ABSTRACT
Anal incontinence affects more than 7% of the population, but it is likely to be underreported due to its sensitive nature. This review summarises the current knowledge of managing this condition. Initial diagnosis and evaluation of anal incontinence, as well as basic conservative treatment, can be managed in primary care. This may include patient education about the nature of the condition, as well as advice about appropriate diet, toilet routine, and lifestyle adjustments. Incontinence due to diarrhoea or constipation may be treated pharmacologically. If necessary, patients should be referred for specialised evaluation and treatment.
Subject(s)
Fecal Incontinence , Humans , Adult , Fecal Incontinence/diagnosis , Fecal Incontinence/therapy , Constipation/diagnosis , Constipation/etiology , Constipation/therapy , Diarrhea , Life Style , Therapeutic IrrigationABSTRACT
BACKGROUND: Aberrations in cyclooxygenase and lipoxygenase (LOX) pathways in non-neoplastic, normal appearing mucosa from patients with colorectal neoplasia (CRN), could hypothetically qualify as predisposing CRN-markers. METHODS: To test this hypothesis, biopsies were obtained during colonoscopy from macroscopically normal colonic mucosa from patients with and without CRN. Prostaglandin E2 (PGE2) receptors, EP1-4, were examined in Ussing-chambers by exposing biopsies to selective EP receptor agonists, antagonists and PGE2. Furthermore, mRNA expression of EP receptors, prostanoid synthases and LOX enzymes were evaluated with qPCR. RESULTS: Data suggest that PGE2 binds to both high and low affinity EP receptors. In particular, PGE2 demonstrated EP4 receptor potency in the low nanomolar range. Similar results were detected using EP2 and EP4 agonists. In CRN patients, mRNA-levels were higher for EP1 and EP2 receptors and for enzymes prostaglandin-I synthase, 5-LOX, 12-LOX and 15-LOX. CONCLUSIONS: In conclusion, normal appearing colonic mucosa from CRN patients demonstrates deviating expression in eicosanoid pathways, which might indicate a likely predisposition for early CRN development and furthermore that PGE2 potently activates high affinity EP4 receptor subtypes, supporting relevance of testing EP4 antagonists in colorectal neoplasia management.
