* (* ) Dr WONG SOONG KUAN, Singapore 50% (antidiarrheal) 50% (colon transit time) (Mechanism of fecal continence) (Sacral plexus) (dentate line) 0.5-1.0cm (somatic) (visceral) (proprioception) Duthie (Sampling Reflex)
(stretch receptor) (resting pressure) (fecal continence) (hemorrhoidal plexus) (fecal continence) (inspissated) (Demyelinating disease) (diabetic neuropathy) (ulcerativc colitis) (episiotomy) (prolonged labour) (excessive straining) (pudendal nerve) (stretch injury) (fistulotomy)
(maceration) (pruritus ani) (tenesmus) (gait) (baseline function) Cleveland Clinic (Cleveland Clinic Incontinence Score)( 1) 1 Cleveland Clinic *(CCIS) 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 CCIS 0 CCIS 1-7 CCIS 8-14 CCIS 15-19 CCIS 20 *( ) (erythema) (moniliasis) (
) (recto-vaginal septum) (perineal body) (fatiguability) 6 (Clostridium difficiles toxin) (flexible) (inflammatory bowel disease) (Barium enema) (anorectal manometry) ( 1) 10 (bowel preparation) ( ) ( ) ( )
1. (anorectal manometry) (EMG) ( ) (pudendal nerve terminal motor latency PTML) St Mark s ( 2) (pudendal nerve) (pudendal canal, Alcock s canal) (ischial spine) PTML 2.2+/-0.2ms ( ) ( ) PTML ( 3) 2. St Mark s
3. (pudendal nerve terminal motor latency PTML) (Endoanal ultrasonography) ( 4) 10MHZ (transducer) 360 o ( 5) 4.
5. (psyllium) ( Metamucil Mucillin Fybosin) (antidiarrheal) loperamide diphenoxylate ( 6, 7)
6. 7. EMG (suppository) (sphincteroplasty)
(fecal diversion) ( ) 80% (50-60%) 2 2 Browning Browning % 13 84 65% 84 64 Engel 20 65 Engel Engel Hool 52 69 95% 53 79 25% 51 80 Lauberg Londono- Schimmer 19 47 12 8 50 Wexner Yomg 17 76 56 87 50% ( ) (Sphincter replacement) (graciloplasty) (gracilis)
(ischial tuberosity) (FDA) (artificial sphincter replacement) (anal canal) (radio opaque) ( 8a, 8b) 8a. Action 8b. Action
(recruitment) (augmentation) ( 9) 9. SECCA ( ) Cleveland Clinic SF36 ( 10)
10. SECCA (fecal diversion) (end colostomy)