests for specific diagnosis or management, including those for fecal incontinence, constipation or impaired defecation, biofeedback treatment, and proctalgia and other sensory syndromes. For each disorder, the statement describes procedures of value, and procedures of possible value. The technical review presents definitions (fecal incontinence, constipation, levator ani syndrome, and proctalgia fugax) discusses anatomic and physiological considerations, and reviews the tests listed above. For each test or testing method, the review offers a conclusion summarizing the indications (or lack thereof) for that test. 6 figures. 8 tables. 239 references. ·

How to Resolve Stool Retention in a Child: Underwear Soiling is Not a Behavior Problem Source: Postgraduate Medicine. 105(1): 159-161, 165-166, 172-173. January 1999. Summary: Many parents do not realize that their child has stool retention when they bring him or her for an office visit. This article guides primary care providers in the diagnosis and patient management of these children and their parents. The authors discuss how and why stool retention gets started, and they summarize the complaints parents often have when they bring in their child. A complete treatment regimen is described and compiled in a form that can be sent home with parents (a chart of strategies for parents to use immediately and on an ongoing basis). The authors note that stool retention is the most common cause of underwear soiling in children who have been toilet trained. Management begins with educating parents that leaking of liquid stool around impaction and onto underwear is completely involuntary, so the child should never be scolded or embarrassed. Stool retention may begin because of unpleasant or unavailable toilet facilities, constipation, or painful elimination and often becomes self perpetuating. The impaction must be removed immediately; magnesium citrate solution is usually effective. To allow the rectum to return to its normal size, which can take a long time, stool must be kept soft and movable with administration of mineral oil and appropriate dietary choices (e.g., fruit, juice, fiber). Recurrence is common, so ongoing measures and followup are important. 1 figure. 1 table. 16 references. (AA-M).

52 Fecal Incontinence

·

When 'Little Accidents' Turn Serious: Understanding Fecal Incontinence Source: Digestive Health and Nutrition. p. 22-25. November-December 1999. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. E-mail: [email protected]. Summary: This article discusses fecal incontinence (encopresis) in children, delineating when this behavior becomes a serious problem and what actions to take to correct it. Fecal incontinence is defined as soiling of a child's underpants (or leaking of stool) at a time when the child should be toilet trained (after ages 2 to 3 for girls; 2 to 4 for boys). It occurs in conjunction with chronic constipation, which results when a child does not completely empty his or her bowel when sitting on the toilet, or refuses to use the toilet altogether. By becoming alert to the warning signs of encopresis, parents can often prevent the problem from worsening. The author reviews the common schedule a child will follow for defecation; the variety of factors that can contribute to the development of constipation, including toilet training forced at too young an age; not drinking enough fluids; holding back because of a particularly painful bowel movement in the past; stress in the family such as a birth, death, divorce, or unfamiliar surroundings; the child's typical behavior after soiling, notably denial; and strategies for addressing the problem of encopresis. One sidebar offers tips on toilet training.

Federally-Funded Research on Fecal Incontinence The U.S. Government supports a variety of research studies relating to fecal incontinence and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.16 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to fecal incontinence and related conditions. 16 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

Studies 53

For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore fecal incontinence and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for fecal incontinence: ·

Project Title: Biofeedback for Fecal Incontinence and Constipation Principal Investigator & Institution: Whitehead, William E.; Medicine; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 0-SEP-1999; Project End 0-NOV2004 Summary: There is no text on file for this abstract. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

·

Project Title: Epidemiology and Mechanisms of Fecal Incontinence Principal Investigator & Institution: Bharucha, Adil E.; ; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-JUL-2006 Summary: Fecal incontinence (FI) is a socially devastating symptom in older women and may contribute to institutionalization. The epidemiology and pathophysiology of "idiopathic" FI is incompletely understood. Current concepts based on tertiary-care studies heavily emphasize the role of anal sphincter defects visualized by endoanal ultrasound. Preliminary studies suggest that the prevalence of FI in Olmsted County in women greater than or equal to 50 years is 17.8 percent with a median age of onset of 61 years. Obstetric events, diarrhea/urgency and obesity are risk factors for FI. Our novel "fluoroscopic" single-shot fast spin-echo MRI techniques visualize pelvic floor descent during defecation in real-time. In contrast to US, endoanal MRI depicts external sphincter defects and atrophy, puborectalis thinning and global pelvic floor laxity. The hypothesis is that fecal incontinence is not attributable to obstetric trauma alone, but the cumulative result of pelvic floor weakness caused by obstetric trauma, excessive straining, obesity, aging and menopause, compounded by diarrhea. This hypothesis will be addressed by combining the data infrastructure of the Rochester Epidemiology Project with state- of-the-art physiological

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measurements in a community-based sample. A questionnaire will be mailed to a cohort of approximately 1,000 women surveyed previously to ascertain the incidence and natural history of FI, and, a new sample of 5,000 women to determine the prevalence and frequency of FI. Putative risk factors for pelvic floor injury (obstetric trauma, chronic straining, obesity and estrogen depletion) and FI (diarrhea and rectal urgency) will be evaluated in a case-control study of approximately 200 patients with FI at least once a month and approximately 200 controls. approximately 100 patients with FI and approximately 100 controls will have MRI fluoroscopy to characterize the specific global pelvic floor abnormality (i.e., anal sphincter defects, sphincter atrophy, puborectalis thinning and pelvic floor laxity) associated with FI. These studies will refine our understanding of the epidemiology of FI, identify the obstetric risk factors responsible for delayed manifestations of pelvic floor injury, i.e. FI, underscore the importance of non- obstetric risk factors for FI and provide novel insights into the specific pattern of pelvic floor injury associated with FI in a community. These steps are necessary for reducing the incidence of pelvic floor damage by risk factor modification, identifying patients at higher risk of progressing to symptomatic FI, and designing appropriate interventions to halt this process. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: The Epidemiology of Fecal Incontinence after Childbirth Principal Investigator & Institution: Guise, Jeanne-Marie M.; Obstetrics and Gynecology; Oregon Health & Science University 3181 Sw Sam Jackson Park Rd Portland, or 97201 Timing: Fiscal Year 2001; Project Start 7-AUG-2001; Project End 1-JUL2005 Summary: Fecal incontinence is thought to be a common condition with profound social impact. Obstetric delivery is thought to be the leading contributor to development of fecal incontinence in women. There are no population-based studies of fecal incontinence following childbirth; the highest-risk period. Previous studies examining postpartum fecal incontinence are from single institutions, populations that are subject to referral bias, and small numbers; making generalizability of the results impossible. The primary goal of this proposal is to provide populationbased information on incidence, and risk factors with essential correlation with anatomic/physiologic findings and longitudinal follow-up. The specific aims of this proposal are to: - Provide population-based estimates of incidence of fecal incontinence in all postpartum women delivering in Oregon state. - Identify contributing modifiable and non-modifiable risk factors for the development of postpartum fecal incontinence. - Explore in

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depth a possible causal relationship between obstetric delivery methods and postpartum fecal incontinence. - Develop a cohort of women with postpartum fecal incontinence to follow longitudinally to identify factors that predict the likelihood of resolution, recurrence or worsening of symptoms. - Correlate anatomic and physiologic findings to symptoms of fecal incontinence. - Understand the physical, psychological, social ramifications of fecal incontinence. These data will provide a better understanding of the extent of the problem and will provide data essential for future trials of prevention and treatment of fecal incontinence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Bladder and Bowel Control Using Neuroprosthetic Devices Principal Investigator & Institution: Creasy, Graham; ; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2000 Summary: Electrical stimulators resembling pacemakers were designed to improve bladder emptying following spinal cord injury, by stimulating the nerve roots at the base of the spine. This causes contraction of the bladder and has been shown in about 90% of the patients on whom it has been used to improve bladder emptying and reduce urine infection. It can also improve continence. This project will document these results accurately in the United States. The stimulator also causes contraction of the rectum and most of the patients in whom it has been used report a reduction in constipation. Techniques for more selective stimulation of the bladder and bowel have been developed by the investigators at CWRU. This project provides an opportunity for evaluating the functional benefit to be gained in human subjects for these techniques. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

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Project Title: Control of Rectoanal Motility Principal Investigator & Institution: Keef, Kathleen D.; Professor; Physiology and Cell Biology; University of Nevada Reno Reno, Nv 89557 Timing: Fiscal Year 2000; Project Start 5-AUG-2000; Project End 1-JUL2004 Summary: The rectoanal region of the GI tract regulates the final storage, transport and evacuation of the GI contents. These functions require substantial differences in the contractile behavior of progressively more distal segments of this region. This study investigates the mechanisms

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underlying spontaneous motility patterns and the actions of excitatory nerves in rectoanal circular muscle of the dog and mouse gastrointestinal tract. The overall hypothesis for these studies is that fundamental changes occur in the nature of pacemaker activity, neuronal innervation and the actions of norepinephrine (NE) and acetylcholine (ACh) which permit adjacent portions of the rectoanal region to perform complimentary but distinct functions. Membrane potential and contractile activity will be measured as well as receptor density using radioligand binding techniques. These data will be compared to immunohistochemical and immunocytochemical measurements to identify putative pacemaker cells (i.e., interstitial cells of Cajal or ICC) and their relationship to intrinsic and extrinsic nerves. An 8 cm region of the canine model and a 1 cm region of the mouse model encompassing both the rectum and internal anal sphincter (IAS) will be used. The specific aims of this proposal are: 1) To compare the spatial distribution of pacemaker potentials to ICC, 2) To characterize the changes which occur in functional motor innervation with distance in the rectoanal region, 3) To determine the anatomical distribution of nerves and their relationship to the distribution of ICC, 4) To evaluate postjunctional adrenergic and muscarinic responses in the rectoanal region using functional measurements and radioligand binding techniques, 5) To evaluate pacemaking using knockout mice and organ culture techniques. Millions of Americans suffer from diseases of the rectoanal region which lead to either constipation or fecal incontinence. The experiments outlined in this proposal will provide important new information regarding the anatomical and physiological characteristics which underlie rectoanal motility and its nervous control. In so doing we may aid future studies directed toward understanding how these functions become altered in disease states. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Epidemiology of Female Pelvic Floor Disorders Principal Investigator & Institution: Kjerulff, Kristen H.; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Professional Schools Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL2003 Summary: Female pelvic floor disorders are a significant public health problem, cause major impairments in quality of life, and impose a substantial burden on individuals and on society as a whole. Uterine prolapse is the most common indication for hysterectomy among women aged 60-79, and the second most common indication among women in

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their fifties. Estimates of the prevalence of urinary incontinence among women overall ages range from 10 percent to 58 percent. However, there have been surprisingly few studies of any female pelvic floor disorders conducted in the national health data sets. Consequently, even basic statistical information concerning female pelvic floor disorders among American women is not available. It is critically important that epidemiologic studies be conducted in national health data sets in order to further our understanding of the scope and nature of the problems experienced by women due to pelvic floor disorders. In this application we propose to conduct a descriptive study of the epidemiology of and recent trends in outpatient visits, in-hospital stays, and surgical procedutes for female pelvic follr disorders utilizing the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), the National Hospital Discharge Survey (NHDS), the Nationwide Inpatient Sample (NIS) and the National Survey of Ambulatory Surgery (NSAS). These data sets have been specifically designed to provide objective, reliable, populationbased information and could be utilized to address several key issues concerning female pelvic floor disorders including outpatient health care utilization, in- hospital and ambulatory operative treatments, physician specialty differences in treatments, characteristics of women seeking treatment and the economic burden imposed by these disorders. Utilizing these data sets we will accomplish the following specific aims: 1.)Describe hospitalizations for female pelvic floor disorders including vaginal vault prolapse, uterine prolapse, uterovaginal prolapse, vaginal enterocele, fecal incontinence, and urinary incontinence in the NHDS and NIS data sets, 2.) Describe ambulatory operative procedures used as treatment for female pelvic floor disorders in the NSAS, and 3.) Describe office-based visits for female pelvic floor disorders in the NAMCS and the NHAMCS. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Fecal-Incontinence Monitor Principal Investigator & Institution: Putnam, David L.; ; Pacific Technologies 21806 Ne 1St Redmond, Wa 98053 Timing: Fiscal Year 2000; Project Start 1-AUG-2000; Project End 1-AUG2001 Summary: The goal of this project is to develop a sensor system for fecalincontinent patients to alert the individual, or send a signal to their health-care attendants, of a bowel movement and that attention is required. The objective is to ultimately produce a small portable batteryoperated optical sensing system that can be worn by the incontinent

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patient. The system will employ a disposable fiber optic sensor placed in an individual's undergarment, which will act like a "sniffer" and respond to gas associated with defecation. To confirm feasibility, Phase I of this project will involve analyses of fresh fecal samples from convalescent center patients using the fiber- based sensor technique. Studies will be conducted to characterize the variation in the amount and rate of liberation of the indicator gas specie. Means of improving the sensor system will also be researched, especially the design of the detector instrument, for this specific application. The Phase I work will provide key information regarding parameters critical to the design and implementation of the monitoring system for patient application. This will enable prototype systems to be developed in Phase IiI. The objective is to conduct trials in Phase II with sensor systems worn by patients. PROPOSED COMMERCIAL APPLICATIONS: This monitoring system will be used by fecal incontinent patients, and by health-care facilities having incontinent patients requiring assisted care. It will allow improved care and management of those incontinent and reduce healthcare delivery costs. There are additional applications for this gas sensing technique in other biomedical applications and in general industry. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Female Pelvic Floor Disorders--Data Coordinating Center Principal Investigator & Institution: Brown, Morton B.; Professor; Biostatistics; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 0-JUN2006 Summary: (provided by applicant) Pelvic floor disorders, including urinary incontinence, pelvic prolapse, and fecal incontinence, are common and significant health-related problems in the United States. Outcomes following surgical intervention for pelvic floor disorders have not been adequately evaluated. As a result, data necessary to fully inform patients and to make important policy decisions are unavailable. The long-term objective of the Clinical Trials Network for Female Pelvic Floor Disorders is to systematically evaluate these outcomes. This application to be the Data Coordinating Center (DCC) for the pelvic floor disorders network brings together experienced investigators from biostatistics, gynecology, urology, quality of life and health services research to prospectively assess the outcomes from various surgical interventions for female pelvic floor disorders using a novel design. The DCC will: 1. Provide expertise in the design of the studies to be performed by the network, 2. Provide expertise in the measurement of quality of life and in the selection of the instruments to assess treatment outcomes, 3. Provide

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expertise in the assessment of cost-effectiveness and in the development of the instruments to measure costs of alternative treatments, 4. Coordinate the implementation of the study protocols approved by the Steering Committee, including centralized database management with either centralized or remote data entry, 5. Monitor the sites with respect to data quality, and 6. Develop the plan for data analysis, perform the analysis and collaborate on the preparation of reports/publications that result from these studies. In this application the applicant proposes a randomized clinical trial to compare surgical procedures for pelvic organ prolapse. This design will provide valid comparisons of the surgical outcomes and allow for the prospective evaluation of the process of care, although surgeons will be able to specify the operative procedures that they are willing to perform. Since randomization may not be acceptable for all eligible subjects, either due to subject or surgeon preferences, the applicant proposes that the non-randomized, but eligible, subjects be enrolled into an observations study that, combined with the randomized subjects undergoing the same surgical procedure, enables the applicant to have greater numbers to evaluate factors that affect the success rate of a specific procedure. It is recognized that the Steering Committee will select the actual protocol to be implemented. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Neurotrophins, Hormones and Postparous Incontinence Principal Investigator & Institution: Smith, Peter G.; Professor; Molecular & Integrative Phys; University of Kansas Medical Center Medical Center Kansas City, Ks 66103 Timing: Fiscal Year 2000; Project Start 1-APR-2000; Project End 1-MAR2005 Summary: (Adapted from Applicant's Description): Traumatic labor and vaginal delivery during childbirth can produce permanent dysfunction of the pelvic musculature, in many cases leading to urinary and fecal incontinence. Damage to the pelvic nerves and failure to achieve complete reinnervation account for much of the deficit. Factors that modulate regrowth of damaged axons therefore may influence functional recovery. The investigators have shown recently that smooth muscle of the reproductive tract, which shares many similarities with urethral and anal sphincter smooth muscle, undergoes dramatic changes in innervation as a consequence of hormonal fluctuations. Elevated plasma estrogen results in marked reductions in numbers of sympathetic nerves, while other neuronal populations are unaffected. Preliminary data suggest that these changes are related to decreased nerve growth factor (NGF) synthesis. The investigators hypothesize that the high levels of

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estrogen in periparous females result in depressed neurotrophin synthesis in pelvic smooth muscle. Accordingly, sympathetic nerves, whose presence is essential for normal sphincter contractile tone, fail to regenerate to their full potential after nerve injury. In Specific Aim 1, the investigators will determine the effects of estrogen and pregnancy on protein and mRNA levels of NGF and the related neurotrophin, NT3, in urethral and anal sphincter smooth muscle using in situ hybridization, quantitative competitive polymerase chain reaction, immunohistochemistry and enzyme-linked immunoassays. In the second aim, they will use quantitative in situ hybridization and immunohistochemistry to determine the extent to which estrogen and pregnancy influence expression of the neurotrophin receptors trkA and p75NTR, which mediate the sympathetic nerve response to NGF and NT3. In aim 3, they will use immunohistochemistry to examine the effects of estrogen and pregnancy on the normal innervation of the urethral and anal sphincter smooth muscles. Aim 4 will employ immunohistochemistry and physiological and pharmacological measurements of urethral and anal smooth muscle contractile function to assess the effects of estrogen on sphincter reinnervation following a noradrenergic neurotoxin lesion with 6-hydroxydopamine, or pelvic distension to simulate childbirth trauma, and these will be compared with injury of normal delivery. The fifth aim uses collagen gel co-cultures of sphincter smooth muscle and sympathetic ganglia in the presence of selective neutralizing antibodies to ascertain the roles of neurotrophins in modulating sympathetic neurite sprouting toward smooth muscle of estrogen-treated or pregnant rats. These studies should provide important new information on how hormones may affect neurotrophin synthesis by smooth muscle of the organs of continence, and how this in turn may alter sympathetic reinnervation of sphincters after axonal damage due to traumatic vaginal delivery, thus leading to urinary and fecal incontinence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Physiology of Colonic Function and Defecation Using Colonic Motility Principal Investigator & Institution: Rao, Satish S.; ; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2000 Summary: The goal of the study is to examine physiological changes in motor function throughout the defecation unit recording the intraluminal pressure activity in healthy subjects and subjects with constipation, diverticular disease and fecal incontinence.

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Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Reproductive Risk Factors for Pelvic Organ Prolapse Principal Investigator & Institution: Brown, Jeanette S.; Professor; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 5-SEP-2001; Project End 1-AUG2005 Summary: (provided by applicant): Pelvic organ prolapse is a common problem among middle-aged and older women and risk factors for the development of pelvic organ prolapse are not well defined. While childbirth has been identified as a risk factor for pelvic organ prolapse, there has been limited research on the relationship between specific parturition events and the occurrence of pelvic organ prolapse in later life. Currently, we are conducting the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 4-year funded study to determine the association between specific childbirth events, hysterectomy, hormone use and subsequent urinary incontinence. This retrospective cohort study will enroll 2100 community-dwelling, ethnically diverse women ages 40 to 69 on which there are continuous medical records since the age of 18. All participants had extensive assessment of urinary incontinence and potential risk factors using selfreport, in-person interview, and chart abstraction of labor and delivery and surgical records. We propose randomiy selecting a 1100 participant subsample of the RRISK cohort to objectively assess pelvic organ prolapse using the Pelvic Organ Prolapse Quantitation staging system. Our specific aims over the next 4 years are to detennine the prevalence of prolapse by vaginal segment and severity (Stage I- IV), and age group. The ethmc diversity of study subjects will allow comparison of prevalence estimates between major ethnic groups; to determine the association between specific aspects of parturition and development of prolapse in later life; to ascertain the association between hysterectomy (type and indication) and subsequent prolapse; To identify other potential risk factors (heavy lifting, obesity, medical illness, etc.) for prolapse, especially those that are preventable or modifiable; and to describe the associations of pelvic organ prolapse with urinary and fecal incontinence and to compare risk factors for each of these conditions. Our proposed study of reproductive risk factors for prolapse in a wellcharacterized representative cohort of community-dwelling women will provide an adequate sample size, excellent outcome measures, and extensive reliable data on a range of risk factors for pelvic organ prolapse, including chart abstracted information on important aspects of

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reproductive history. Identification of risk factors for prolapse will help guide the development of preventive intervention trials to test the efficacy of modifying risk factors for pelvic organ prolapse. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Synaptic Transmission in Diabetic Enteric Nervous System Principal Investigator & Institution: Lepard, Kathy J.; Physiology; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2002 Summary: (Applicant's abstract): Gastrointestinal (GI) disturbances are not normally life-threatening but do profoundly affect quality of life. Diabetic patients often experience a wide range of GI discomforts including heartburn, nausea, vomiting, diarrhea, constipation, fecal incontinence and abdominal pain. Many patients have abnormalities in motility arising from identifiable conditions; but over 50% of GI complaints are idiopathic and are indicative of autonomic neuropathy. Both enteric nerves in and sympathetic nerves to the GI tract undergo neuropathy in animal models of diabetes as supported by immunohistochemical, histological, and functional data. A streptozotocin-induced diabetic guinea pig model will be used to isolate and evaluate alterations in sympathetic and enteric nerve activity at the histochemical, functional and cellular level. Neuropathy of enteric neurons will be investigated immunohistochemically by quantifying enzyme and peptide content of the small intestine, functionally by recording contractions/ relaxations from circular/ longitudinal smooth muscle strips of small intestine and cellularly by recording junction potentials from smooth muscle cells. Neuropathy of sympathetic neurons will be evaluated histochemically by quantifying norepinephrine (NE) content of small intestine and cellularly by recording NE mediated inhibitory postsynaptic potentials from submucosal neurons and by evaluating presynaptic inhibition of enteric neurotransmission by NE. Experimental data will be correlated with metabolic indices (body weight, glycosylated hemoglobin and plasma glucose) to determine normal control deviations and degree of diabetic severity with the intent of identifying a threshold for GI dysfunction. By defining the individual contribution of sympathetic and enteric neuropathies to dysfunctional GI motility, targets for therapeutic intervention to improve patient quality of life will be pinpointed. Adaptations of enteric neurons to diabetes will provide insight into enteric plasticity occurring in other GI diseases such as neuronal intestinal dysplasia, achalasia, scleroderma, pyloric stenosis,

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idiopathic constipation, diverticular disease, Parkinson's disease, and paraneoplastic syndromes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Treatment of Early Childhood Constipation and Encopresis Principal Investigator & Institution: Cox, Daniel J.; Psychiatric Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2001; Project Start 1-APR-1992; Project End 0-JUN2006 Summary: (provided by applicant): It is estimated that 3-5 percent of children suffer from fecal incontinence. One of the most effective ways of treating encopresis is through Enhanced Toilet Training (ETT). ETT is twice as effective as intensive medial management alone at 3, 6, and 12month follow-up when delivered by skilled and knowledgeable clinicians. Although this finding is a clear indication that ETT can be effective in treating encopretic children, there are 5 major barriers to its implementation: 1) availability of a knowledgeable and skilled clinician, 2) parental acceptance of referral to a mental health professional, 3) expense for this available service, 4) burden of time and distance to access such specialty services, and 5) child resistance to disclosure of embarrassing material. We have attempted to circumvent these barriers by operationalizing the treatment components of ETT in creating an interactive Internet-based program, which we demonstrated significantly enhances treatment provided by primary care physicians. We have developed a theoretical model for therapeutic behavior change achieved by web-based interventions, and completed a feasibility study demonstrating the acceptance, function and effectiveness of such an intervention for children with encopresis. We propose a 5-year, 4-phase project: Expert Optimization Phase 1 will bring together clinical and website experts to identify optimal web and treatment elements as well as issues in need of experimental investigation. Experimental Optimization Phase 2 (years 1-2) will investigate how to enhance internet-based interventions with a series of experimental investigations. Clinical Trial Phase 3 (years 3-4) will evaluate the relative benefit of adding the internet treatment to clinical services provided by generalists and specialists in the fields of medicine and mental health. Cost-Benefit/ Dissemination Phase 4 (Years 4-5) will investigate the relative long-term benefits of adding such an internet based intervention to professional interventions, to determine impact on symptom improvement, generalization of symptom impact, relapse prevention, quality of life, and

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cost-effectiveness. Phase 4 will also assess to what extent the program is disseminated world wide when made generally available on the Internet. After 5 years we will have documented basic elements and dissemination patters of web-based pediatric behavior change programs generally, and, in particular Enhanced Toilet Training. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central17 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).18 Access to this growing archive of e-journals is free and unrestricted.19 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “fecal incontinence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for fecal incontinence in the PubMed Central database: ·

Anal incontinence after childbirth by Erica Eason, Michel Labrecque, Sylvie Marcoux, and Myrto Mondor; 2002 February 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99311

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Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial by Cathryn M A Glazener, G Peter Herbison, P Don Wilson, Christine MacArthur, Gordon D Lang, Harry Gee, and Adrian M Grant; 2001 September 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=55571

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Midline episiotomy and anal incontinence: retrospective cohort study by Lisa B Signorello, Bernard L Harlow, Amy K Chekos, and John T Repke; 2000 January 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27253

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 18 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 19 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 17

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.20 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with fecal incontinence, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “fecal incontinence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “fecal incontinence” (hyperlinks lead to article summaries): ·

Manometric evaluation of defecation disorders: Part II. Fecal incontinence. Author(s): Rao SS. Source: Gastroenterologist. 1997 June; 5(2): 99-111. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9193928&dopt=Abstract

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Methodology of biofeedback for adults with fecal incontinence: a program of care. Author(s): Norton C, Chelvanayagam S. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2001 May; 28(3): 156-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11337702&dopt=Abstract

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

20

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·

Postanal repair for fecal incontinence--is it worthwhile? Author(s): Matsuoka H, Mavrantonis C, Wexner SD, Oliveira L, Gilliland R, Pikarsky A. Source: Diseases of the Colon and Rectum. 2000 November; 43(11): 15617. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11089593&dopt=Abstract

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Progress in biofeedback conditioning for fecal incontinence. Author(s): Cerulli MA, Nikoomanesh P, Schuster MM. Source: Gastroenterology. 1979 April; 76(4): 742-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=422002&dopt=Abstract

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Prospective trial of pelvic floor retraining in patients with fecal incontinence. Author(s): Rieger NA, Wattchow DA, Sarre RG, Cooper SJ, Rich CA, Saccone GT, Schloithe AC, Toouli J, McCall JL. Source: Diseases of the Colon and Rectum. 1997 July; 40(7): 821-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9221860&dopt=Abstract

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Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Author(s): Leroi AM, Dorival MP, Lecouturier MF, Saiter C, Welter ML, Touchais JY, Denis P. Source: Diseases of the Colon and Rectum. 1999 June; 42(6): 762-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10378600&dopt=Abstract

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Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. Author(s): Bai Y, Yuan Z, Wang W, Zhao Y, Wang H, Wang W. Source: Journal of Pediatric Surgery. 2000 March; 35(3): 462-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10726690&dopt=Abstract

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Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence. Author(s): Chiarioni G, Bassotti G, Stanganini S, Vantini I, Whitehead WE, Stegagnini S.

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Source: The American Journal of Gastroenterology. 2002 January; 97(1): 109-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11808933&dopt=Abstract ·

Special delivery: a biofeedback program for fecal incontinence. Author(s): Zimmaro Bliss D. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2001 May; 28(3): 169-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11337703&dopt=Abstract

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Supplementation with dietary fiber improves fecal incontinence. Author(s): Bliss DZ, Jung HJ, Savik K, Lowry A, LeMoine M, Jensen L, Werner C, Schaffer K. Source: Nursing Research. 2001 July-August; 50(4): 203-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11480529&dopt=Abstract

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Surgical treatment of constipation and fecal incontinence. Author(s): Rotholtz NA, Wexner SD. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 131-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11394027&dopt=Abstract

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Transanal electrostimulation for fecal incontinence: clinical, psychologic, and manometric prospective study. Author(s): Pescatori M, Pavesio R, Anastasio G, Daini S. Source: Diseases of the Colon and Rectum. 1991 July; 34(7): 540-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2055139&dopt=Abstract

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Treatment of fecal incontinence in children with spina bifida: comparison of biofeedback and behavior modification. Author(s): Whitehead WE, Parker L, Bosmajian L, Morrill-Corbin ED, Middaugh S, Garwood M, Cataldo MF, Freeman J.

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Source: Archives of Physical Medicine and Rehabilitation. 1986 April; 67(4): 218-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3964054&dopt=Abstract ·

Treatment options for fecal incontinence. Author(s): Whitehead WE, Wald A, Norton NJ. Source: Diseases of the Colon and Rectum. 2001 January; 44(1): 131-42; Discussion 142-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11805574&dopt=Abstract

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Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagittal anorectoplasty (PSARP). Author(s): Martins JL, Pinus J. Source: Rev Paul Med. 1997 May-June; 115(3): 1427-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9532844&dopt=Abstract

·

Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele. Author(s): Wald A. Source: Pediatrics. 1981 July; 68(1): 45-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7243508&dopt=Abstract

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Biofeedback: a new modality in the management of children with fecal soiling. Author(s): Olness K, McParland FA, Piper J. Source: The Journal of Pediatrics. 1980 March; 96(3 Pt 1): 505-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7359249&dopt=Abstract

·

Liquid stool incontinence with severe urgency: anorectal function and effective biofeedback treatment. Author(s): Chiarioni G, Scattolini C, Bonfante F, Vantini I. Source: Gut. 1993 November; 34(11): 1576-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8244147&dopt=Abstract

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·

Practical and emotional aspects of soiling in children with anorectal anomalies. Possibilities for prevention and early intervention. Author(s): Vandvik IH, Odegaard B. Source: Z Kinderchir. 1981 August; 33(4): 321-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7324575&dopt=Abstract

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Studies of manometric abnormalities of the rectoanal region during defecation in constipated and soiling children: modification through biofeedback therapy. Author(s): Keren S, Wagner Y, Heldenberg D, Golan M. Source: The American Journal of Gastroenterology. 1988 August; 83(8): 827-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3394685&dopt=Abstract

Vocabulary Builder Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anomalies: Birth defects; abnormalities. [NIH] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU]

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Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Contractility: stimulus. [EU]

Capacity for becoming short in response to a suitable

Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]

Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU]

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Evacuation: An emptying, as of the bowels. [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Fluoroscopy: screen. [NIH]

Production of an image when x-rays strike a fluorescent

Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein Hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal

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h.) [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Inertia: Inactivity, inability to move spontaneously. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Micturition: The passage of urine; urination. [EU]

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Musculature: The muscular apparatus of the body, or of any part of it. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Parturition: The act or process of given birth to a child. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after

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birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]

Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: Occurring after a surgical operation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Prosthesis: A man-made substitute for a missing body part such as an arm or a leg; also an implant such as for the hip. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflux: A backward or return flow. [EU] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU]

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Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Visceral: , from viscus a viscus) pertaining to a viscus. [EU]

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CHAPTER 4. PATENTS ON FECAL INCONTINENCE Overview You can learn about innovations relating to fecal incontinence by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.21 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with fecal incontinence within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with fecal incontinence. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

21Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Patents on Fecal Incontinence By performing a patent search focusing on fecal incontinence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on fecal incontinence: ·

Devices and methods for assessment and treatment of urinary and fecal incontinence Inventor(s): Benderev; Theodore V. (26975 Magnolia Ct., Laguna Hills, CA 92653) Assignee(s): none reported Patent Number: 6,110,099 Date filed: July 16, 1998 Abstract: Apparatus and methods for treating urinary and fecal incontinence, urinary drainage, and prolapse. In the first preferred embodiment, the invention comprises a device body insertable into an anatomical passageway and includes a stimulus-producing device disposed therein to provide a signal to the user to perform pelvic strengthening exercises or alternatively, an exercise monitoring device for monitoring exercise activity. In an embodiment for facilitating urinary drainage, there is provided an annular base panel coupled to an anchor member, the latter being designed to anchor the device within an anatomical passageway, such as the vagina. A port formed on the annular panel is provided to mate with the urethral meatus so that a continuous conduit is formed between the urethral meatus and the port. The various embodiments disclosed may further be utilized as pessary devices to provide structural support to the pelvis or utilized to construct customized pessary devices. Excerpt(s): The present invention relates generally to medical devices and methods, and more particularly to devices and methods for evaluating and treating urinary and fecal incontinence by using proprioceptive neuromuscular facilitation and sensation, as well as devices and methods to facilitate urinary drainage and pelvic organ support. ... The

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management apparatus modes of treatment generally comprise absorbent and/or catheter structures worn by a user to retain any urinary and/or fecal incontinence. In their simplest forms, such devices comprise diaperlike structures which must be periodically changed by the user. Although such management apparatus has proven generally effective in masking the results of incontinence, they are uncomfortable to wear, difficult to change, and oftentimes fail during use thereby embarrassing the user. ... The use of behavioral training as a treatment for urinary and/or fecal incontinence can involve numerous behavioral techniques including; bladder re-training (e.g., voiding on a timed schedule), and/or the performance of exercises (e.g., Kegel exercises) to strengthen and retrain a group of muscles collectively known as the "pelvic floor muscles." As an adjunct to these behavioral training techniques, various intravaginal and/or intra-anal devices may be utilized to facilitate the performance of such pelvic muscle training exercises. Such intravaginal and/or intra-anal devices have included simple weighted apparatus such as pessaries or intravaginal cones. Exemplary of such prior art pessaries are the pessaries manufactured by Milex Wester Company, 639 North Fairfax, Los Angeles, Calif. 90036; while an example of such weighted cone device is the "FEMINA" cone manufactured by Dacomed Corporation, 1701 East 79th Street, Minneapolis, Minn., 55425. Other types of prior art devices include pneumatic-type devices and electromyographic (EMG) transducers or sensors which are insertable into or placed just outside of the vagina and/or anus to obtain EMG data indicative of baseline pelvic floor muscle tone and/or contraction(s) of the pelvic floor muscles during the performance of specific muscle contraction exercises. Such EMG data may be usable for diagnostic purposes as well as for monitoring the performance and/or effect of muscle training exercises. Some EMG devices have included means for providing visual or auditory feedback to assist the patient in the performance of pelvic floor muscle exercises (e.g., Myoexorciser III, available from Verimed 1401 East Broward Boulevard, Suite 200, Fort Lauderdale, Fla. 33301 and the PRS 8900 Office System made by Incare Medical Products, Libertyville, Ill. 60048. Web site: http://www.delphion.com/details?pn=US06110099__

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·

Fecal incontinence device and method Inventor(s): Klingenstein; R. James (151 Tremont St., Apt. 23E, Boston, MA 02111) Assignee(s): none reported Patent Number: 6,096,057 Date filed: January 30, 1997 Abstract: Provided is a device to control fecal incontinence and methods for its use. The device comprises a longitudinal tubular member having attached thereto bilaterally-extending wings for securing the device while in use. The device also comprises an expandable portion for prevention of unwanted defecation during use of the device. Excerpt(s): The invention relates to rectal continence devices and methods which permit comfortable sitting, standing, and walking. Devices and methods of the invention are useful for treating fecal incontinence. ... Fecal incontinence typically is a source of physical discomfort and the cause of social and personal debilitation. It is most likely to affect the aged or individuals suffering from neurological trauma. However, abnormalities in stool volume or consistency, colonic transit, anal sphincter function, anorectal sensation, or anorectal reflexes also may result in incontinence. Madoff, et al., New. Eng. J. Med., 326:1002-1007 (1992). Finally, a significant number of incontinence cases involve postpartum pelvic neuropathies, and thus may affect women at a relatively young age. ... Mild cases of fecal incontinence typically are treated by instituting dietary changes. Biofeedback therapies also have been proposed in which a balloon, inserted in the rectum, provides a sensation similar to that of stool immediately prior to voiding. The patient is trained to perceive differing volumes of distention in the balloon and to respond accordingly by contracting and relaxing the anal sphincter muscles. See, e.g., Cerulli, et al., Gastroenterology, 76: 742-746 (1979). Web site: http://www.delphion.com/details?pn=US06096057__

·

Anal patch for fecal incontinence Inventor(s): Cox; Brian J. (10191 Lebanon Dr., Cupertino, CA 95014) Assignee(s): none reported Patent Number: 5,695,484 Date filed: December 12, 1995

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Abstract: An anal patch for controlling fecal incontinence comprising a polymeric body member adapted to be fitted into the natal cleft about the anal opening and secured to the natal cleft with a releasable adhesive material. Excerpt(s): This invention relates to the field of medical devices used to control fecal incontinence in patients. In particular, the present invention is directed to an anal patch removably attached to the natal cleft surrounding the anal opening for closure or damming of the anal opening. ... Fecal incontinence is an extremely uncomfortable, inconvenient and embarrassing condition from which a substantial number of human beings suffer due to disease, such as nerve compression impairment or degeneration, surgical impairment due to radical surgery in the lower spine or in the anal or rectal zones of the body, injury such as spinal column injuries, or old age. A number of solutions to this problem have been suggested, unfortunately none of them have been successful enough to be utilized commercially. At the present time, most people that suffer from fecal incontinence wear large diapers and/or plastic or rubber underpants and practice bowel control by dietary control and a bowel release regimen to prevent soiling and odors associated with fecal incontinence. Fecal incontinence has a number of serious hygienic problems associated with it which requires constant monitoring. People suffering from fecal incontinence normally require the attendance of a nurse or other medical helper once a day. ... The present invention, in its broadest terms, comprises a pad having a biocompatible adhesive on one side. The pad is adapted to be inserted into the natal cleft about the anal opening to form a removable seal having sufficient adhesive power to occlude the anal opening and prevent the leakage or discharge of fecal material. The use of the anal patch permits the patient suffering from fecal incontinence to develop a bowel movement regimen, so that the patient can have a better quality of life. Such a regimen is considered therapeutic and healthful since it ferments the colon and the rectum areas to reabsorb moisture from the fecal material in a matter that is considered normal for human discharge to develop firm stools. It has been found that patients who suffer from fecal incontinence have a tendency to discharge watery stools causing the loss of water and nutrients to the body. The formation of firm stools in the rectum and colon also improves the tone of these organs to exhibit peristaltic muscle contractions. Web site: http://www.delphion.com/details?pn=US05695484__

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·

Use of modafinil for the treatment of urinary and fecal incontinence Inventor(s): Laurent; Philippe (Oullins, FR) Assignee(s): Laboratoire L. Lafon (Maisons Alfort, FR) Patent Number: 5,401,776 Date filed: October 18, 1993 Abstract: The present invention relates to the use of modafinil for the manufacture of a medicinal product for the treatment of urinary and fecal incontinence and urethrovesical and anal sphincteral disorders. Excerpt(s): Consequently, the subject of the present invention is the use of modafinil for the manufacture of a medicinal product for the treatment of urinary and fecal incontinence and urethrovesical and anal sphincteral disorders. ... The results of pharmacological, pharmacoclinical and clinical trials demonstrating the effects of modafinil on the sphinteral activity as well as on urinary and/or fecal incontinence of neurological origin will be given below. Web site: http://www.delphion.com/details?pn=US05401776__

·

Fecal incontinence receptacle and methods of use Inventor(s): Christian; Delores J. (3878 Riveria Dr., San Diego, CA 92109) Assignee(s): none reported Patent Number: 4,784,656 Date filed: April 23, 1987 Abstract: A new and improved receptacle for collecting fecal matter from incontinent patients and in particular bedridden incontinent patients is disclosed. The fecal incontinence receptacle comprises generally a gasket for sealingly engaging an area substantially adjacent to a stoma or anus of a wearer to form a liquid-tight seal therebetween, a conduit joined to the gasket for providing a passageway for discharge received from the stoma or anus of the wearer to pass therethrough, and a disposable receptacle detachably connected to the conduit for collecting and disposing of fecal matter received from the conduit. The gasket comprises generally a flexible plastic material having an adhesive coating on one surface with a removeable protective sheet covering the adhesive coating. The receptacle comprises generally an opening at one end for detachably connecting the receptacle to the bottom opening of the conduit. The contents collected in the receptacle may then be disposed of by disconnecting the receptacle from the conduit for disposing of the

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contents collected therein without disconnecting the gasket from the wearer. A new or previously cleaned receptacle may be connected to the conduit. In addition, preferably the conduit of the fecal collecting receptacle is provided with venting capability for permitting gases accumulated therein to escape therefrom, passage capability for permitting an instrument, such as a thermometer, to be inserted into the receptacle for contact with the wearer and deodorizing capability for deodorizing undesirable odors emanating from the fecal matter collected in the receptacle. Excerpt(s): The present invention relates generally to a fecal incontinence collecting device and more particularly to an incontinence device for collecting fecal matter from the anus of a person. ... While numerous attempts in the past have been made to correct the shortcomings discussed above, the disadvantages stated are still encountered with the fecal incontinence bags available today. Consequently, there exist definite needs for an economical fecal incontinence receptacle that can effectively and conveniently eliminate the above mentioned problems. ... In a further feature of the present invention, the fecal incontinence receptacle provides a bag which automatically releases gas discharged from the stoma or anus to the environment thereby eliminating undesirable inflation of the bag. Web site: http://www.delphion.com/details?pn=US04784656__

Patent Applications on Fecal Incontinence As of December 2000, U.S. patent applications are open to public viewing.22 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to fecal incontinence: ·

Method for treating fecal incontinence Inventor(s): Silverman, David E. ; (Palo Alto, CA), Stein, Alan ; (Moss Beach, CA) Correspondence: FLEHR HOHBACH TEST ALBRITTON & HERBERT LLP; Suite 3400; Four Embarcadero Center; San Francisco; CA; 941114187; US Patent Application Number: 20020019579 Date filed: June 15, 2001

22

This has been a common practice outside the United States prior to December 2000.

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Abstract: A method for treating fecal incontinence in a body of a mammal having a rectum formed by a rectal wall extending to an anus wherein the rectal wall includes a sphincter muscle surrounding the anus. At least one nonaqueous solution is introduced into the rectal wall in the vicinity of the anus. A nonbiodegradable solid is formed in the rectal wall from the at least one nonaqueous solution. Excerpt(s): This invention pertains to the treatment of the gastrointestinal tract and, more particularly, to the treatment of fecal incontinence. ... Fecal incontinence, which is most common in the elderly, is the loss of voluntary control to retain stool in the rectum. In most cases, fecal incontinence is the result of an impaired involuntary internal anal sphincter. The internal sphincter may be incompetent due to laxity or discontinuity. Discontinuity, or disruption of the internal anal sphincter, can be caused by a number of different muscle injuries. ... In most patients, fecal incontinence is initially treated with conservative measures, such as biofeedback training or alteration of the stool consistency. Biofeedback is successful in approximately two-thirds of patients who retain some degree of rectal sensation and functioning of the external anal sphincter. However, multiple sessions are often necessary, and patients need to be highly motivated. Electronic home biofeedback systems are available and may be helpful as adjuvant therapy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with fecal incontinence, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “fecal incontinence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on fecal incontinence. You can also use this procedure to view pending patent applications concerning fecal incontinence. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

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Vocabulary Builder Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Perineal: Pertaining to the perineum. [EU] Pessary: 1. an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. a medicated vaginal suppository. [EU] Senility: Old age; the physical and mental deterioration associated with old age. [EU]

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CHAPTER 5. BOOKS ON FECAL INCONTINENCE Overview This chapter provides bibliographic book references relating to fecal incontinence. You have many options to locate books on fecal incontinence. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on fecal incontinence include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “fecal incontinence” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on fecal incontinence:

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Pediatric Clinical Gastroenterology. 4th ed Source: St. Louis, MO: Mosby-Year Book, Inc. 1995. 1065 p. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive. St. Louis, MO 63146. (800) 426-4545 or (800) 325-4177 or (314) 8728370. Fax (314) 432-1380. PRICE: $100 (as of 1995). ISBN: 0815174063. Summary: This textbook of pediatric clinical gastroenterology presents 37 chapters in 5 sections: symptoms and signs; diseases of the gastrointestinal tract; diseases of the liver; diseases of the pancreas; and nutritional support. Specific topics include gastrointestinal (GI) emergencies of the neonate; intestinal obstruction; sucking and swallowing disorders; diseases of the esophagus; disorders of the stomach and duodenum; diarrheal disorders; carbohydrate intolerance; malabsorption syndrome; protein losing gastroenteropathy; immune homeostasis and the gut; inflammatory bowel diseases; constipation, fecal incontinence, and proctologic conditions; functional recurrent abdominal pain; parasitic and fungal disease of the GI tract; neonatal unconjugated hyperbilirubinemias; neonatal hepatitis; prolonged obstructive jaundice; acute and chronic viral hepatitis; bacterial, rickettsial, and parasitic infections and infestations; fulminant hepatic failure and hepatic coma; cirrhosis; portal hypertension; inborn errors of metabolism; hepatic tumors; liver transplantation; congenital anomalies and heredity disorders; cystic fibrosis; pancreatitis and pancreatic tumors; energy and nutrient requirements; infant feeding; and enteral and parenteral alimentation. Each chapter includes numerous references and a subject index concludes the volume.

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Keeping Control: Understanding and Overcoming Fecal Incontinence Source: Baltimore, MD: Johns Hopkins University Press. 1994. 166 p. Contact: Available from Johns Hopkins University Press. Box 50370, Baltimore, MD 21211-4370. (800) 537-5487. Fax (410) 516-6998. PRICE: $29.95 (hardcover) or $12.95 (paperback). ISBN: 0801849152 (hardcover) or 0801849160 (paperback). Summary: This book is an information resource about the causes and important advances in treatment and management of fecal incontinence. Topics include the digestive system and normal continence; how to keep a symptom diary; working with a physician to find the cause of the problem; what to expect during diagnostic tests; behavioral treatment techniques such as biofeedback and habit training; ways to cope when incontinence cannot be completely overcome; when to consider surgery; the effects on intimacy and sexual relations; special considerations for older people with incontinence; special considerations for children with

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incontinence, including a step by step bowel training program; and products that can help when treatment is not entirely successful. The book includes a glossary of terms and information about contacting support groups and using additional resources. ·

Continence with Biofeedback: New Treatment for Fecal Incontinence Source: Carmichael, CA: Avantage Publications. 1991. 174 p. Contact: Available from Avantage Publications. P.O. Box 489, Carmichael, CA 95609-0489. (916) 944-7454. PRICE: $24.95 plus shipping and handling. ISBN: 0963033956. Summary: This book provides a comprehensive literary review and discussion of the medical problems and therapy essential to the management of organic fecal incontinence. The author focuses on the use of biofeedback intervention for bowel disorders associated with a number of medical conditions. Six chapters cover topics including the history of biofeedback for fecal incontinence, anorectal anatomy and physiology, biofeedback requirements and goals, biofeedback training, and biofeedback research. A concluding chapter includes a bibliography, glossary, and subject index. 6 figures. 38 references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to fecal incontinence (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

A colour atlas of faecal incontinence and complete rectal prolapse by M. M. Henry; ISBN: 072341016X; http://www.amazon.com/exec/obidos/ASIN/072341016X/icongroupi nterna

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A Colour Atlas of Fecal Incontinence and Complete Rectal Prolapse (Single Surgical Procedures Series, Vol 32) by N.H. Porter, M. M. Henry; ISBN: 0815142811; http://www.amazon.com/exec/obidos/ASIN/0815142811/icongroupin terna

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A Practical Guide to Bowel and Bladder Retraining of the Elderly Client (Briggs Guidebook Series) by Helyn S. Agee (1988); ISBN: 094135301X; http://www.amazon.com/exec/obidos/ASIN/094135301X/icongroupi nterna

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Children Who Soil: Assessment and Treatment by Ann Buchanan, Graham Clayden; ISBN: 0471934798; http://www.amazon.com/exec/obidos/ASIN/0471934798/icongroupin terna

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Colorectal Physiology: Fecal Incontinence by Johannes Hendrikus Cornelis Kuijpers (1994); ISBN: 0849345650; http://www.amazon.com/exec/obidos/ASIN/0849345650/icongroupin terna

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Constipation and Fecal Incontinence and Motility Disturbances of the Gut (Progress in Pediatric Surgery, Vol 24) by J. Yokoyama, T.A. Angerpointner (Editor) (1989); ISBN: 0387508139; http://www.amazon.com/exec/obidos/ASIN/0387508139/icongroupin terna

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Continence Promotion in General Practice (Practical Guides for General Practice 13 Oxford Medical Publications) by Nigel Smith, et al (1995); ISBN: 0192620436; http://www.amazon.com/exec/obidos/ASIN/0192620436/icongroupin terna

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Continence With Biofeedback: New Treatment for Fecal Incontinence by Susan Trunnell (1991); ISBN: 0963033956; http://www.amazon.com/exec/obidos/ASIN/0963033956/icongroupin terna

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Coping With Bowel and Bladder Problems (Coping With Aging Series) by Barbara Doherty King, Judy Harke (1994); ISBN: 1565930681; http://www.amazon.com/exec/obidos/ASIN/1565930681/icongroupin terna

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Diagnosis and Treatment of Fecal Incontinence by Giovanni Romano, et al (2000); ISBN: 192864919X; http://www.amazon.com/exec/obidos/ASIN/192864919X/icongroupi nterna

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Elektromanometrie des Enddarmes : Diagnostik d. Inkontinenz u. chron. Obstipation by Alexander Holschneider; ISBN: 354107941X; http://www.amazon.com/exec/obidos/ASIN/354107941X/icongroupi nterna

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Faecal incontinence ; ISBN: 9068270117; http://www.amazon.com/exec/obidos/ASIN/9068270117/icongroupin terna

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Fecal Incontinence by J. A. Barrett (1993); ISBN: 0340543612; http://www.amazon.com/exec/obidos/ASIN/0340543612/icongroupin terna

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Female Pelvic Floor Disorders: Investigation and Management by J. Thomas Benson (Editor); ISBN: 0393710130; http://www.amazon.com/exec/obidos/ASIN/0393710130/icongroupin terna

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Incontinence by Malcolm Lucas (Editor), et al; ISBN: 0632050039; http://www.amazon.com/exec/obidos/ASIN/0632050039/icongroupin terna

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Incontinence : bibliography by Dorothy Mandelstam; ISBN: 0906544068; http://www.amazon.com/exec/obidos/ASIN/0906544068/icongroupin terna

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Incontinence and its management ; ISBN: 0709900880; http://www.amazon.com/exec/obidos/ASIN/0709900880/icongroupin terna

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Incontinence and Its Management (1986); ISBN: 0709935803; http://www.amazon.com/exec/obidos/ASIN/0709935803/icongroupin terna

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Incontinence and Its Management by Dorothy Mandelstam (Editor) (1986); ISBN: 0412340402; http://www.amazon.com/exec/obidos/ASIN/0412340402/icongroupin terna

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Incontinence in the elderly ; ISBN: 0127570500; http://www.amazon.com/exec/obidos/ASIN/0127570500/icongroupin terna

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Keeping Control : Understanding and Overcoming Fecal Incontinence (A Johns Hopkins Health Book) by Marvin M. Schuster, Jacqueline Wehmueller (1994); ISBN: 0801849152; http://www.amazon.com/exec/obidos/ASIN/0801849152/icongroupin terna

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Management of incontinence in the home : a survey by Patricia Dobson; ISBN: 090190824X; http://www.amazon.com/exec/obidos/ASIN/090190824X/icongroupi nterna

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Neurobiology of Incontinence - Symposium No. 151 ; ISBN: 0471926876; http://www.amazon.com/exec/obidos/ASIN/0471926876/icongroupin terna

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Nursing for Continence by Katherine F. Jeter, et al (1990); ISBN: 0721628923; http://www.amazon.com/exec/obidos/ASIN/0721628923/icongroupin terna

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Nursing the incontinent by Eric Edmondson; ISBN: 0407853200; http://www.amazon.com/exec/obidos/ASIN/0407853200/icongroupin terna

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Pelvic floor re-education : principles and practice ; ISBN: 3540198601; http://www.amazon.com/exec/obidos/ASIN/3540198601/icongroupin terna

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Pelvic Floor Re-Education: Principles and Practice by B. Schussler (1994); ISBN: 0387198601; http://www.amazon.com/exec/obidos/ASIN/0387198601/icongroupin terna

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People Don't Understand: Children, Young People & Their Families Coping With a Hidden Disability by Judith Cavet (1998); ISBN: 1900990245; http://www.amazon.com/exec/obidos/ASIN/1900990245/icongroupin terna

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Solving Children's Soiling Problems: A Handbook for Health Professionals by Jackie Bracey (2002); ISBN: 0443071446; http://www.amazon.com/exec/obidos/ASIN/0443071446/icongroupin terna

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Surgical treatment of anal incontinence by Charles V. Mann; ISBN: 3540196404; http://www.amazon.com/exec/obidos/ASIN/3540196404/icongroupin terna

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The Promotion of Continence in Adult Nursing by David Colburn, D. Colborn (1994); ISBN: 0412494604; http://www.amazon.com/exec/obidos/ASIN/0412494604/icongroupin terna

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Urinary & Fecal Incontinence: Nursing Management by Dorothy B. Doughty (Editor); ISBN: 0815129122; http://www.amazon.com/exec/obidos/ASIN/0815129122/icongroupin terna

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Urinary and Fecal Incontinence (1991); ISBN: 9991851968; http://www.amazon.com/exec/obidos/ASIN/9991851968/icongroupin terna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “fecal incontinence” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:23 ·

Biofeedback for the treatment of fecal incontinence. Author: ECRI; Year: 1998; Plymouth Meeting, PA: ECRI, 1998

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Caring for the person with faecal incontinence: a compassionate approach to management. Author: by Karen Cavarra, Andrea Prentice, Cynthea Wellings; Year: 1998; Melbourne: AUSMED Publications, 1998; ISBN: 0958717141

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Caring for the person with faecal incontinence: a compassionate approach to the management of faecal incontinence for the state enrolled nurse: a self instructional learning. Author: teaching package / by Karen Cavarra, Andrea Prentice & CyntheaWellings; clinic; Year: 1991; Melbourne University, Vic.: Ausmed Publications, c1991; ISBN: 0646029878

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Clinical handbook for continence care. Author: Brenda Roe, Kate Williams; Year: 1994; London: Scutari Press, 1994; ISBN: 1871364981

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Clinical nursing practice: the promotion and management of continence. Author: Brenda H. Roe, editor; Year: 1992; New York: Prentice Hall, 1992; ISBN: 0131382071

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Colorectal physiology: fecal incontinence. Author: edited by Han C. Kuijpers; Year: 1994; Boca Raton: CRC Press, c1994; ISBN: 0849345650 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0849345650/icongroupin terna

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Continence: promotion and management by the primary health care team: consensus guidelines. Author: Denise Button... [et al.]; Year: 1998; London: Whurr Publishers, 1998; ISBN: 1861560788 http://www.amazon.com/exec/obidos/ASIN/1861560788/icongroupin terna

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Continence with biofeedback: new treatment for fecal incontinence. Author: Susan Trunnell; foreword by Arnold Wald; Year: 1991; Carmichael, CA: Avantage Publications, 1991; ISBN: 0963033956 http://www.amazon.com/exec/obidos/ASIN/0963033956/icongroupin terna

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Faecal incontinence and related problems in the older adult. Author: J.A. Barrett; Year: 1993; London; Boston: E. Arnold; Boston, MA: Distributed in the Americas by Little, Brown, 1993; ISBN: 0340543612 http://www.amazon.com/exec/obidos/ASIN/0340543612/icongroupin terna

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Incontinence: causes, management, and provision of services. Author: Mann, Charles V; Year: 1995; London: Royal College of Physicians of London, c1995; ISBN: 187324097X

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Incontinence: diagnosis and management in general practice. Author: by Jacqueline V. Jolleys; Year: 1994; London: Royal College of General Practitioners, 1994; ISBN: 085084200X

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Incontinence in the elderly. Author: Gerald W. Tobin; Year: 1992; London: E. Arnold, c1992; ISBN: 0340545585 http://www.amazon.com/exec/obidos/ASIN/0340545585/icongroupin terna

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Incontinence. Author: edited by Malcolm Lucas, Simon Emery, John Beynon; Year: 1999; Oxford; Malden, MA.: Blackwell Science, 1999; ISBN: 0632050039 http://www.amazon.com/exec/obidos/ASIN/0632050039/icongroupin terna

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Management of incontinence: an information paper. Author: Anthony Lea; Year: 1993; Canberra: Australian Govt. Pub. Service, [1993]

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Pelvic floor dysfunction: investigations & conservative treatment. Author: editors, R.A. Appell, A.P. Bourcier, F. La Torre; Year: 1999; Rome: Casa Editrice Scientifica Internazionale, c1999; ISBN: 8886062435

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Pelvic floor re-education: principles and practice. Author: [edited by] B. Schüssler ... [et al.]; Year: 1994; London; New York: Springer-Verlag, c1994; ISBN: 3540198601 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540198601/icongroupin terna

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Placement of artificial bowel sphincters in the management of faecal incontinence: final assessment report. Author: Carrière, Beate, 1943-; Year: 1999; Canberra, ACT: Medicare Services Advisory Committee, 1999; ISBN: 0642415757

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Promoting continence: clinical audit for the management of urinary and faecal incontinence. Author: prepared by John Brocklehurst; [Research Unit of the Royal College of Physicians]; Year: 1998; London: The College, 1998; ISBN: 1860160530

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Promoting continence in the nursing home: a resource for nurses working in aged care. Author: edited by Susan Hunt; Year: 1993; Collingwood, Vic.: Continence Foundation of Australia, 1993; ISBN: 0646135600

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Promotion of continence in adult nursing. Author: David Colborn; Year: 1994; London; New York: Chapman & Hall; San Diego, Calif.: Distributed in the USA and Canada by Singular Pub. Group, 1994; ISBN: 0412494604 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0412494604/icongroupin terna

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Report of the triangulation study of incontinence in a Victorian geriatric hospital. Author: by Louis P.C. Wong, Kwei C. Cheung; Year: 1992; St. Albans: Victoria University of Technology, 1992; ISBN: 1875338101

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Solving children's soiling problems: a handbook for health professionals. Author: Jackie Bracey; Year: 2002; Edinburgh; New York: Churchill Livingstone, 2002; ISBN: 0443071446 http://www.amazon.com/exec/obidos/ASIN/0443071446/icongroupin terna

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Surgical treatment of anal incontinence. Author: Charles V. Mann, Richard E. Glass; illustrations by B. Hyams, R. Lane and G. Oliver; Year: 1997; London; New York: Springer, c1997; ISBN: 354076061X (hardback: alk. paper) http://www.amazon.com/exec/obidos/ASIN/354076061X/icongroupi nterna

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Therapeutic management of incontinence and pelvic pain: pelvic organ disorders. Author: J. Laycock and J. Haslam (eds.); Year: 2002; London; New York: Springer, c2002; ISBN: 1852332247 (alk. paper)

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http://www.amazon.com/exec/obidos/ASIN/1852332247/icongroupin terna ·

Urinary and fecal incontinence: nursing management. Author: [edited by] Dorothy B. Doughty; Year: 2000; St. Louis: Mosby, c2000; ISBN: 0815129122 http://www.amazon.com/exec/obidos/ASIN/0815129122/icongroupin terna

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Urogynecology and reconstructive pelvic surgery. Author: edited by Mark D. Walters, Mickey M. Karram; Year: 1999; St. Louis: Mosby, c1999; ISBN: 0815136714 http://www.amazon.com/exec/obidos/ASIN/0815136714/icongroupin terna

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Urogynecology and reconstuctive pelvic surgery. Author: volume editor, J. Thomas Benson; with 14 contributors; Year: 2000; Philadelphia: Current Medicine; New York: McGraw-Hill, Health Professions Division, c2000; ISBN: 0838503209 http://www.amazon.com/exec/obidos/ASIN/0838503209/icongroupin terna

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Using biofeedback with the elderly. Author: Engel, Bernard T; Year: 1978; [Bethesda Md.]: U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, [1978]

Chapters on Fecal Incontinence Frequently, fecal incontinence will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with fecal incontinence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and fecal incontinence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “fecal incontinence” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on fecal incontinence: ·

Everything You Ever Wanted to Ask a Gastroenterologist Source: in Magee, E. Tell Me What to Eat If I Have Irritable Bowel Syndrome. Franklin Lakes, NJ: Career Press, Inc. 2000. p. 12-23.

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Contact: Available from Career Press, Inc. 3 Tice Road, P.O. Box 687, Franklin Lakes, NJ 07417. (800) 227-3371. Website: www.careerpress.com or www.newpagebooks.com. PRICE: $10.99 plus shipping and handling. Summary: This chapter is from a book that offers eating and nutrition guidelines for people who have been diagnosed with irritable bowel syndrome (IBS). People with IBS have bowels that tend to overreact in certain situations. Whatever affects the bowels of the population at large, such as diet, hormones, or stress, affects those of people with IBS even more, resulting in the symptoms of the disorder. This introductory chapter answers common questions about IBS ('everything you ever wanted to ask a gastroenterologist'). IBS is described as a common disorder of the intestines that can lead to crampy abdominal pain, gassiness (flatulence), bloating, changes in bowel habits (diarrhea, constipation, or both), a feeling of incomplete emptying of the bowel, and passing mucus with bowel movements. The symptoms range from mildly annoying (for most patients) to disabling (for a few patients), and tend to fluctuate over time. The author explores the hypotheses for the causes of IBS, including a trigger such as flu or food poisoning, the role of hormones (many women have more IBS symptoms during their menstruation), genetics, childhood constipation and colic, and childhood physical or sexual abuse. There is no standard way of treating IBS and there is no drug available to cure the discomfort of an irritable bowel. There are some medications that can help relieve symptoms in some people. Stress may worse IBS symptoms by stimulating colonic spasm is people with IBS. Three types of psychotherapy may be helpful for IBS patients: brief psychodynamic therapy, cognitive behavioral therapy, and hypnosis. The author cautions that some symptoms (gastrointestinal bleeding, fever, weight loss, nocturnal symptoms, fecal incontinence, persistent severe pain) are not part of IBS and may indicate another problem that should be investigated. 2 tables. 1 reference. ·

Solving Gastrointestinal Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 249-262. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter on solving gastrointestinal (GI) problems is from a patient education handbook on managing diabetes related problems. People with diabetes are more likely to have neuropathy (nerve damage) and experience problems with the GI tract, from the mouth to the rectum.

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The author discusses gastroparesis (delayed GI motility, particularly stomach emptying), gastroesophageal reflux (stomach acid backing up into the esophagus), diarrhea (and fecal incontinence), constipation, and abdominal pain. For each condition, the author describes the symptoms, provides suggestions for handling the problem, outlines treatment options, and discusses preventive strategies. The diagnostic tests for these conditions are described, including stomach emptying tests, gastroscopy, tests for neuropathy, food diaries, and upper GI x-ray. The chapter is written to help patients understand these GI problems and enable them to incorporate practical preventive strategies into their daily lives. ·

Fecal Incontinence Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 637-645. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 8746418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Fecal incontinence (involuntary loss of stool) is a socially limiting and embarrassing disorder that may occur in persons of all ages. This chapter on fecal incontinence is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. Although fecal incontinence may occur in otherwise healthy individuals with acute episodes of diarrhea, chronic incontinence is most often associated with neurologic or myopathic disorders affecting critical anorectal continence mechanisms. Risk factors for fecal incontinence include female gender, increasing age, physical limitations, and poor general health. The successful management of fecal incontinence requires an understanding of anorectal function, careful definition of the disorder by a detailed history and physical examination, and specialized studies of anorectal and pelvic floor function in selected patients. A variety of diagnostic tests may be used to investigate the cause of incontinence and to select treatment modalities that allow the patient to resume a normal life. Tests used include sigmoidoscopy, anorectal manometry, pelvic floor neurophysiologic tests, proctography, and anal ultrasonography. Therapeutic options include dietary modifications, drug therapy, biofeedback, and surgery. 11 figures. 3 tables. 15 references.

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Gastrointestinal Disease in the Aged Source: in Reichel, W., et al., eds. Care of the Elderly: Clinical Aspects of Aging. 4th ed. Baltimore, MD: Williams and Wilkins. 1995. p. 198-205. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 4478438 or (410) 528-8550. PRICE: $69.00 (as of 1996). ISBN: 0683072099. Summary: This chapter on gastrointestinal (GI) disease in the aged is from a text on the clinical aspects of aging. This chapter covers problems associated with the esophagus, the stomach, the small bowel and pancreas, and the colon and rectum; liver disease; biliary disease; and pancreatic disease. Specific conditions discussed include appendicitis, heartburn, dysphagia, drug-induced gastritis, gastroparesis, lactose intolerance, inflammatory bowel disease, diverticulosis, colon cancer, constipation, fecal incontinence, irritable bowel syndrome, jaundice, hepatitis, gallstones, pancreatitis, and pancreatic cancer. 1 table. 22 references.

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Managing Fecal Incontinence Source: in King, B.D. and Harke, J. Coping with Bowel and Bladder Problems. San Diego, CA: Singular Publishing. 1994. p. 163-169. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. PRICE: $18.95. ISBN: 1565930681. Summary: This chapter, from a book in the Coping with Aging Series, a group of books written for men and women coping with the challenges of aging, addresses the management of fecal incontinence. The authors note that fecal incontinence is not considered part of normal aging. Specific topics include fecal impaction, including clearing the bowel, establishing a bowel program to prevent future impaction, and the role of habit training; structural incontinence; neurogenic incontinence and the role of scheduled toileting; electrical stimulation; biofeedback; and surgical options. The authors stress that it is crucial to understand the specific cause of a patient's incontinence before choosing an appropriate therapeutic course.

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Gastrointestinal Conditions Source: in Loeb, S., ed. Teaching Patients with Chronic Conditions. Springhouse, PA: Springhouse Corporation. 1992. p. 408-480.

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Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, Springhouse, PA 19477. (800) 346-7844. PRICE: $29.95; plus $3.50 shipping and handling. ISBN: 0874344972. Summary: This chapter, from a book for nurses about education for patients with chronic conditions, addresses gastrointestinal conditions. Conditions covered include irritable bowel syndrome; inflammatory bowel disease; cirrhosis; chronic pancreatitis; hiatal hernia; constipation; and fecal incontinence. The chapter contains information about drug therapy for each condition, noting reactions and important teaching points. Each section lists teaching topics related to that area and provides numerous patient education handouts for photocopying and distribution to patients. Each section concludes with a list of sources of information and support and further readings. ·

Toileting: Encopresis Source: in Schroeder, C.S., and Gordon, B.N. Assessment and Treatment of Childhood Problems: A Clinician's Guide. New York, NY: Guildford Press. 1991. p. 176-200. Contact: Available from Guildford Press. 72 Spring Street, New York, NY 10012. (212) 431-9800. Fax (212) 966-6708. PRICE: $42.00. ISBN: 0898625653. Summary: This chapter on encopresis (fecal incontinence) is from a clinical guide to the assessment and treatment of childhood problems. The authors briefly review the definition and prevalence of encopresis, and then present recommended diagnostic and therapeutic procedures. Topics include assessment tools, information sharing with the parents and child, physical intervention (laxatives and cathartics), development of toileting skills, environmental interventions, changing the consequences of the behavior, family dynamics, retentive encopresis, diarrhetic encopresis, and manipulative encopresis. The chapter concludes with a detailed case study of an 8-year-old child with encopresis. 5 figures. 1 table.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to fecal incontinence have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on fecal incontinence. The Combined

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Health Information Database lists the following, which you may wish to consult in your local medical library:24 ·

Resource Guide: Products and Services for Incontinence Source: Spartanburg, SC: National Association for Continence. 199x. [104 p.]. Contact: Available from National Association for Continence (NAFC). (formerly Help For Incontinent People). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. PRICE: $10.00 plus $3.00 shipping and handling; free with membership. Summary: This directory, compiled by the National Association for Continence (formerly Help for Incontinent People, or HIP), lists products and services for incontinence. The resource guide was developed to assist people who are awaiting professional treatment for incontinence, people whose incontinence is presently being treated by a health professional, and for people whose incontinence cannot be cured. The guide is divided into five sections: product listings, manufacturers' index, distributors' index, mail and phone order index, and organizations and services index. The product listings section is divided into sixteen categories: disposable products, reusable products, external urinary devices and accessories, intermittent self-catheterization, fecal incontinence, skin care products, deodorizing products, nocturnal enuresis (bedwetting), pelvic muscle reeducation equipment, pelvic organ support devices, implanted devices, treatments for erectile dysfunction, medications, support surface equipment, miscellaneous, and educational materials. Each product description is illustrated with a simple line drawing. The directory is revised each year.

General Home References In addition to references for fecal incontinence, you may want a general home medical guide that spans all aspects of home healthcare. The following

You will need to limit your search to “Directories” and fecal incontinence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “fecal incontinence” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with fecal incontinence. You should check back periodically with this database as it is updated every three months. 24

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list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna

Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity;

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called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Catheterization: The employment or passage of a catheter. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Gastritis: Inflammation of the stomach. [EU]

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Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Immunization: The induction of immunity. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU]

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Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric

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juices. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU]

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CHAPTER 6. MULTIMEDIA ON FECAL INCONTINENCE Overview Information on fecal incontinence can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on fecal incontinence. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most disorders do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on fecal incontinence is the Combined Health Information Database. You will need to limit your search to “video recording” and “fecal incontinence” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “fecal incontinence” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on fecal incontinence:

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·

Gastroenterology for the Primary Care Physician Source: Mount Laurel, NJ: CME Conference Video, Inc. 1994. (instructional package). Contact: Available from CME Conference Video, Inc. 2000 Crawford Place, Suite 100, Mount Laurel, NJ 08054. (800) 284-8433. Fax (800) 2845964. PRICE: $450 plus $12.25 shipping and handling (as of 1995); group practice package available. Program No. 153. Summary: This continuing education course is designed to update internists, family practitioners, and other primary care physicians on new developments in gastroenterology. The format of the course focuses on case presentations emphasizing important and evolving concepts in gastroenterology. The emphasis is on practical diagnostic and therapeutic choices and the development of cost effective management algorithms. Topics include hepatitis C, non-cardiac chest pain, psychopharmacologic approaches to acid reduction, peptic ulcer disease, Helicobacter pylori, risk factors for NSAID injury, Clostridium difficile, travelers' diarrhea, constipation in the elderly, pancreatitis, endoscopic ultrasound, gastroesophageal reflux disease, Barrett's esophagus, liver disease, GI manifestations in AIDS, esophagitis, fecal incontinence, diagnostic testing, irritable bowel syndrome, inflammatory bowel disease, drug therapy, chronic diarrhea, gallstone disease, colon cancer, cirrhosis, and ascites. The program offers 11 hours of AMA-PRA Category 1 credit. (AA-M).

·

Approach to the Patient with Chronic Diarrhea Source: Secaucus, NJ: Network for Continuing Medical Education (NCME). 1993. Contact: Available from NCME. One Harmon Plaza, Secaucus, NJ 07094. (800) 223-0272 or, in New Jersey, (800) 624-2102, or (201) 867-3550. PRICE: $20 for 2-week rental or $50 for purchase. Available only to NCME subscribers; subscriber fees as of 1995 are $1,920 for VHS subscription, $2,120 for U-matic subscription. Summary: In this continuing education program, Dr. Asher Kornbluth guides viewers through the approach to the patient with chronic diarrhea. In the first section, Dr. Kornbluth presents a definition of chronic diarrhea, emphasizes the importance of obtaining a comprehensive, accurate patient history, and reviews the categories of chronic diarrhea, including altered motility, osmotic, inflammatory, secretory, and factitious. He briefly reviews conditions that may cause fecal incontinence, including advanced age, diabetes, and neuromuscular disease, and comments on HIV-associated diarrhea. In the second section,

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he reviews the diagnostic tests used to confirm the diagnosis, including stool examination tests such as culture and sensitivity; the upper GI series; the use of sigmoidoscopy; and endoscopy. The endoscopic differences between ulcerative colitis and Crohn's disease are demonstrated. Dr. Kornbluth concludes with a discussion of the drug treatments available and the indications for each, including opiates and their derivatives, absorbants, anticholinergic agents, agents for treating inflammatory bowel disease (IBD), and octreotide. The video program confers CME credit. (AA-M). ·

Managing Diarrhea and Fecal Incontinence Source: Libertyville, IL: Hollister Incorporated. 1992. (videocassette). Contact: Available from Hollister Incorporated. 2000 Hollister Drive, Libertyville, IL 60048. (800) 323-4060. PRICE: Single copy free. Summary: This videotape program guides nurses in managing diarrhea and fecal incontinence. The program features comments from various physicians and enterostomal therapy nurses. Topics include the timeconsuming nature of dealing with fecal incontinence, psychosocial factors, fecal incontinence in institutionalized patients, the etiology of fecal incontinence and diarrhea, patient assessment, the nursing role, and the drawbacks of three treatment methods currently in use (diapers, absorbent pads, and rectal tubes). The program then introduces a new product from Hollister, the drainable fecal incontinence collector, and describes its advantages.

Bibliography: Multimedia on Fecal Incontinence The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in fecal incontinence (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on fecal incontinence. For more information, follow the hyperlink indicated: ·

Approach to urinary incontinence in the elderly. Source: a production of the Wrightwood Group; Year: 1987; Format: Videorecording; [Los Angeles, Calif.]: Hospital Satellite Network, c1987

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·

Biofeedback training for fecal incontinence in geriatric patients. Source: produced by Marsha Stahler Love (NIA); Year: 1984; Format: Videorecording; Capitol Heights, MD: National AudioVisual Center, [1984]

·

Bowel and bladder retraining. Source: [presented by] American Journal of Nursing Co., Educational Services Division; Year: 1977; Format: Videorecording; New York: The Company, c1977

·

Bowel care of the spinal cord injury patient. Source: produced by Salt Lake City Regional Learning Resources Services for Spinal Cord Injury Service, VA Central Office, in conjunction with Long Beach VA Medical Center; Year: 1988; Format: Videorecording; [Washington, D.C.: Veterans Administration], 1988

·

Colon and rectal surgery. Source: American College of Surgeons; Year: 1991; Format: Sound recording; Chicago, Ill.: The College, [1991]

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Compendium of surgical procedures for female stress incontinence. Source: Brigham and Women's Hospital [and] Medical Video Services; Year: 1992; Format: Videorecording; Washington, DC: American College of Obstetricians & Gynecologists, [1992]

·

Electrically stimulated neosphincter for fecal incontinence. Source: from the Film Library and the Clinical Congress of ACS; Year: 1995; Format: Videorecording; Woodbury, CT: Ciné-Med, [1995]

·

Essentials of wound and incontinence care for nurses. Source: written by Diane Krasner; Year: 1994; Format: Electronic resource; Baltimore, Md.: Williams & Wilkins: Medi-Sim, c1994

·

Faecal incontinence. Source: produced by the University of Manchester, Department of Geriatric Medicine and the King's Fund Center, London, produced by MUTV, Manchester University Television Productions; Year: 1987; Format: Videorecording; [Manchester, Eng.]: The University, c1987

·

Gracilis muscle transposition for rectal incontinence. Source: produced by DG, Davis & Geck; Year: 1983; Format: Videorecording; Danbury, Conn.: Davis & Geck, [1983]

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Living with incontinence. Source: a presentation of Films for the Humanities & Sciences; Information Television Network; Year: 2000; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c2000

·

Modified transvaginal fascia lata sling for stress incontinence. Source: American College of Obstetricians & Gynecologists, SGS, the Society of Gynecologic Surgeons, Inc.; produced by Ciné-Med; Year: 1996; Format: Videorecording; Washington, DC: The College, c1996

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·

Overlapping sphincteroplasty and levatorplasty for anal incontinence. Source: from the Film Library and the Clinical Congress of the ACS; Division of Colon and Rectal Surgery, University of Minnesota; Year: 1994; Format: Videorecording; Woodbury, CT: Ciné-Med, [1994]

·

Sacral nerve stimulation for refractory urinary urge incontinence or urinary retention : assessment report. Source: [prepared by the Medicare Services Advisory Committee (MSAC)]; Year: 2000; Format: Electronic resource; Canberra, ACT: Medicare Services Advisory Committee, Dept. of Health and Aged Care, 2000

·

Stress incontinence treated by the tension-free vaginal tape method. Source: American College of Obstetricians and Gynecologists; Year: 2000; Format: Videorecording; Washington, DC: The College, [2000]

·

Surgical treatment of high intermuscular rectal abscess. Source: [production company unknown]; presented by Jack W. McElwain, Richard M. Alexander, M. Douglas Maclean; Year: 1964; Format: Motion picture; [S.l.: s.n., 1964]

·

Urinary incontinence : what you need to know; My aching heel: plantar fasciitis. Year: 2000; Format: Videorecording; Carrollton, TX: HSTN, c2000

Vocabulary Builder Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Cardiac: Pertaining to the heart. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU]

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Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Refractory: Not readily yielding to treatment. [EU]

Periodicals and News 113

CHAPTER 7. PERIODICALS INCONTINENCE

AND

NEWS

ON

FECAL

Overview Keeping up on the news relating to fecal incontinence can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on fecal incontinence. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover fecal incontinence beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on fecal incontinence is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “fecal incontinence” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.

Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to fecal incontinence. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “fecal incontinence” (or synonyms). The following was recently listed in this archive for fecal incontinence: ·

Radiofrequency therapy shows promise as treatment for fecal incontinence Source: Reuters Industry Breifing Date: June 07, 2002 http://www.reuters.gov/archive/2002/06/07/business/links/20020607 clin020.html

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Implanted stimulator effective for fecal incontinence Source: Reuters Medical News Date: May 22, 2002 http://www.reuters.gov/archive/2002/05/22/professional/links/20020 522drgd012.html

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FDA clears American Medical fecal incontinence device Source: Reuters Industry Breifing Date: December 19, 2001 http://www.reuters.gov/archive/2001/12/19/business/links/20011219 rglt005.html

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Sacral nerve stimulation shows promise as fecal incontinence treatment Source: Reuters Medical News Date: September 18, 2001 http://www.reuters.gov/archive/2001/09/18/professional/links/20010 918clin013.html

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·

Forceps delivery ups moms' fecal incontinence risk Source: Reuters Health eLine Date: August 16, 2001 http://www.reuters.gov/archive/2001/08/16/eline/links/20010816elin 007.html

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Forceps delivery increases fecal incontinence risk Source: Reuters Medical News Date: August 16, 2001 http://www.reuters.gov/archive/2001/08/16/professional/links/20010 816clin001.html

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Sacral nerve modulation reduces fecal incontinence in select patients Source: Reuters Medical News Date: June 04, 2001 http://www.reuters.gov/archive/2001/06/04/professional/links/20010 604clin005.html

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Episiotomy increases risk of fecal incontinence Source: Reuters Health eLine Date: January 07, 2000 http://www.reuters.gov/archive/2000/01/07/eline/links/20000107elin 001.html

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Episiotomy associated with greater risk of fecal incontinence Source: Reuters Medical News Date: January 07, 2000 http://www.reuters.gov/archive/2000/01/07/professional/links/20000 107clin004.html

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Fecal incontinence due to delivery worse after later babies Source: Reuters Health eLine Date: September 22, 1999 http://www.reuters.gov/archive/1999/09/22/eline/links/19990922elin 014.html

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Fecal incontinence common after childbirth Source: Reuters Health eLine Date: May 21, 1998 http://www.reuters.gov/archive/1998/05/21/eline/links/19980521elin 004.html

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·

Urinary Incontinence Plus Pelvic Organ Prolapse Associated With Fecal Incontinence Source: Reuters Medical News Date: March 04, 1997 http://www.reuters.gov/archive/1997/03/04/professional/links/19970 304epid001.html

·

New Surgical Procedure Effective For Correction Of Fecal Incontinence Source: Reuters Medical News Date: June 16, 1995 http://www.reuters.gov/archive/1995/06/16/professional/links/19950 616clin007.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “fecal incontinence” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

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Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “fecal incontinence” (or synonyms). If you know the name of a company that is relevant to fecal incontinence, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “fecal incontinence” (or synonyms).

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “fecal incontinence” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on fecal incontinence: ·

Gastrointestinal Motility Disorders of the Colon, Rectum, and Pelvic Floor Source: Participate. 10(1): 3-5. Spring 2001. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI

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53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: Motility is a term used to describe the contraction of the muscles in the gastrointestinal tract. This article, the second in a two part series, reviews gastrointestinal (GI) motility disorders of the colon, rectum, and pelvic flood. The four parts of the GI tract (esophagus, stomach, small intestine and large intestine or colon) are separated from each other by special muscles called sphincters, which normally stay tightly closed and which regulate the movement of food and food residues from one part to another. Each part of the GI tract has a unique function in digestion, and each part has a distinct type of motility and sensation. Motility problems can cause symptoms such as pain, bloating, fullness, and urgency to have a bowel movement. The author describes the normal patterns of large intestine motility and sensation, along with the symptoms that can result from abnormal motility or sensations. Symptoms of motility problems in the large intestine include constipation, diarrhea, fecal incontinence, Hirschsprung's disease, and outlet obstruction type constipation (pelvic floor dyssynergia). For each, the author describes the diagnostic tests that may be used to establish an appropriate diagnosis. ·

Controlling Incontinence by Controlling Diarrhea: The Role of Diet Source: Intestinal Fortitude. 6(3): 7-10. Winter 1995-1996. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This article helps patients understand the role of diet in controlling fecal incontinence, notably by controlling diarrhea. Topics include diarrhea and nutritional deficiencies; the role of meal size and composition; preservatives, alcohol, and caffeine; dietary fat, dietary fiber, and adequate fluids; the special role of pectin; and meal time recommendations. For each topic, the author provides specific suggestions for readers to incorporate into their meal habits.

·

Encopresis in Children Source: Participate. 3(2): 2-3. Summer 1994. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org.

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Summary: This newsletter article reviews encopresis (fecal incontinence) in children. Topics addressed in the article include the prevalence of encopresis; etiological factors; psychosocial complications; pathology; and treatment options. The author stresses that a high fiber diet is necessary to ensure adequate bulk in the stool. Also, daily bowel habits are encouraged: such as sitting on the toilet twice a day for ten minutes each time and use of positive reinforcements for the child's efforts and successes in bowel retraining. ·

Surgical Treatment of Fecal Incontinence Source: Participate. 3(2): 1-2. Summer 1994. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This article, from a newsletter for people affected by functional bowel disorders or incontinence, discusses the surgical treatment of fecal incontinence. Written in a question-and-answer format, the article addresses when surgery is useful and what options are available; primary sphincter repair; sphincteroplasty; the encirclement procedure; and the development of an artificial anal sphincter. The author notes that surgery is not the answer for all patients with incontinence, but for appropriately selected patients it can restore their continence.

·

Childhood Defecation Disorders: Constipation and Soiling Source: Participate. 9(3): 4-6. Fall 2000. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This article is the second in a two part series on pediatric functional gastrointestinal (GI) disorders that may prompt parents to bring their child to the doctor for constipation or fecal soiling. In this article, the author focuses on non retentive fecal soiling and functional fecal retention. Functional refers to a disorder where the primary problem is not due to disease or visible tissue damage or inflammation; in this article, the author uses functional to refer to symptoms that occur within the expected range of the body's behavior. Functional fecal retention is defined in children by the passage of large or enormous bowel movements at intervals less than twice per week, and the attempt to avoid having bowel movements on purpose. Accompanying

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symptoms include soiling of the underclothes, irritability, abdominal cramps, and decreased appetite. Functional fecal retention begins when there is a painful bowel movement and the child learns to fear the urge to have a bowel movement. After diagnosis, treatment goals include family and patient education, medication as necessary to assure painless defecation, and the provision of continued availability and interest in the child's problem. Fecal soiling refers to passage of bowel movements into the underclothing, or other inappropriate places. Fecal soiling commonly accompanies functional fecal retention, or after a chronic problem with diarrhea. Functional non retentive (not associated with fecal retention) fecal soiling is diagnosed in children older than 4, who have bowel movements in places and at times that are inappropriate, at least once a week for 3 months, in the absence of a disease to explain it. Treatment goals are to help the parent to understand that there is no medical disease, and to accept a referral to a mental health professional. Parents need guidance to understand that soiling is a symptom of emotional upset, not simply bad behavior. 1 table. ·

Clay Therapy for Encopresis Source: Messenger. 8(3): 7. 1997. Contact: Available from American Pseudo-obstruction and Hirschsprung's Disease Society (APHS). 158 Pleasant Street, North Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488. E-mail: [email protected]. Summary: This newsletter article describes the use of modeling clay therapy for treating children with encopresis (fecal soiling). The author reports on a study in which researchers examined the effect of this clay therapy on encopretic children who had not benefited from traditional behavioral (laxatives, enemas, dietary fiber, toilet sitting) and psychological (reinforcement, positive practice, overcorrection, biofeedback) interventions. The researchers describe clay therapy as an Ericksonian intervention, meaning that there is no need for the patient to recognize the problem as such for it to be resolved. Erickson helped patients by using modeling clay as a metaphor for feces to treat a small sample of six boys (ages 4 to 12) who had failed to respond to other therapies. The children were placed together for 1 hour for 3 months and were given no instructions on how to play with the modeling clay; the children eagerly interacted with one another. The author notes that the treatment of encopresis must include an explanation to the child, in terms he or she can understand, of why the body is producing feces and the problems that can accompany this process (e.g., impaction, overflow incontinence). Modeling clay is an effective tool to help children realize

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what is happening to them. The author also describes using the Playdoh Fun Factory to help children understand the movement of feces through the bowel. The author contends that group therapy is an effective way to demystify encopresis, and that some children may be more willing to accept information from peers than from an adult authority figure, especially if they are engaged in an emotional power struggle for control of defecation. ·

Sympathetic Approach to Fecal Incontinence in the Elderly Source: Participate. 1(4): 3. Winter 1992. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964-1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This brief article reminds readers of the importance of a sympathetic approach to fecal incontinence in older adults. The author notes that fecal soiling can have a devastating impact on the older patient, leading to isolation. The author explores the prevalence of this problem; the multifaceted nature of fecal continence; problems with fecal impaction; the use of anal manometry and defocography; and management options including an increase in dietary fiber, the use of enemas, the use of anti-diarrheal agents, biofeedback, and surgery. The author concludes that there are often simple non-surgical methods that can help improve patients' quality of life.

Academic Periodicals covering Fecal Incontinence Academic periodicals can be a highly technical yet valuable source of information on fecal incontinence. We have compiled the following list of periodicals known to publish articles relating to fecal incontinence and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on fecal incontinence published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit the Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name

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of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on fecal incontinence: ·

Acp Journal Club. (ACP J Club) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac p+Journal+Club&dispmax=20&dispstart=0

·

American Family Physician. (Am Fam Physician) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Family+Physician&dispmax=20&dispstart=0

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Archives of Physical Medicine and Rehabilitation. (Arch Phys Med Rehabil) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Physical+Medicine+and+Rehabilitation&dispmax=20&dispsta rt=0

·

Clinical Nurse Specialist Cns. (Clin Nurse Spec) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Cli nical+Nurse+Specialist+Cns&dispmax=20&dispstart=0

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Developmental Medicine and Child Neurology. (Dev Med Child Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=De velopmental+Medicine+and+Child+Neurology&dispmax=20&dispstart= 0

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Digestive Diseases and Sciences. (Dig Dis Sci) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Di gestive+Diseases+and+Sciences&dispmax=20&dispstart=0

·

Diseases of the Colon and Rectum. (Dis Colon Rectum) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Di seases+of+the+Colon+and+Rectum&dispmax=20&dispstart=0

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·

Gastroenterology Clinics of North America. (Gastroenterol Clin North Am) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ga stroenterology+Clinics+of+North+America&dispmax=20&dispstart=0

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Journal of Clinical Gastroenterology. (J Clin Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Gastroenterology&dispmax=20&dispstart=0

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Journal of Pediatric Gastroenterology and Nutrition. (J Pediatr Gastroenterol Nutr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Pediatric+Gastroenterology+and+Nutrition&dispmax=20&dis pstart=0

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Journal of Pediatric Surgery. (J Pediatr Surg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Pediatric+Surgery&dispmax=20&dispstart=0

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Journal of the American Geriatrics Society. (J Am Geriatr Soc) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+American+Geriatrics+Society&dispmax=20&dispstart=0

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Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. (J Wound Ostomy Continence Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Wound,+Ostomy,+and+Continence+Nursing+:+Official+Publi cation+of+the+Wound,+Ostomy+and+Continence+Nurses+Society+/+ Wocn&dispmax=20&dispstart=0

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Nursing Research. (Nurs Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=N ursing+Research&dispmax=20&dispstart=0

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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0

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The American Journal of Gastroenterology. (Am J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Gastroenterology&dispmax=20&dispstart=0

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The Journal of Pediatrics. (J Pediatr) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Pediatrics&dispmax=20&dispstart=0

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The Mount Sinai Journal of Medicine, New York. (Mt Sinai J Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Mount+Sinai+Journal+of+Medicine,+New+York&dispmax=20&dispst art=0

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The New England Journal of Medicine. (N Engl J Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+New+England+Journal+of+Medicine&dispmax=20&dispstart=0

Vocabulary Builder Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Respiratory: Pertaining to respiration. [EU]

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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common disorders, the National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.25 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:26 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 26 See http://www.nlm.nih.gov/databases/databases.html. 25

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat fecal incontinence, the following are particularly noteworthy.

The NLM Gateway27 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.28 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

27 28

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researchers, librarians, students, and, increasingly, patients, their families, and the public.29 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “fecal incontinence” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343187 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349233

HSTAT30 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.31 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.32 Simply search by “fecal Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 30 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 31 The HSTAT URL is http://hstat.nlm.nih.gov/. 32 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) 29

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incontinence” (or synonyms) http://text.nlm.nih.gov.

at

the

following

Web

site:

Coffee Break: Tutorials for Biologists33 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.34 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.35 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 33 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 34 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 35 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

·

MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.

The Genome Project and Fecal Incontinence With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to fecal incontinence. In the following section, we will discuss databases and references used by physicians and scientists who work in this area. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).36 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

36

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “fecal incontinence” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for fecal incontinence: ·

Anal Sphincter Dysplasia Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?105563

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Chloride Diarrhea, Familial Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?214700

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Hydrocephalus, Normal-pressure Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?236690

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Prion Protein; Prnp Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?176640

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Prolapse of Vagina and Rectum Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?176780

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Transthyretin Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?176300

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Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI).

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These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genom e, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “fecal incontinence” (or synonyms) and click “Go.”

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Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database37 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an alphabetical index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database38 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “fecal incontinence” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 38 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 37

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synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Specialized References The following books are specialized references written for professionals interested in fecal incontinence (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna

Vocabulary Builder Hydrocephalus: A condition marked by dilatation of the cerebral ventricles, most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]

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PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with fecal incontinence and related conditions.

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APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with fecal incontinence. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for fecal incontinence. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of fecal incontinence. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

Your Medications: The Basics39 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of fecal incontinence. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with fecal incontinence take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid

39

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.

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problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for fecal incontinence. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

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What food, drinks, other medicines, or activities you should avoid while taking the medicine.

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What side effects the medicine may have, and what to do if they occur.

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If you can get a refill, and how often.

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About any terms or directions you do not understand.

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What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for fecal incontinence). This includes prescription

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medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

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Diet pills

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Vitamins

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Cold medicine

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Aspirin or other pain, headache, or fever medicine

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Cough medicine

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Allergy relief medicine

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Antacids

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Sleeping pills

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Others (include names)

Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for fecal incontinence. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP

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DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.40 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided.

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.

Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with fecal incontinence (including those with contraindications):41 ·

Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm

·

Donepezil http://www.reutershealth.com/atoz/html/Donepezil.htm

·

Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm. 41 Adapted from A to Z Drug Facts by Facts and Comparisons. 40

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·

Rivastigmine Tartrate http://www.reutershealth.com/atoz/html/Rivastigmine_Tartrate.htm

·

Valproic Acid and Derivatives http://www.reutershealth.com/atoz/html/Valproic_Acid_and_Derivati ves.htm Mosby’s GenRx

Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.

Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with fecal incontinence--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat fecal incontinence or potentially create deleterious side effects

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in patients with fecal incontinence. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with fecal incontinence. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with fecal incontinence. The FDA warns patients to watch out for42: ·

Secret formulas (real scientists share what they know)

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

42

Researching Your Medications 145

·

Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn’t true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna

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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to fecal incontinence. Finally, at the conclusion of this chapter, we will provide a list of readings on fecal incontinence from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.

What Is CAM?43 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 43

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.

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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?44 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

44

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.

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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.

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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.

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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.45

45

Adapted from http://www.4woman.gov/faq/alternative.htm.

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Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Fecal Incontinence Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for fecal incontinence. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.

The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “fecal incontinence” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·

Biofeedback Treatment of Fecal Incontinence: A Critical Review Source: Diseases of the Colon and Rectum. 44(5): 728-736. May 2001.

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Summary: This journal article reviews the literature on biofeedback for fecal incontinence. MEDLINE was searched for articles published between 1973 and 1999 in any language. To be included, studies had to be prospective, have five or more subjects, and provide a description of the treatment protocol. Thirty-five articles were reviewed. Only six used a parallel treatment design and just three of these randomized patients to treatment groups. A meta-analysis (weighted by subjects) was performed to compare the results of two treatment protocols that dominate the literature. The mean success rate of studies using Coordination training (coordinating pelvic floor muscle contraction with the sensation of rectal filling) was 67 percent, while for Strength training (pelvic floor muscle contraction) it was 70 percent. The mean success rate was 74 percent for Strength training studies using electromyographic biofeedback and 64 percent for those using Strength training and anal canal pressure biofeedback. However, conclusions are limited by the absence of clearly identified criteria for determining success. Further, there are inconsistencies in the literature regarding patients selection criteria, severity and cause of symptoms, amount of treatment, and type of biofeedback protocols and instrumentation used. Finally, no patient characteristics were identified that would assist in predicting successful outcome. Recommendations are made for future research. The article has 2 figures, 1 table, and 61 references. (AA-M). ·

Long-Term Results of Electromyographic Biofeedback Training for Fecal Incontinence Source: Diseases of the Colon and Rectum. 43(9): 1262-1266. September 2000. Summary: This journal article examines the long-term effects of electromyographic biofeedback training for fecal incontinence. Thirtyseven patients completed 2 to 11 (median, 3) biofeedback training sessions with an anal plug electromyometer. Duration of voluntary sphincter contraction (endurance score) was measured by anal electromyography before and after treatment. The patients also rated their degree of incontinence, level of dissatisfaction with bowel function, and subjective impressions of results. Twenty-two patients (60 percent) rated the result as very good (n=8) or good (n=14) after treatment. Median endurance score improved from 1 to 2 minutes. Median incontinence score improved from 11 to 7, and bowel dissatisfaction rating improved from 5 to 2.8. After a median follow-up of 44 months, 15 patients still rated the overall result as very good (n=3) or good (n=12). The incontinence score did not change. Median bowel dissatisfaction deteriorated somewhat, but remained better than before treatment. Poor

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early subjective rating and the need for more than three biofeedback sessions were predictive of worsening during follow-up. In the authors' opinion, it is encouraging that the long-term success rate for biofeedback training was nearly 50 percent in this sample of patients with fecal incontinence. The article has 2 figures, 4 tables, and 24 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to fecal incontinence and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “fecal incontinence” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to fecal incontinence: ·

A components analysis of biofeedback in the treatment of fecal incontinence. Author(s): Latimer PR, Campbell D, Kasperski J. Source: Biofeedback Self Regul. 1984 September; 9(3): 311-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6525357&dopt=Abstract

·

A nursing assessment tool for adults with fecal incontinence. Author(s): Norton C, Chelvanayagam S. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2000 September; 27(5): 279-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10999967&dopt=Abstract

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A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma. Author(s): Fynes MM, Marshall K, Cassidy M, Behan M, Walsh D, O'Connell PR, O'Herlihy C.

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Source: Diseases of the Colon and Rectum. 1999 June; 42(6): 753-8; Discussion 758-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10378599&dopt=Abstract ·

Advances in the diagnosis and treatment of fecal incontinence. Biofeedback in the forefront. Author(s): Perry JD, Perry LM. Source: Adv Nurse Pract. 1999 October; 7(10): 55-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10808774&dopt=Abstract

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Anal reeducation for postoperative fecal incontinence in congenital diseases of the rectum and anus. Author(s): Menard C, Trudel C, Cloutier R. Source: Journal of Pediatric Surgery. 1997 June; 32(6): 867-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9200088&dopt=Abstract

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Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. Author(s): Wald A, Tunuguntla AK. Source: The New England Journal of Medicine. 1984 May 17; 310(20): 1282-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6717494&dopt=Abstract

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Antegrade continent enema management of chronic fecal incontinence in children. Author(s): Meier DE, Foster ME, Guzzetta PC, Coln D. Source: Journal of Pediatric Surgery. 1998 July; 33(7): 1149-51; Discussion 1151-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9694112&dopt=Abstract

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Biofeedback conditioning for fecal incontinence. Author(s): Berti Riboli E, Frascio M, Pitto G, Reboa G, Zanolla R.

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Source: Archives of Physical Medicine and Rehabilitation. 1988 January; 69(1): 29-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3337637&dopt=Abstract ·

Biofeedback for fecal incontinence using transanal ultrasonography: novel approach. Author(s): Solomon MJ, Rex J, Eyers AA, Stewart P, Roberts R. Source: Diseases of the Colon and Rectum. 2000 June; 43(6): 788-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10859078&dopt=Abstract

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Biofeedback for neurogenic fecal incontinence: rectal sensation is a determinant of outcome. Author(s): Wald A. Source: Journal of Pediatric Gastroenterology and Nutrition. 1983 May; 2(2): 302-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6875754&dopt=Abstract

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Biofeedback for the treatment of fecal incontinence. Long-term clinical results. Author(s): Guillemot F, Bouche B, Gower-Rousseau C, Chartier M, Wolschies E, Lamblin MD, Harbonnier E, Cortot A. Source: Diseases of the Colon and Rectum. 1995 April; 38(4): 393-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7720447&dopt=Abstract

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Biofeedback is effective therapy for fecal incontinence and constipation. Author(s): Ko CY, Tong J, Lehman RE, Shelton AA, Schrock TR, Welton ML. Source: Archives of Surgery (Chicago, Ill. : 1960). 1997 August; 132(8): 829-33; Discussion 833-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9267265&dopt=Abstract

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Biofeedback therapy for fecal incontinence after surgery for anorectal malformations: preliminary results. Author(s): Iwai N, Nagashima M, Shimotake T, Iwata G.

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Source: Journal of Pediatric Surgery. 1993 June; 28(6): 863-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8331522&dopt=Abstract ·

Biofeedback therapy for fecal incontinence. Author(s): Loening-Baucke V. Source: Digestive Diseases (Basel, Switzerland). 1990; 8(2): 112-24. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2178813&dopt=Abstract

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Biofeedback therapy for fecal incontinence. Author(s): Goldenberg DA, Hodges K, Hershe T, Jinich H. Source: The American Journal of Gastroenterology. 1980 October; 74(4): 342-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7457458&dopt=Abstract

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Biofeedback training for patients with myelomeningocele and fecal incontinence. Author(s): Loening-Baucke V, Desch L, Wolraich M. Source: Developmental Medicine and Child Neurology. 1988 December; 30(6): 781-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3234607&dopt=Abstract

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Biofeedback training in patients with fecal incontinence. Author(s): Glia A, Gylin M, Akerlund JE, Lindfors U, Lindberg G. Source: Diseases of the Colon and Rectum. 1998 March; 41(3): 359-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9514433&dopt=Abstract

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Biofeedback training is useful in fecal incontinence but disappointing in constipation. Author(s): Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME, Schoetz DJ Jr, Roberts PL, Murray JJ, Veidenheimer MC. Source: Diseases of the Colon and Rectum. 1994 December; 37(12): 1271-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7995157&dopt=Abstract

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Biofeedback treatment is ineffective in neurogenic fecal incontinence. Author(s): van Tets WF, Kuijpers JH, Bleijenberg G.

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Source: Diseases of the Colon and Rectum. 1996 September; 39(9): 992-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8797647&dopt=Abstract ·

Biofeedback treatment of fecal incontinence in geriatric patients. Author(s): Whitehead WE, Burgio KL, Engel BT. Source: Journal of the American Geriatrics Society. 1985 May; 33(5): 320-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3989196&dopt=Abstract

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Biofeedback treatment of fecal incontinence in patients with myelomeningocele. Author(s): Whitehead WE, Parker LH, Masek BJ, Cataldo MF, Freeman JM. Source: Developmental Medicine and Child Neurology. 1981 June; 23(3): 313-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7250540&dopt=Abstract

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Biofeedback treatment of fecal incontinence: a critical review. Author(s): Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE. Source: Diseases of the Colon and Rectum. 2001 May; 44(5): 728-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11357037&dopt=Abstract

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Can biofeedback therapy improve anorectal function in fecal incontinence? Author(s): Rao SS, Welcher KD, Happel J. Source: The American Journal of Gastroenterology. 1996 November; 91(11): 2360-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8931418&dopt=Abstract

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Can manometric parameters predict response to biofeedback therapy in fecal incontinence? Author(s): Sangwan YP, Coller JA, Barrett RC, Roberts PL, Murray JJ, Schoetz DJ Jr. Source: Diseases of the Colon and Rectum. 1995 October; 38(10): 1021-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7555413&dopt=Abstract

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Constipation and fecal incontinence in the elderly. Author(s): Wald A. Source: Semin Gastrointest Dis. 1994 October; 5(4): 179-88. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7834251&dopt=Abstract

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Controlling fecal incontinence with sensory retraining managed by advanced practice nurses. Author(s): Bentsen D, Braun JW. Source: Clinical Nurse Specialist Cns. 1996 July; 10(4): 171-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8900792&dopt=Abstract

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Diagnosis and management of fecal incontinence in elderly patients. Author(s): Hirsh T, Lembo T. Source: American Family Physician. 1996 October; 54(5): 1559-64, 1569-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8857779&dopt=Abstract

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Diagnosis and treatment of fecal incontinence. Author(s): Bielefeldt K, Enck P, Wienbeck M. Source: Digestive Diseases (Basel, Switzerland). 1990; 8(3): 179-88. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2186883&dopt=Abstract

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Dietary fiber supplementation with psyllium or gum arabic reduced fecal incontinence in community-living adults. Author(s): Korula J. Source: Acp Journal Club. 2002 January-February; 136(1): 23. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11829564&dopt=Abstract

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Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Author(s): Patankar SK, Ferrara A, Larach SW, Williamson PR, Perozo SE, Levy JR, Mills J.

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Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 907-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9269806&dopt=Abstract ·

Electrostimulation in fecal incontinence: relevance of the sphincteric compound muscle action potential. Author(s): Jost WH. Source: Diseases of the Colon and Rectum. 1998 May; 41(5): 590-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9593240&dopt=Abstract

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Etiology and management of fecal incontinence. Author(s): Jorge JM, Wexner SD. Source: Diseases of the Colon and Rectum. 1993 January; 36(1): 77-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8416784&dopt=Abstract

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Fecal Incontinence. Author(s): Fogel R. Source: Curr Treat Options Gastroenterol. 2001 June; 4(3): 261-266. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11469983&dopt=Abstract

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Fecal incontinence. Effective nonsurgical treatments. Author(s): Wald A. Source: Postgraduate Medicine. 1986 September 1; 80(3): 123-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3748917&dopt=Abstract

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Fecal incontinence: a clinical approach. Author(s): Cooper ZR, Rose S. Source: The Mount Sinai Journal of Medicine, New York. 2000 March; 67(2): 96-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10747364&dopt=Abstract

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Fecal incontinence: a practical approach to evaluation and treatment. Author(s): Soffer EE, Hull T.

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Source: The American Journal of Gastroenterology. 2000 August; 95(8): 1873-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10950029&dopt=Abstract ·

Fecal incontinence: a simple pneumatic device for home biofeedback training. Author(s): Constantinides CG, Cywes S. Source: Journal of Pediatric Surgery. 1983 June; 18(3): 276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6875773&dopt=Abstract

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Functional colonic and anorectal disorders. Detecting and overcoming causes of constipation and fecal incontinence. Author(s): Rao SS. Source: Postgraduate Medicine. 1995 November; 98(5): 115-9, 124-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7479446&dopt=Abstract

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Gluteus maximus augmentation for the treatment of fecal incontinence. Author(s): Meehan JJ, Hardin WD Jr, Georgeson KE. Source: Journal of Pediatric Surgery. 1997 July; 32(7): 1045-7; Discussion 1047-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9247231&dopt=Abstract

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Idiopathic Constipation and Fecal Incontinence. Author(s): Krevsky B. Source: Curr Treat Options Gastroenterol. 1998 December; 1(1): 20-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11096560&dopt=Abstract

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Investigation of mode of action of biofeedback in treatment of fecal incontinence. Author(s): Miner PB, Donnelly TC, Read NW. Source: Digestive Diseases and Sciences. 1990 October; 35(10): 1291-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2209296&dopt=Abstract

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Is a new biofeedback therapy effective for fecal incontinence in patients who have anorectal malformations? Author(s): Iwai N, Iwata G, Kimura O, Yanagihara J. Source: Journal of Pediatric Surgery. 1997 November; 32(11): 1626-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9396542&dopt=Abstract

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Long-term cost of fecal incontinence secondary to obstetric injuries. Author(s): Mellgren A, Jensen LL, Zetterstrom JP, Wong WD, Hofmeister JH, Lowry AC. Source: Diseases of the Colon and Rectum. 1999 July; 42(7): 857-65; Discussion 865-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10411431&dopt=Abstract

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Long-term efficacy of biofeedback training for fecal incontinence. Author(s): Enck P, Daublin G, Lubke HJ, Strohmeyer G. Source: Diseases of the Colon and Rectum. 1994 October; 37(10): 997-1001. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7924721&dopt=Abstract

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Long-term results of electromyographic biofeedback training for fecal incontinence. Author(s): Ryn AK, Morren GL, Hallbook O, Sjodahl R. Source: Diseases of the Colon and Rectum. 2000 September; 43(9): 1262-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11005494&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna

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For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with fecal incontinence. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with fecal incontinence may be given different recommendations. Some recommendations may be directly related to fecal incontinence, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of fecal incontinence. We will then show you how to find studies dedicated specifically to nutrition and fecal incontinence.

Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet:

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Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs.

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Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.

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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:46 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

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RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

46

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.

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·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?47

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”48 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.49 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 48 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 49 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 47

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works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Fecal Incontinence The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.50 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

50

Researching Nutrition 171

references in a comprehensive format. Type “fecal incontinence” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “fecal incontinence” (or a synonym): ·

A clinical approach to fecal incontinence. Author(s): Department of Colorectal Surgery, the Cleveland Clinic Florida, Fort Lauderdale, USA. Source: Mavrantonis, C Wexner, S D J-Clin-Gastroenterol. 1998 September; 27(2): 108-21 0192-0790

·

A practical guide to the diagnosis and management of fecal incontinence. Author(s): Department of Surgery, University of Louisville School of Medicine, KY 40292, USA. Source: Rudolph, William Galandiuk, Susan Mayo-Clin-Proc. 2002 March; 77(3): 271-5 0025-6196

·

Clinical and manometric evaluation of postoperative fecal soiling in patients with Hirschsprung's disease. Author(s): Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. Source: Hsu, W M Chen, C C J-Formos-Med-Assoc. 1999 June; 98(6): 4104 0929-6646

·

Development and evaluation of a protocol to manage fecal incontinence in the patient with cancer. Author(s): Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Ontario, Canada. Source: Beddar, S A Holden Bennett, L McCormick, A M J-Palliat-Care. 1997 Summer; 13(2): 27-38 0825-8597

·

Factors determining outcome in children with chronic constipation and faecal soiling. Author(s): Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242. Source: Loening Baucke, V Gut. 1989 July; 30(7): 999-1006 0017-5749

·

Fecal incontinence and rectal prolapse. Author(s): Central Middlesex Hospital, London. Source: Henry, M M Surg-Clin-North-Am. 1988 December; 68(6): 1249-54 0039-6109

·

Fecal incontinence in children. Author(s): Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242-1083, USA.

172 Fecal Incontinence

Source: Loening Baucke, V Am-Fam-Physician. 1997 May 1; 55(6): 2229-38 0002-838X ·

Fecal incontinence in scleroderma. Clinical features, anorectal manometric findings, and their therapeutic implications. Author(s): Department of Medicine, Mount Sinai Medical Center, New York, New York 10029, USA. Source: Jaffin, B W Chang, P Spiera, H J-Clin-Gastroenterol. 1997 October; 25(3): 513-7 0192-0790

·

Fecal incontinence. Author(s): Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts. Source: Sangwan, Y P Coller, J A Surg-Clin-North-Am. 1994 December; 74(6): 1377-98 0039-6109

·

Fecal incontinence: three steps to successful management. Author(s): Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Source: Wald, A Geriatrics. 1997 July; 52(7): 44-6, 49-52 0016-867X

·

Fecal seepage and soiling: a problem of rectal sensation. Author(s): Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, Louisiana 70121, USA. Source: Hoffmann, B A Timmcke, A E Gathright, J B Hicks, T C Opelka, F G Beck, D E Dis-Colon-Rectum. 1995 July; 38(7): 746-8 0012-3706

·

Pathophysiology and management of fecal incontinence. Author(s): School of Medicine, Division of Gastroenterology and Hepatology, University of Pittsburgh. Source: Wald, A Rev-Gastroenterol-Mex. 1994 Apr-June; 59(2): 139-46 0375-0906

·

Patterns of male fecal incontinence. Author(s): Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska. Source: Sentovich, S M Rivela, L J Blatchford, G J Christensen, M A Thorson, A G Dis-Colon-Rectum. 1995 March; 38(3): 281-5 0012-3706

Researching Nutrition 173

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&pag e=0

·

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

·

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

·

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

·

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

·

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

·

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

·

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

·

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

·

Google: http://directory.google.com/Top/Health/Nutrition/

·

Healthnotes: http://www.thedacare.org/healthnotes/

174 Fecal Incontinence

·

Open Directory Project: http://dmoz.org/Health/Nutrition/

·

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

·

WebMDÒHealth: http://my.webmd.com/nutrition

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH]

Researching Nutrition 175

Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 177

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.51

51

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

178 Fecal Incontinence

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):52 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

52

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 179

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/

180 Fecal Incontinence

·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml

Finding Medical Libraries 181

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41

182 Fecal Incontinence

·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld /

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp

Finding Medical Libraries 183

·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Your Rights and Insurance 185

APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with fecal incontinence faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.

Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.53 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.

53Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.

186 Fecal Incontinence

·

Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.

·

Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.

·

Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.

Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·

Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.

·

Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.

·

Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

·

Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health

Your Rights and Insurance 187

plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·

Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.

Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

·

Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.

benefits,

and

consequences

to

treatment

or

188 Fecal Incontinence

·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.

·

Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.

Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.

Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information

Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable

Your Rights and Insurance 189

healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.54

Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”55 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.

·

Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

·

Use your health insurance plan’s internal complaint and appeal processes to address your concerns.

·

Avoid knowingly spreading disease.

To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 55 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 54

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·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.

·

Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.

·

Show respect for other patients and health workers.

·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.56 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.57 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.

More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 57 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 56

Your Rights and Insurance 191

3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.

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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful

Your Rights and Insurance 193

contact information on how to find more in-depth information about Medicaid.58

Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or endstage renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·

You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

·

You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

·

You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if: ·

You have received Social Security or Railroad Retirement Board disability benefit for 24 months.

·

You are a kidney dialysis or kidney transplant patient.

Medicare has two parts: ·

Part A (Hospital Insurance). Most people do not have to pay for Part A.

·

Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)

Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.

This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.

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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The

Your Rights and Insurance 195

phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.

Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·

Part A (Hospital Insurance),

·

Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and

·

A monthly income that is below certain limits.

For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.59 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.

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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare conditions or disorders. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:60 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

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Online Glossaries 197

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to fecal incontinence and keep them on file.

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 199

FECAL INCONTINENCE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Pertaining to the abdomen. [EU] Abscess: A localized collection of pus caused by suppuration buried in tissues, organs, or confined spaces. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anal: Pertaining to the anus. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an

200 Fecal Incontinence

allergic or bad reaction to the beef or pork insulins. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU]

Glossary 201

Cardiac: Pertaining to the heart. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Catheterization: The employment or passage of a catheter. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cholangitis: Inflammation of a bile duct. [EU] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clostridium: A genus of motile or nonmotile gram-positive bacteria of the family bacillaceae. Many species have been identified with some being pathogenic. They occur in water, soil, and in the intestinal tract of humans and lower animals. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [EU] Collagen: The protein substance of the white fibres (collagenous fibres) of skin, tendon, bone, cartilage, and all other connective tissue; composed of molecules of tropocollagen (q.v.), it is converted into gelatin by boiling. collagenous pertaining to collagen; forming or producing collagen. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contractility: stimulus. [EU]

Capacity for becoming short in response to a suitable

Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defecography: Radiographic examination of the process of defecation after the instillation of a contrast media into the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the

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character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diphenoxylate: A meperidine congener used as an antidiarrheal, usually in combination with atropine. At high doses, it acts like morphine. Its unesterified metabolite difenoxin has similar properties and is used similarly. It has little or no analgesic activity. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]

Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Duodenum: The first or proximal portion of the small intestine, extending from the pylorus to the jejunum; so called because it is about 12 fingerbreadths in length. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU]

Glossary 203

Enema: A clyster or injection; a liquid injected or to be injected into the rectum. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Episiotomy: Surgical incision into the perineum and vagina to prevent traumatic tearing during delivery. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Evacuation: An emptying, as of the bowels. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: An abnormal passage or communication, usually between two internal organs, or leading from an internal organ to the surface of the body; frequently designated according to the organs or parts with which it communicates, as anovaginal, brochocutaneous, hepatopleural, pulmonoperitoneal, rectovaginal, urethrovaginal, and the like. Such passages are frequently created experimentally for the purpose of obtaining body secretions for physiologic study. [EU] Flatulence: The presence of excessive amounts of air or gases in the stomach or intestine, leading to distention of the organs. [EU] Fluoroscopy:

Production of an image when x-rays strike a fluorescent

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screen. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gastroscopy: Endoscopic examination, therapy or surgery of the interior of the stomach. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH]

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Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hernia: (he protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein Hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrocephalus: A condition marked by dilatation of the cerebral ventricles, most often occurring secondarily to obstruction of the cerebrospinal fluid pathways, and accompanied by an accumulation of cerebrospinal fluid within the skull; the fluid is usually under increased pressure, but occasionally may be normal or nearly so. It is typically characterized by enlargement of the head, prominence of the forehead, brain atrophy, mental deterioration, and convulsions; may be congenital or acquired; and may be of sudden onset (acute h.) or be slowly progressive (chronic or primary b.). [EU]

Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH]

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Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hysterectomy: The operation of excising the uterus, performed either through the abdominal wall (abdominal h.) or through the vagina (vaginal h.) [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immunization: The induction of immunity. [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Inertia: Inactivity, inability to move spontaneously. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation

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of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU]

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Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Micturition: The passage of urine; urination. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motility: The ability to move spontaneously. [EU] Mucus: The free slime of the mucous membranes, composed of secretion of the glands, along with various inorganic salts, desquamated cells, and leucocytes. [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neonatal: Pertaining to the first four weeks after birth. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal

Glossary 209

and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Octreotide: A potent, long-acting somatostatin octapeptide analog which has a wide range of physiological actions. It inhibits growth hormone secretion, is effective in the treatment of hormone-secreting tumors from various organs, and has beneficial effects in the management of many pathological states including diabetes mellitus, orthostatic hypertension, hyperinsulinism, hypergastrinemia, and small bowel fistula. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Pancreas: An organ behind the lower part of the stomach that is about the

210 Fecal Incontinence

size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parturition: The act or process of given birth to a child. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Pessary: 1. an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. a medicated vaginal suppository. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]

Poisoning:

A condition or physical state produced by the ingestion,

Glossary 211

injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: Occurring after a surgical operation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Proctitis: Inflammation of the rectum. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: A man-made substitute for a missing body part such as an arm or a leg; also an implant such as for the hip. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU]

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Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Respiratory: Pertaining to respiration. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Senility: Old age; the physical and mental deterioration associated with old age. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Stabilization: The creation of a stable state. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU]

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Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Surgical: Of, pertaining to, or correctable by surgery. [EU] Sympathetic: 1. pertaining to, caused by, or exhibiting sympathy. 2. a sympathetic nerve or the sympathetic nervous system. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]

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Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Visceral: , from viscus a viscus) pertaining to a viscus. [EU]

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

·

Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC Press-

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Parthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna ·

Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

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INDEX A Abdomen ...................18, 28, 73, 201, 210 Abdominal.....62, 71, 88, 97, 98, 102, 103, 104, 120, 202, 203, 206, 208 Abscess ...............................103, 111, 204 Acetylcholine .........................................56 Adjuvant.................................................84 Adrenergic .............................................56 Algorithms............................................108 Anal ..... 12, 13, 14, 17, 18, 21, 24, 46, 47, 48, 50, 53, 56, 59, 64, 66, 79, 80, 81, 82, 84, 92, 95, 98, 111, 119, 121, 153 Anatomical.......................................56, 78 Anomalies ........................................69, 88 Anorectal ....24, 46, 47, 51, 66, 68, 69, 80, 89, 98, 156, 158, 161, 162, 172 Antibodies..................60, 69, 72, 201, 208 Anticholinergic .....................................109 Anus .....12, 17, 18, 24, 28, 50, 79, 82, 83, 84, 155, 201 Appendicitis ...........................99, 103, 204 Ascites .................................................108 Atrophy ..........................53, 132, 135, 207 Auditory ...........................................48, 79 Autonomic..................62, 69, 73, 201, 211 Axons.....................................................59 B Bacteria ....18, 29, 30, 103, 104, 111, 166, 203, 205, 206, 214 Barium ...................................................50 Biliary.....................................................99 Biopsy......................................30, 47, 212 C Capsules..............................................169 Carbohydrate...................71, 88, 168, 206 Cardiac ..................................73, 108, 211 Catheter .................................79, 103, 203 Catheterization ....................................101 Causal ...................................................55 Cholesterol ..................................166, 168 Chronic .......19, 23, 35, 48, 52, 54, 88, 98, 100, 103, 108, 120, 135, 155, 159, 171, 186, 203, 205, 207 Colic.......................................................97 Colitis .............................................35, 109 Collagen ..................................60, 70, 203 Colorectal ..............................................26 D Defecation ..... 28, 29, 34, 48, 50, 52, 53, 58, 60, 65, 69, 80, 120, 121, 203, 208 Defecography ..................................14, 24

Degenerative ...................... 103, 167, 204 Dehydration........................................... 16 Diarrhea .... 13, 15, 16, 17, 18, 53, 62, 97, 98, 108, 109, 118, 120, 166 Diphenoxylate ....................................... 17 Distal ......................... 28, 30, 55, 202, 214 Distention ........................ 51, 80, 103, 205 Dorsal............................................ 74, 213 Duodenum ............................ 88, 104, 206 Dysphagia ............................................. 99 Dysplasia ...................................... 62, 132 E Elastic ................................................... 13 Electromyography....... 14, 24, 47, 51, 153 Encopresis .......... 4, 52, 63, 100, 119, 120 Endocrinology ............................... 71, 206 Endoscopy .................................... 50, 109 Enema........................................... 50, 155 Enuresis .............................. 101, 103, 205 Enzyme ............................. 60, 62, 70, 205 Episiotomy ...................................... 12, 64 Esophagitis ......................................... 108 Evacuation ........................ 28, 50, 55, 203 F Faecal ........... 29, 64, 89, 93, 95, 171, 208 Fats ..... 30, 103, 165, 166, 174, 203, 205, 211 Feces ... 4, 19, 23, 24, 29, 46, 48, 70, 120, 204, 205 Fibrosis ................................. 88, 103, 203 Fistula ............. 29, 46, 104, 111, 206, 211 Flatulence ............................................. 97 Fluoroscopy .......................................... 54 Fructose ................................................ 15 G Ganglia.................................... 60, 69, 201 Gastritis................................................. 99 Gastroduodenal .......................... 104, 206 Gastrointestinal .... 29, 48, 56, 84, 88, 97, 99, 100, 118, 119, 206 Gastroscopy.......................................... 98 Genital............................. 31, 71, 206, 215 Glucose..... 30, 62, 71, 105, 206, 212, 214 Gynecology ........................................... 58 H Heartburn ........................................ 62, 99 Hematology........................................... 10 Hepatic.................................................. 88 Hepatitis .................................. 88, 99, 108 Heredity................................................. 88 Hernia ................................................. 100

Index 217

Homeostasis..........................................88 Hormonal ...............................59, 105, 210 Hormones ............60, 72, 74, 97, 209, 213 Hybridization..........................................60 Hygienic .................................................81 Hyperbilirubinemia.......................105, 209 Hypertension .........................88, 111, 211 Hysterectomy...................................56, 61 I Immunohistochemistry ..........................60 Indicative .............62, 73, 74, 79, 212, 215 Inflammation ...14, 30, 102, 103, 104, 119, 202, 203, 204, 206, 214 Infusion ..................................................51 Ingestion ..............................106, 169, 212 Innervation.......................................56, 59 Institutionalization ..................................53 Intermittent...........................................101 Interstitial .................30, 56, 103, 203, 214 Intestines .................29, 97, 104, 205, 206 Intrinsic ..................................................56 Invasive .................................................25 J Jaundice ..........................................88, 99 L Lesion ....................................................60 Loneliness .............................................18 M Malabsorption ................................88, 132 Malformation..........................................66 Malignant .....................................103, 202 Mannitol .................................................15 Membrane ...................................112, 211 Menopause............................53, 105, 210 Menstruation............................72, 97, 210 Mental .......35, 63, 85, 106, 120, 135, 147, 150, 188, 207, 213, 214 Molecular ..10, 31, 74, 126, 129, 130, 213, 215 Motility .......................56, 62, 98, 108, 118 Mucus ....................................................97 Musculature ...........................................59 N Nausea ..................................62, 104, 206 Neonatal ................................................88 Neural ..................................................167 Neuromuscular ................69, 78, 108, 201 Neuronal ....................................56, 59, 62 Neurons .......62, 71, 73, 75, 206, 210, 215 Neuropathy ................................62, 66, 97 Niacin...................................................166 Nosocomial..................................105, 211 O Octreotide ............................................109 Ointments ..............................................18 Oral ..........................19, 30, 174, 202, 211

Osmotic............................................... 108 Overdose ............................................ 167 P Pacemaker.............................. 56, 73, 211 Pancreas......................... 88, 99, 105, 212 Pancreatitis ..................... 88, 99, 100, 108 Parasitic ................................................ 88 Parenteral ............................................. 88 Parturition................................ 61, 73, 211 Pathologic ............................... 48, 74, 212 Pelvic ... 13, 17, 23, 25, 47, 48, 53, 56, 58, 59, 61, 66, 78, 80, 95, 96, 98, 101, 118, 124, 153, 213 Peptic .................................................. 108 Percutaneous........................................ 25 Pessary ................................................. 78 Pharmacist .................................. 140, 144 Physiologic..... 46, 47, 48, 54, 71, 74, 105, 205, 210, 213 Poisoning .............................. 97, 104, 206 Polyethylene ............. 20, 30, 31, 213, 215 Posterior.................................. 68, 70, 204 Postnatal ............................................... 64 Postoperative .............................. 155, 171 Potassium ..................................... 49, 168 Presynaptic ........................................... 62 Prevalence ........ 53, 57, 61, 100, 119, 121 Prolapse.......... 13, 56, 58, 61, 78, 89, 171 R Receptor ............................................... 56 Rectal... 13, 24, 31, 47, 51, 54, 80, 81, 84, 89, 109, 110, 111, 153, 156, 171, 172, 215 Recurrence ........................................... 55 Reflex.................................................... 25 Reflux............................................ 98, 108 Refractory ........................................... 111 Riboflavin ............................................ 166 S Saline ...................................... 51, 72, 208 Sclerosis ....................................... 13, 132 Selenium ............................................. 168 Sorbitol.................................... 15, 29, 209 Spectrum............................................... 10 Sphincter.... 12, 14, 17, 21, 24, 30, 46, 47, 48, 53, 56, 59, 66, 80, 84, 119, 153, 214 Stabilization........................................... 25 Stenosis ................................................ 62 Suppository ............... 23, 31, 85, 212, 215 Surgical .... 21, 25, 30, 31, 46, 47, 49, 57, 58, 61, 68, 71, 73, 74, 81, 85, 99, 110, 119, 121, 203, 206, 211, 213, 214, 215 Sympathetic . 59, 62, 69, 73, 74, 121, 201, 211, 215 Symptomatic ........................... 54, 74, 215

218 Fecal Incontinence

T Thermoregulation ................................166 Thyroxine.............................................167 Tone ....................................51, 60, 79, 81 Toxicology .....................................10, 127 Transplantation......................................88 U Ultrasonography ..........14, 47, 50, 98, 156

Urinary .... 23, 25, 29, 31, 34, 57, 58, 59, 61, 64, 78, 82, 95, 101, 103, 109, 111, 205, 208, 215 Urology............................................ 10, 58 V Vaginal ..... 12, 31, 57, 59, 61, 71, 85, 111, 208, 212, 215 Viral....................................................... 88 Visceral ................................................. 48

Index 219

220 Fecal Incontinence