Transanal irrigation to manage neurogenic bowel in the pediatric population with spina bifida: a scoping review.

OBJECTIVE: To map available scientific evidence about the pediatric population with spina bifida submitted to transanal irrigation to manage signs and symptoms of neurogenic bowel. SOURCE OF DATA: This research was developed according to recommendations from the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Reviews. Searches were carried out in the databases: CINAHL, Medline/Pubmed, Scielo, Scopus, Web of Science, Embase, LILACS, Proquest, and the CAPES catalog of theses and dissertations. Quantitative and qualitative studies on the topic were included, as long as they dealt with this population. There was no predetermined time frame. SUMMARY OF THE FINDINGS: The authors found 1.020 studies, selected 130 for close reading, and included 23 in the review, all of which had been published from 1989 to 2021. The authors mapped the characteristics of the studies, including their definitions of concepts and use of scales, criteria for the indication of transanal irrigation, training to carry out the procedure, devices and solutions used, number and frequency of transanal irrigations, health care actions, time spent, associated complications, complementary exams, adherence rate, follow-up, and outcomes, focusing on the benefits for bowel management. CONCLUSIONS: Despite the variability of evaluation parameters and term definitions, evidence suggests that transanal irrigation is a safe and effective method to manage fecal incontinence. Studies in the field are likely to grow, using standardized scales and longitudinal follow-ups. The authors suggest further research on transanal irrigation in the pediatric population with spina bifida in the Latin American context.

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function.

OBJECTIVE: To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. METHODS: A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. RESULTS: Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. CONCLUSION: The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

OBJETIVO: Analisar a função sexual de pacientes do sexo feminino com espinha bífida (EB), e avaliar quais fatores influenciam na função sexual. MéTODOS: Uma pesquisa transversal em que um questionário validado para mulheres foi aplicado em 140 pacientes com EB de quatro cidades diferentes (Porto Alegre, Brasil; e Barcelona, Madri e Málaga, Espanha) entre 2019 e 2020. Os questionários coletaram dados sobre características clínicas da espinha bífida, e a função sexual feminina foi avaliada com a versão de seis itens do Índice de Funcionamento Sexual Feminino (IFSF-6) nas versões validadas para português e espanhol. RESULTADOS: Metade das pacientes havia praticado atividade sexual pelo menos uma vez na vida, mas a maioria (57.1%) não utilizava nenhum método contraceptivo. A disfunção sexual estava presente na maioria das pacientes (84.3%), sendo todos os domínios de função sexual prejudicados em comparação com os de mulheres não neurogênicas. A presença de incontinência urinária e fecal afetou significativamente a qualidade da atividade sexual das pacientes. CONCLUSãO: Aspectos clínicos específicos da EB, como incontinência urinária e fecal, devem ser adequadamente abordados pelos médicos assistentes, visto que estão associados à redução na atividade sexual e piores resultados no IFSF-6. Também é necessário melhorar o atendimento ginecológico das pacientes sexualmente ativas, uma vez que a maioria não utiliza métodos contraceptivos e corre o risco de gravidez inadvertida.

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function / Sexualidade feminina em pacientes com espinha bífida: preditores de uma função sexual satisfatória

Abstract Objective To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. Methods A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. Results Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. Conclusion The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

Resumo Objetivo Analisar a função sexual de pacientes do sexo feminino com espinha bífida (EB), e avaliar quais fatores influenciam na função sexual. Métodos Uma pesquisa transversal em que um questionário validado para mulheres foi aplicado em 140 pacientes com EB de quatro cidades diferentes (Porto Alegre, Brasil; e Barcelona, Madri e Málaga, Espanha) entre 2019 e 2020. Os questionários coletaram dados sobre características clínicas da espinha bífida, e a função sexual feminina foi avaliada com a versão de seis itens do Índice de Funcionamento Sexual Feminino (IFSF-6) nas versões validadas para português e espanhol. Resultados Metade das pacientes havia praticado atividade sexual pelo menos uma vez na vida, mas a maioria (57.1%) não utilizava nenhum método contraceptivo. A disfunção sexual estava presente na maioria das pacientes (84.3%), sendo todos os domínios de função sexual prejudicados em comparação com os de mulheres não neurogênicas. A presença de incontinência urinária e fecal afetou significativamente a qualidade da atividade sexual das pacientes. Conclusão Aspectos clínicos específicos da EB, como incontinência urinária e fecal, devem ser adequadamente abordados pelos médicos assistentes, visto que estão associados à redução na atividade sexual e piores resultados no IFSF-6. Também é necessário melhorar o atendimento ginecológico das pacientes sexualmente ativas, uma vez que a maioria não utiliza métodos contraceptivos e corre o risco de gravidez inadvertida.

Functional outcome after cord detethering in fecally incontinent patients with anorectal malformations.

PURPOSE: Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS: This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS: Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION: Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.

Incontinence associated dermatitis in elderly people admitted to a university hospital.

OBJECTIVE: To identify the frequency and factors associated to incontinence associated dermatitis in elderly people. METHODS: Cross-sectional study with 202 elderly patients admitted to a university hospital between September 2017 and January 2018. Data collection included: cognitive screening, sociodemographic and clinical questionnaire. It was performed exploratory and descriptive analysis, where prevalence and ratios (PR) were calculated. RESULTS: Prevalence of injury was 9.4%, age range 70-79 years (13.5%), African American (21.4%), hospitalization period ≥ 21 days (44.4%), in use of nasogastric tube (33.3%), medical device (11.3%), restricted mobility (18.5%). It was associated with hospitalization period, use of nasogastric tube, restricted mobility, medical devices, and cognition. CONCLUSION: It was confirmed an average frequency of incontinence associated dermatitis in elderly patients and association to factors such as hospitalization period, immobility, cognition, use of nasogastric tube and devices. It must be highlighted the importance of prevention measures, early detection, assessment and monitoring of this type of injury.

Incontinence-associated dermatitis in elderly patients: prevalence and risk factors.

OBJECTIVE: To determine the prevalence and risk factors for incontinence-associated dermatitis in the elderly. METHOD: Cross-sectional exploratory study carried out in public hospitals. The dermatitis prevalence and associations were obtained by calculating the ratio. The effect dimension was estimated by the odds ratio with a 95% confidence interval and statistical significance p <0.05. RESULTS: 138 elderly people were included, with an average age of 77.2 years old (± 9.3); 69 (50%) had combined fecal and urinary incontinence. The dermatitis prevalence was 36.2% (50); 28% (14) had pressure injuries; 14% (7), candidiasis. Risk factors were: longer hospital stay (Odds Ratio = 5.8 [2.6-12.9]), obesity (Odds Ratio = 3.6 [1.2-10.4]), high level of dependence (Odds Ratio = 2.4 [1,1-5,0]) and high risk for pressure injury (Odds Ratio = 6.1 [1,4-26,9]). CONCLUSION: The study found a high prevalence of dermatitis associated with incontinence. The early recognition of risk factors favors effective preventive actions.

Constipação com obstrução à saída e incontinência fecal: o tratamento de reabilitação é o caminho? Mito ou realidade / Outlet obstructed constipation and fecal incontinence: is rehabilitation treatment the way? myth or reality

ABSTRACT Pelvic floor rehabilitation aims to address perineal functional and anatomic alterations as well as thoraco-abdominal mechanic dysfunctions leading to procto-urologic diseases like constipation, fecal and urinary incontinence, and pelvic pain. They require a multidimensional approach, with a significant impact on patients quality of life. An exhaustive clinical and instrumental protocol to assess defecation disorders should include clinical and instrumental evaluation as well as several clinical/physiatric parameters. All these parameters must be considered in order to recognize and define any potential factor playing a role in the functional aspects of incontinence, constipation and pelvic pain. After such evaluation, having precisely identified any thoraco-abdomino-perineal anatomic and functional alterations, a pelvi-perineal rehabilitation program can be carried out to correct the abovementioned alterations and to obtain clinical improvement. The success of the rehabilitative process is linked to several factors such as a careful evaluation of the patient, aimed to select the most appropriate and specific targeted rehabilitative therapy, the therapist's scrupulous hard work, especially as regards the patient's emotional and psychic state, and finally the patient's compliance in undertaking the therapy itself, especially at home. These factors may deeply influence the overall outcomes of the rehabilitative therapies, ranging from "real" success to illusion "myth".

RESUMO A reabilitação do assoalho pélvico visa abordar alterações funcionais e anatômicas perineais, bem como disfunções mecânicas torácicas-abdominais que levam a doenças procto-urológicas como prisão de ventre, incontinência fecal e urinária e dor pélvica. Requerem uma abordagem multidimensional, com impacto significativo na qualidade de vida dos pacientes. Um protocolo clínico e instrumental exaustivo para avaliar os transtornos de defecação deve incluir avaliação clínica e instrumental, bem como diversos parâmetros clínicos/fisiátricos. Todos esses parâmetros devem ser considerados para reconhecer e definir qualquer fator potencial desempenhando um papel nos aspectos funcionais da incontinência, prisão de ventre e dor pélvica. Após tal avaliação, tendo identificado com precisão quaisquer alterações anatômicas e funcionais tóraco-abdomino-perineais, um programa de reabilitação pelvi-perineal pode ser realizado para corrigir as alterações acima mencionadas e obter melhora clínica. O sucesso do processo de reabilitação está ligado a diversos fatores, como uma avaliação cuidadosa do paciente, visando selecionar a terapia de reabilitação direcionada mais adequada e específica, além do trabalho árduo e escrupuloso do terapeuta, especialmente no que diz respeito ao estado emocional e psíquico do paciente e, finalmente, a conformidade do paciente em realizar a terapia em si, especialmente em casa. Esses fatores podem influenciar profundamente os resultados globais das terapias de reabilitação, que vão desde o sucesso "real" até o "mito" ilusório.

OUTLET OBSTRUCTED CONSTIPATION AND FECAL INCONTINENCE: IS REHABILITATION TREATMENT THE WAY? MYTH OR REALITY.

Pelvic floor rehabilitation aims to address perineal functional and anatomic alterations as well as thoraco-abdominal mechanic dysfunctions leading to procto-urologic diseases like constipation, fecal and urinary incontinence, and pelvic pain. They require a multidimensional approach, with a significant impact on patients quality of life. An exhaustive clinical and instrumental protocol to assess defecation disorders should include clinical and instrumental evaluation as well as several clinical/physiatric parameters. All these parameters must be considered in order to recognize and define any potential factor playing a role in the functional aspects of incontinence, constipation and pelvic pain. After such evaluation, having precisely identified any thoraco-abdomino-perineal anatomic and functional alterations, a pelvi-perineal rehabilitation program can be carried out to correct the abovementioned alterations and to obtain clinical improvement. The success of the rehabilitative process is linked to several factors such as a careful evaluation of the patient, aimed to select the most appropriate and specific targeted rehabilitative therapy, the therapist's scrupulous hard work, especially as regards the patient's emotional and psychic state, and finally the patient's compliance in undertaking the therapy itself, especially at home. These factors may deeply influence the overall outcomes of the rehabilitative therapies, ranging from "real" success to illusion "myth".

Dermatite associada à incontinência em idosos: prevalência e fatores de risco / Incontinence-associated dermatitis in elderly patients: prevalence and risk factors

Objetivo: Determinar prevalência e fatores de risco para dermatite associada à incontinência em idosos. Método: Estudo transversal exploratório realizado em hospitais públicos. Obtevese prevalência da dermatite e associações pelo cálculo da razão. A dimensão do efeito foi estimada pela razão de chances com intervalo de confiança de 95% e significância estatística p < 0,05. Resultados: Incluíram-se 138 idosos, média de idade 77,2 anos (± 9,3); 69 (50%) com incontinência fecal e urinária combinadas. A prevalência de dermatite foi 36,2% (50); 28% (14) apresentavam lesão por pressão; 14% (7), candidose. Foram fatores de risco: maior tempo de internação (Odds Ratio = 5,8 [2,6-12,9]), obesidade (Odds Ratio = 3,6 [1,2-10,4]), alto nível de dependência (Odds Ratio = 2,4 [1,1-5,0]) e alto risco para lesão por pressão (Odds Ratio = 6,1 [1,4-26,9]). Conclusão: Houve alta prevalência de dermatite associada à incontinência. O reconhecimento precoce dos fatores de risco favorece ações preventivas efetivas(AU).

Objective: To determine the prevalence and risk factors for incontinence-associated dermatitis in the elderly. Method: Cross-sectional exploratory study carried out in public hospitals. The dermatitis prevalence and associations were obtained by calculating the ratio. The effect dimension was estimated by the odds ratio with a 95% confidence interval and statistical significance p <0.05. Results: 138 elderly people were included, with an average age of 77.2 years old (± 9.3); 69 (50%) had combined fecal and urinary incontinence. The dermatitis prevalence was 36.2% (50); 28% (14) had pressure injuries; 14% (7), candidiasis. Risk factors were: longer hospital stay (Odds Ratio = 5.8 [2.6-12.9]), obesity (Odds Ratio = 3.6 [1.2-10.4]), high level of dependence (Odds Ratio = 2.4 [1,1-5,0]) and high risk for pressure injury (Odds Ratio = 6.1 [1,4-26,9]). Conclusion: The study found a high prevalence of dermatitis associated with incontinence. The early recognition of risk factors favors effective preventive actions(AU).

Objetivo: Determinar prevalencia y factores de riesgo para dermatitis relacionada a la incontinencia y sus relaciones en ancianos. Método: Estudio transversal exploratorio con ancianos incontinentes en hospitales públicos. Se obtuvo la prevalencia de la dermatitis y relaciones por el cálculo de la razón, y la dimensión del efecto ha sido estimada por la razón de oportunidades con intervalo de confianza de 95% y significación estadística p < 0,05. Resultados: Se incluyeron 138 ancianos, la edad promedio de 77,2 años (± 9,3); 69 (50%) de ellos, con incontinencia fecal y urinaria combinadas. La prevalencia de dermatitis ha sido 36,2% (50); 28% (14) presentaban lesión por presión; y 14% (7), candidosis. Han sido factores de riesgo para la dermatitis: mayor tiempo de internación (OR = 5,8 [2,6-12,9]), obesidad (OR = 3,6 [1,2-10,4]), alto nivel de dependencia (OR = 2,4 [1,1-5,0]) y alto riesgo para lesión por presión (OR = 6,1 [1,4-26,9]). Conclusiones: Hubo alta prevalencia de dermatitis relacionada a la incontinencia, y el reconocimiento precoz de los factores de riesgo pode favorecer acciones preventivas efectivas(AU).

Validity of utility measures for women with pelvic organ prolapse.

BACKGROUND: Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established. OBJECTIVE: The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores. STUDY DESIGN: This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence. RESULTS: Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values -0.26 to -0.57), and prolapse, bladder, and bowel subscales (r values -0.16 to -0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001). CONCLUSION: The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.

Efeito da pomada de óxido de zinco e da película de barreira não irritante na prevenção da dermatite associada à incontinência em idosos hospitalizados: ensaio clínico randomizado / Effect of zinc oxide ointment and non-irritant barrier film on the prevention of incontinence-associated dermatitis in hospitalized elderly: a randomized clinical trial

Observa-se na prática clínica pacientes internados com Dermatite Associada à Incontinência (DAI), uma inflamação cutânea que ocorre como consequência do contato entre a pele perineal, perigenital, perianal e áreas adjacentes com urina e fezes, além de epiderme com erosão e maceração. O cuidado com a prevenção deve ser estabelecido, mas pouco se sabe sobre esse cuidado. É necessário evitar ou minimizar a exposição a fatores causais e uma combinação de cuidados específicos da pele, como a limpeza da região, aplicação de produtos barreira. Normalmente, são utilizados sabão e água e é aplicado a pomada de óxido de zinco, um creme de barreira. No entanto, desde a década de 1990, uma película de barreira não irritante (PBNI), livre de álcool foi projetado para proteger a pele. O objetivo deste estudo foi comparar o efeito do uso de pomada de óxido de zinco e PBNI na prevenção de DAI em pacientes incontinentes internados em unidades de clínica médica. É um estudo experimental, do tipo ensaio clínico randomizado realizado em um hospital geral, de grande porte, público e de ensino. A população do estudo foi constituída por 114 pacientes idosos, que apresentavam eliminações urinárias e fecais em fralda descartável. Foram definidos três grupos de estudo, com 38 paciente em cada grupo: controle com o uso da higienização com água e sabão, intervenção I com a higienização e aplicação da pomada de óxido de zinco e intervenção II com higienização e aplicação do PBNI spray. Para a análise descritiva, foram utilizadas as distribuições de frequência simples, medidas de tendência central e medidas de variabilidade; para a avaliação do efeito das intervenções, o teste de regressão de Cox. Quanto ao efeito dos tratamentos sobre o risco de adquirir a DAI, identificou-se que os pacientes que receberam a intervenção II apresentaram menor risco (HR=0,54; p= 0,183) quando comparado ao grupo que recebeu intervenção I (HR=1,06; p=0,895) e ao grupo que recebeu somente a higienização. Contudo, não se encontrou diferença estatisticamente significativa entre os dois grupos de intervenção e o controle, não sendo possível afirmar qual a melhor intervenção. As variáveis que tiveram influência no aparecimento da DAI foram: dias de uso de tamanho adequado da fralda, número de dias de fezes pastosas, pacientes em risco nutricional e nível de saturação de oxigênio, sendo, portanto, fatores que devem ser monitorados pela enfermagem para evitar o surgimento do problema.(AU)

It is observed in clinical practice patients hospitalized with Incontinence-Associated Dermatitis (IAD), a cutaneous inflammation that occurs as a consequence of the contact between the perineal, perigenital, perianal skin and adjacent areas with urine and feces, as well as epidermis with erosion and maceration. Care with prevention should be established, but little is known about such care. It is necessary to avoid or minimize exposure to causative factors and a combination of specific skin care, such as cleaning the region, applying barrier products. Usually, soap and water are used and it is applied to zinc oxide ointment, a barrier cream. However, since the 1990s, a non-irritating barrier film (NIBF), alcohol-free was designed to protect the skin. The objective of this study was to compare the effect of the use of zinc oxide ointment and NIBF in the prevention of IAD in incontinent patients hospitalized in medical clinic units. It is an experimental study, of the type randomized clinical trial conducted in a general hospital, large, public and teaching. The study population consisted of 114 elderly patients, who had urinary and fecal eliminations in a disposable diaper. Three study groups were defined, with 38 patients in each group: control with the use of soap and water hygiene, intervention I with the hygiene and application of the zinc oxide ointment and intervention II with hygiene and application of NIBF spray. For the descriptive analysis, we used the simple frequency distributions, measures of central tendency and measures of variability; for the evaluation of the effect of the interventions, the Cox regression test. Regarding the effect of the treatments on the risk of acquiring the IAD, it was identified that the patients who received the intervention II had a lower risk (HR = 0.54; p = 0,183) when compared to the group that received intervention I (HR = 1.06, p = 0.895) and the group that received only the hygiene. However, no statistically significant difference was found between the two intervention groups and the control, and it was not possible to state the best intervention. The variables that influenced the appearance of IAD were: days of adequate diaper size, number of days of pasty stools, patients at nutritional risk and oxygen saturation level, and therefore, factors that should be monitored by nursing to prevent the problem from arising.

Retrospective analysis of patients submitted to surgical treatment of perianal fistula in Santa Marcelina Hospital, São Paulo / Análise retrospectiva de pacientes submetidos à tratamento cirúrgico de fístula perianal no Hospital Santa Marcelina, São Paulo

Abstract Introduction Perianal fistula is a condition commonly found in surgical practice, with an incidence of approximately 1 in 10,000 individuals, with a predisposition for the male gender, occurring mainly in patients between 30 and 50 years and in 80% of the cases originating from infection in the glandular crypts (cryptoglandular). Objective To perform a retrospective analysis using electronic medical record data of patients submitted to surgical treatment for perianal fistula in Santa Marcelina Hospital in São Paulo, as well as to verify the incidence of relapse and anal continence disorders, in addition to the complexity and types of fistulas and patient characterization. Results Two hundred patients were submitted to surgical treatment of perianal fistula were analyzed. Among men, there was a higher incidence of patients with lower educational level (p = 0.02), hypertension (0.03), diabetes (0.05), older age (p = 0.001), whereas among women previous perianal abscess predominated (0.001). There was no statistical difference in anal continence between patients submitted to fistulotomy with or without seton. Conclusion We observed a predominance of male patients and a low incidence of recurrence and symptoms of anal continence disorders, in addition to a predominance of complex fistulas.

Resumo Introdução Fístula perianal é uma condição comumente encontrada na prática cirúrgica com incidência de cerca 1 em 10000 indivíduos com predisposição para o sexo masculino, ocorrendo fundamentalmente em pacientes entre 30 e 50 anos e em 80% dos casos tem origem em infecção nas criptas glandulares (criptoglandular). Objetivo Realizar análise retrospectiva através de dados de prontuário eletrônico de pacientes submetidos a tratamento cirúrgico de fístula perianal no Hospital Santa Marcelina São Paulo, além de verificar a incidência de recidiva e desordens da continência anal, além da complexidade e tipos das fístulas e caracterização dos pacientes. Resultados Duzentos pacientes foram submetidos a tratamento cirúrgico de fístula perianal. Entre os homens houve maior incidência de pacientes com menor escolaridade (p = 0,02), hipertensos (0,03), diabéticos (0,05), maior idade (p = 0,001) e nas mulheres predominou abscesso perianal prévio (p = 0,001). Não houve diferença estatística na continência anal entre os pacientes submetidos a fistulotomia com ou sem sedenho. Conclusão Verifica-se predomínio de pacientes do sexo masculino e uma baixa incidência de recidiva e sintomas de desordens da continência anal, além de um predomínio de fístulas complexas.

Incontinence-associated dermatitis: a cohort study in critically ill patients. / Dermatite associada à incontinência: estudo de coorte em pacientes críticos.

OBJECTIVES: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. METHOD: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. RESULTS: An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. CONCLUSION: The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and hirschsprung's disease / Validação de questionários para avaliação da qualidade de vida relacionada à continência fecal em crianças com malformações anorretais e doença de hirschsprung

Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease (HD) leads to alterations in bowel habits and fecal incontinence, with consequent quality of life impairment. The objectives were to create and validate a Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider score, as well as a Questionnaire for the Assessment of Quality of Life Related to Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal Incontinence Quality of Life. Methods: The questionnaires were applied to 71 children submitted to surgical procedure, in two stages. Validity was tested by comparing the QQVCFCA and a generic quality of life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal children was used as control. Results: At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal incontinence. It was observed that the QQVCFCA showed a significant correlation with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of life is directly proportional to improvement in fecal incontinence. Quality of life in patients with fecal incontinence is still globally impaired, when compared with control subjects (p<0.05, Student's t-test). There were also significant differences between the results of children with ARMs and children with HD. Conclusions: QQVCFCA and FII are useful tools to assess the quality of life and fecal incontinence in these groups of children. Children with ARMs submitted to surgical procedure and HD have similar quality of life impairment.

O tratamento cirúrgico das malformações anorretais (MAR) e da doença de Hirschsprung (DH) leva a alterações do hábito intestinal e incontinência fecal com prejuízo da qualidade de vida. Os objetivos foram criar e validar o Questionário para o Índice de Continência Fecal (ICF), baseado no Holschneider Criteria, bem como o Questionário para Avaliar a Qualidade de Vida Relativa à Continência Fecal em Crianças e Adolescentes (QQVCFCA), baseado no Fecal Incontinence Quality of Life. Métodos: Os questionários foram aplicados em 71 crianças operadas, em duas etapas. A validade foi testada por meio da comparação do QQVCFCA e um questionário genérico de qualidade de vida (SF-36) e entre o QQVCFCA e o ICF. Um grupo de 59 crianças normais foi usado como controle. Resultados: Nas duas etapas, 45,0% (32/71) e 42,8% (21/49) dos pacientes apresentaram incontinência fecal. Verificou-se que o QQVCFCA apresentou correlação significativa com o SF-36 e o ICF (correlação de Pearson 0,57) e mostrou que a qualidade de vida é diretamente proporcional à melhoria da continência fecal. A qualidade de vida no paciente com incontinência fecal está ainda comprometida globalmente, em comparação com os indivíduos controles (p<0,05; teste t de Student). Não houve ainda diferença significativa entre os resultados de crianças com MAR e crianças com DH. Conclusões: O QQVCFCA e o ICF são instrumentos úteis para a avaliação da qualidade de vida e da incontinência fecal nesses grupos de crianças. Crianças operadas de MAR e DH apresentam comprometimentos semelhantes da qualidade de vida.

Dermatite associada à incontinência: estudo de coorte em pacientes críticos / Dermatitis asociada con incontinencia: estudio de cohorte en pacientes críticos / Incontinence-associated dermatitis: a cohort study in critically ill patients

RESUMO Objetivos Estimar incidência, determinar fatores de risco e propor modelo de predição de risco para desenvolvimento de dermatite associada a incontinência em pacientes adultos críticos. Método Trata-se de um estudo de coorte concorrente realizado com 157 pacientes críticos. A coleta de dados foi conduzida diariamente entre fevereiro e julho de 2015 em hospital público e de ensino de Belo Horizonte, MG. Os dados foram lançados em banco de dados, submetidos a análise descritiva de sobrevida e multivariada. Resultados Obteve-se uma incidência global de 20,4%. Foram encontrados 19 fatores de risco que apresentaram associação significativa com o problema. As variáveis encontradas no modelo de predição de risco foram: sexo masculino, trauma, uso de hipnótico/sedativos, lactulona, suporte nutricional, fezes pastosas e queixa de ardência (local). Conclusão Os resultados mostraram que a dermatite é um achado clínico comum em pacientes adultos críticos e merece atenção especial para maior qualidade da assistência de enfermagem.

RESUMEN Objetivos Estimar incidencia, determinar factores de riesgo y proponer modelo de predicción de riesgo para el desarrollo de la dermatitis asociada a la incontinencia en pacientes adultos críticos. Método Se trata de un estudio de cohorte concurrente de 157 pacientes críticamente enfermos. La recolección de datos se realizó diariamente entre febrero y julio de 2015, en un hospital público y de enseñanza de Belo Horizonte-MG. Los datos se introdujeron en la base de datos, sometidos a análisis descriptivo, de supervivencia y multivariada. Resultados Se obtuvo una incidencia global del 20,4%. Se encontraron 19 factores de riesgo asociados significativamente con el problema. Las variables identificadas en el modelo de predicción de riesgo fueron: sexo masculino, trauma, uso de hipnóticos/sedantes, lactulona, soporte nutricional, heces sueltas y queja de ardor (local). Conclusión Los resultados mostraron que la dermatitis es un hallazgo clínico frecuente en pacientes adultos críticos y merece una atención especial para una mayor calidad de los cuidados de enfermería.

ABSTRACT Objectives Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. Results An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. Conclusion The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Experiencia inicial del impacto de la reparación con colgajos de cloaca traumática postparto en la calidad de vida / Initial experience, of the impact of the repair, with postpartum traumatic cloaca flaps, on the quality of life

Introducción: La incontinencia fecal mayor es un trastorno que modifica significativamente la calidad devida. Un grupo particularmente afectado son las mujeres con antecedentes de trauma obstétrico. Dentrode ellos, los más graves son los de cuarto grado que involucran la totalidad de las capas del tabique rectovaginal, produciendo una comunicación completa entre la luz rectal y la vagina, generando una cloaca. Sibien la incidencia de éstas, es de alrededor del 0,3% de los partos, el efecto que tiene sobre las pacienteses devastador. El único tratamiento efectivo para este tipo de lesiones es la reparación quirúrgica.Objetivo: Evaluar el impacto que presenta la corrección quirúrgica de la cloaca por trauma obstétrico en lacalidad de vida de las afectadas.Material y Métodos: Análisis prospectivo secundario y ampliado de una serie consecutiva de pacientestratadas por desgarro perineal completo tipo cloaca durante el año 2013. Se evaluó la demografía de lamuestra, la paridad de las pacientes, el tiempo medio hasta la consulta desde el último parto, la manometríapre y postoperatoria, la evaluación de incontinencia fecal pre y postoperatorio. Para valorar la severidad dela incontinencia fecal se utilizó el índice CCF-FIS y el índice de severidad de incontinencia fecal (FISI). Parala evaluación de calidad de vida se utilizó la encuesta FIQLS de la Sociedad Americana de Cirujanos delColon y Recto (ASCRS).Resultados: Tres pacientes fueron intervenidas entre enero de 2013 y diciembre de 2013. En el examenfísico, el 100% de las pacientes presentaron una cloaca perineal. El score CCF-FIS preoperatorio fue del16,7 (16 a 18 puntos). El puntaje de FISI pre-operatorio fue de 54,3 (52 a 57). Las tres pacientes refirieronalteraciones en su actividad social y sexual. Se reevaluaron las pacientes al tercer mes de postoperatorio yluego del cierre de la colostomía...

Introduction: The major fecal incontinence is a disorder that significantly change the quality of life. Aparticularly affected group are women with a history of obstetric trauma and presenting demonstrationsimmediately. Among them, the most serious are the fourth degree involving all the layers of the rectovaginalseptum, producing a complete communication between the rectal lumen and vagina, creating a sewer.Although their incidence is about 0.3% of births, the effect on patients is devastating.Objective: To evaluate the impact making the surgical correction of the cloaca by obstetrical trauma in thequality of life of those affected.Material and Methods: Secondary and expanded Prospective analysis of a consecutive series of patientstreated by complete perineal tear type cloaca in 2013. The demographics of the sample was evaluated theparity of the patients, the median time to the query from the last delivery, pre and postoperative manometry,assessment of pre-and postoperative fecal incontinence. To assess the severity of fecal incontinence CCFFISindex and the severity of fecal incontinence (FISI) was used. The FIQLS survey by the American Societyof Colon and Rectal Surgeons (ASCRS) was used for the evaluation of quality of lifeResults: Three patients were operated between January 2013 and December 2013 on physical examination, 100% of patients had a perineal cloaca. The CCF-FIS preoperative score was 16.67 (16-18 points). Thescore FISI pre-surgery was 54.33 (52-57). The three patients reported changes in their social and sexualactivity. Patients at the third month after surgery and after colostomy closure were reassessed...

A multicenter study on childhood constipation and fecal incontinence: effects on quality of life.

OBJECTIVE: To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning. STUDY DESIGN: This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report. RESULTS: Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory. CONCLUSION: Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.

Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence / Avaliação clínica, funcional e morfológica de pacientes submetidas à esfincterotomia para tratamento da fissura anal. Identificação dos fatores que podem interferir na continência fecal

Objective: Evaluate clinical, functional and morphologic outcomes of lateral sphincterotomy for chronic anal fissure treatment, and correlate the findings with factors that influence in the anal continence. Method: In a prospective study, female patients treated by lateral sphincterotomy for chronic anal fissure were assessed using Wexner's incontinence score and grouped according to score: group I (score = 0) and group 2 (score ≥1) and evaluated with anal manometry and anorectal 3D ultrasonography. Results: Thirty-six womens were included, 33% had vaginal delivery. Seventeen patients were included in group I and 19 in group II. We found no difference in age, parity and mode of delivery between groups. A significant difference with respect to percentage reduction in resting pressures was noted, when comparing group 1 versus group 2. The anal sphincter muscle length was similar in both groups. However, the length and percentage of transected internal anal sphincter was significantly greater in group II. Conclusion: There was a correlation between fecal incontinence symptoms after sphincterotomy with the percentage of resting pressure reduction, length and percentage of transected internal anal sphincter. .

Objetivo: Avaliar os resultados clínicos, funcionais e morfológicos de pacientes submetidas à esfincterotomia para tratamento de fissura anal, correlacionando os resultados com os fatores que podem interferir com a continência fecal. Método: Foram avaliadas prospectivamente pacientes do sexo feminino submetidas à esfincterotomia lateral interna devido à presença de fissura anal crônica utilizando o escore de incontinência de Wexner e distribuídas em dois grupos. Grupo 1- Escore igual a zero e Grupo 2 - maior ou igual a 1. As pacientes foram submetidas à avaliação funcional e anatômica do canal anal utilizando manometria anorretal e ultrassonografia tridimensional anorretal. Resultados: Das 36 pacientes incluídas, 33% tinham história de parto vaginal. Dezessete pacientes foram incluídas no Grupo 1 e 19 no Grupo 2. Não houve diferença quanto à idade, paridade e tipo de parto entre grupos. Houve diferença significante em relação ao percentual de redução na pressão de repouso quando comparado o grupo 1 com grupo 2. Não houve diferença no comprimento da musculatura esfincteriana entre grupos. No entanto, o comprimento e o percentual de esfíncter anal interno seccionado foram significativamente maiores no grupo 2. Conclusão: Há correlação entre os sintomas de incontinência fecal pós esfincterotomia com o percentual de reducão das pressões de repouso, tamanho e percentual do esfíncter anal interno seccionado. .

Complicaciones durante la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal grave / Complications during sacral nerve stimulation in the treatment of severe fecal incontinence

Objective: to evaluate the complications of sacral nerve stimulation for the treatment of fecal incontinence. Background: sacral nerve stimulation is considered to be nowadays an effective treatment for fecal incontinence in selected patients. Many authors have reported excellent results and indication for his use have increased. Nevertheless, even being a simple technique, not it exempts this from complications. Methods: fifty-two patients with severe faecal incontinence, treated with sacral nerve stimulation between january 2002 and december 2010, were analysed. All adverse events during follow-up were recorded. Results: there was not surgical complication during peripheral neural evaluation test. In our series, with an average follow-up to 55.52 +/- 31.84 months (range: 12-121), we had a rate of adverse effects of 14 percent, infection of surgical wound in two patients, break of electrode in two patients and the presence of pain in the place of the implant, with episodes of extremity pain and paresthesias in low members in 3 patients. Conclusions: sacral nerve stimulation in severe fecal incontinence is a safe treatment, with a low index of complications.

Objetivo: evaluar las complicaciones de la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal. Introducción: la neuromodulación de raíces sacras ha sido descrita como un tratamiento quirúrgico eficaz en pacientes con incontinencia fecal grave. Muchos autores han comunicado excelentes resultados y las indicaciones en su uso han aumentado. Sin embargo, a pesar de ser una técnica quirúrgica sencilla, no está exenta de complicaciones. Material y Método: 52 pacientes con incontinencia fecal grave, tratados mediante neuromodulación de raíces sacras entre enero de 2002 y diciembre de 2010, fueron analizados. Todas las complicaciones, tanto durante la implantación del dispositivo como durante el seguimiento, fueron registradas. Resultados: no se registraron complicaciones durante la prueba de estimulación. En nuestra serie, con un seguimiento de 55,52 +/- 31,84 meses, observamos un 14 por ciento de efectos adversos, infección de la herida quirúrgica en dos pacientes, rotura o movilización del electrodo en 2 pacientes y dolor y parestesias en 3 pacientes. Discusión: la neuroestimulación de raíces sacras en el tratamiento de la incontinencia fecal es un tratamiento seguro, con un bajo índice de complicaciones.

Autism spectrum disorders in children with functional defecation disorders.

OBJECTIVE: To prospectively assess the prevalence of autism spectrum disorder (ASD) symptoms in children presenting with functional defecation disorders. STUDY DESIGN: Children (age 4-12 years) with functional constipation or functional non-retentive fecal incontinence according to the Rome III criteria referred to a specialized outpatient clinic were included. Parents completed 2 validated ASD screening questionnaires about their child; the Social Responsiveness Scale (SRS) and the Social Communication Questionnaire-Lifetime (SCQ-L). A total SRS score of ≥ 51 is a strong indicator for the presence of ASD. On the SCQ-L, a score of ≥ 15 is suggestive for ASD. RESULTS: In total, 242 patients (130 males, median age 7.9 years) were included. Of these, 91% were diagnosed with functional constipation and 9% with functional non-retentive fecal incontinence. Thirteen children (5.4%) had previously been diagnosed with ASD. Twenty-six children (11%) had both SRS and SCQ-L scores at or above cutoff points, strongly suggestive for the presence of ASD. Solely high SRS were present in 42 children (17%), whereas two children (1%) only had high SCQ-L scores. Altogether, 29% had ASD symptoms, indicated by SRS and/or SCQ-L scores at or above the cutoff values. These children were older than children without ASD symptoms and presented with a longer duration of symptoms. CONCLUSIONS: A substantial number of children (29%) presenting with a functional defecation disorder at a tertiary hospital has concomitant ASD symptoms. Clinicians should be aware of ASD symptoms in children with functional defecation disorders.