INTRODUCTION: The goal of this project was to create an up-to-date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI. METHODS: These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework. For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher-level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus. RESULTS: These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients. CONCLUSION: These multidisciplinary European guidelines provide an up-to-date comprehensive evidence-based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.

• Klíčová slova
• GRADE, Sacral neuromodulation, clinical guidelines, diagnosis, faecal incontinence, fecal incontinence, guidelines, ptns, treatment, unwanted loss of feces,
• MeSH
• dospělí MeSH
• fekální inkontinence * diagnóza   terapie   MeSH
• gastroenterologie * MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

INTRODUCTION: High resolution anorectal manometry (HRAM) is a diagnostic method indicated in patients with anorectal dysfunction. The aim of the study was to evaluate the prevalence of anorectal dysfunctions and to assess therapeutic consequences. METHODS: Retrospective data of consecutive patients referred to HRAM in the period from March 2019 to February 2021 were evaluated. Basic manometric parameters were assessed: resting pressure (RP), maximal squeeze pressure (SP), rectal sensitivity (RS), and dyssynergic defecation (DD). RESULTS: 113 patients with combined fecal incontinence and obstructive defecation syndrome (FI + ODS: 44.2%), fecal incontinence (FI: 26.5%), obstructive defecation syndrome (ODS: 16.8 %), stoma before restoration of intestinal continuity (6.2%), functional pelvic pain (FP: 3.5 %) and controversial cases (2.7%) were analyzed. The average age was 54 years; female patients predominated (72 %). Patients with FI and FI+ODS had lower mean RP (57 mmHg and 53 mmHg) and/or lower SP (160 mmHg and 140 mmHg) compared to baseline. Patients with ODS had normal values of mean RP (75 mmHg) and SP (225 mmHg). DD was noted in most patients (FI: 76.6%, FI + ODS: 88%, ODS: 89.5%, FP: 100%). Conservative therapy with pelvic floor physiotherapy was provided in most cases (FI+ODS: 40%, ODS: 36.8%, FI: 13.3%, FP: 75%). CONCLUSION: In patients with defecation disorders there is a high prevalence of pathological manometric findings that combine with each other. Based on manometric findings, conservative treatment with individual pelvic floor physiotherapy can be initiated.

• Klíčová slova
• anorectal dysfunction, anorectal manometry, pelvic floor physiotherapy,
• MeSH
• anální kanál * MeSH
• defekace MeSH
• fekální inkontinence * diagnóza   epidemiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• manometrie MeSH
• rektum MeSH
• retrospektivní studie MeSH
• zácpa diagnóza   epidemiologie   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Complex anorectal examination including a detailed medical history, physical proctological examination and evaluation of the sensorimotor and structural function of the anorectum is essential for the diagnosis and therapeutic management of functional anorectal dysfunction. The aim of the work is to provide an overview of diagnosing functional anorectal disorders according to the new update and consensus statement of the International Anorectal Physiology Working Group (IAPWG) with a focus on indications, a standardized examination protocol and introduction of the new London classification of anorectal dysfunction. The indications are: fecal incontinence, defecation disorders, functional pelvic (anorectal) pain, evaluation before an anorectal intervention and before planned delivery to assess the function of a previously traumatized anal sphincter. Standardization of the diagnosis and the evaluated data are the basis for multidisciplinary cooperation and determination of a treatment plan for each patient individually.

• Klíčová slova
• London classification, anorectal manometry, functional anorectal testing, indications, standardized protocol,
• MeSH
• anální kanál MeSH
• defekace MeSH
• fekální inkontinence diagnóza   MeSH
• lidé MeSH
• manometrie MeSH
• plánování péče o pacienty MeSH
• rektum MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Londýn MeSH

INTRODUCTION: Anorectal manometry is a diagnostic tool designed for the evaluation of functional parameters and assessment of anorectal activity coordination. In the last decade, the development of 3D high-resolution (HR) manometry and its expansion in experimental and clinical settings has been evident. Literature search (in the MEDLINE and PubMed databases) focusing on studies about 3-dimensional HR manometry was performed. The aim of this paper is to offer an overview of the current state of the art of manometry while concentrating on indications, protocol of the procedure and applicability of this examination in clinical practice. RESULTS: Development of solid catheters with miniaturized semiconductor sensors has enabled very precise measurement (high resolution) and creation of anorectal 3D pressure models. In comparison with water-perfused manometry systems, this method offers more accurate and more detailed data that can be employed in functional disorders assessment. The indications for anorectal manomery are symptoms of faecal incontinence and functional constipation. This modality can also be used in biofeedback therapy, in functional anorectal pain and when assessing patients undergoing continent rectal resection. The HR manometry protocol should comprise the measurement of anorectal resting pressures, the squeeze manoeuvre, the bear down manoeuvre, the cough reflex test, the rectoanal inhibitory reflex examination, rectal sensitivity testing and rectal compliance measurement. Processed data are fundamental in determining an individually tailored treatment plan for patients suffering from anorectal functional disorders. CONCLUSION: Anorectal 3D HR manometry presents a valuable diagnostic modality offering a new dimension in anorectal function understanding and can reveal new pathophysiologic mechanisms of anorectal functional disorders.

• MeSH
• anální kanál patofyziologie   MeSH
• fekální inkontinence diagnóza   patofyziologie   MeSH
• lidé MeSH
• manometrie metody   MeSH
• rektum patofyziologie   MeSH
• tlak MeSH
• zácpa diagnóza   patofyziologie   MeSH
• zobrazování trojrozměrné metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Faecal incontinence is a significantly depressing and mentally devastating disability. Surgical treatment, as a first choice method, is indicated for incontinence originating as a result of traumatic or iatrogenic infliction of the sphincter apparatus, particularly of the external sphincter. In case of idiopathic (neurogenic) incontinence, it is indicated very exceptionally, if ever. The authors present a pilot study to verify the possibility of surgical treatment of anal incontinence with the support of a puborectal muscle loop by means of the absorbable STRATASIS® TF mesh. MATERIAL AND METHODS: In the years 2010-2012, eight experimental surgical procedures were performed. Female patients with a history of faecal incontinence of the third stage longer than one year and with EMG-verified neurological lesion were recruited. The evaluating criteria were the Wexner score and changes in the levator and anorectal angle acquired from a MR defecographic examination performed before and six months after the operation. RESULTS: The complaints improved distinctly in six patients; in the two remaining cases, the method failed completely. The failures were associated with an inflammatory complication in both cases. In one patient, the authors do not rule out an incorrect indication, too. The Wexner score decreased from 18 to 10 in improved patients. Changes in the levator and anorectal angle were not significant. CONCLUSION: The results confirm the possibility of successful surgical influence on incontinence of the third stage by correcting the levator hiatus with biodegradable mesh. Continence improvement persists even after the mesh transforms into scar tissue.

• MeSH
• anální kanál chirurgie   MeSH
• chirurgické síťky MeSH
• dospělí MeSH
• elektromyografie MeSH
• fekální inkontinence diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Based on the complex evaluation of the continence by anorectal manometry, EMG examination of sphincters, transrectal sonography, defecography and Colonic Transit Time examination, the analysis of the group of 15 patients partially incontinent after operation of carcinoma of the lower part of the rectum has been done. In these patients the deep pelvic anastomosis or coloanal anastomosis was performed. In none of the patients any serious organic damage of sphincters was manifested, the causes were dominantly extrasphincteric and functional, solvable well by conservative methods.

• MeSH
• anastomóza chirurgická MeSH
• fekální inkontinence diagnóza   etiologie   MeSH
• lidé MeSH
• nádory rekta chirurgie   MeSH
• pooperační komplikace * MeSH
• střeva chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH