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The
Equation
Flow
Index calculator
Flow
Index contispation
Defecation Norm Gram
Anal Incontinence
Continence Norm Gram
Applications of the Theory
Facts and Controversies
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Passive
Anal Incontinence:
- A
50 Years old male with post-hemorroidectomy.
Passive Solid incontinence (Grade VI p).
His maximum Intrarectal pressure (rest) = 7.9 mmHg.
A.CL. (rest) = 4 cm
A.C.D. (rest) = 0.6 cm.
- Measurement
without correction = Grade I (i.e. continent).
Correction for delayed first sensation at 120 ml.
where
Maximum IRP (before the first sensation) = 18.69 mmHg.
And profound RAIR takes place at 100 ml water.
where: A.C.L. (Defecation) = 1.7 cm, and A.C.D. (DEF.) = 2.5
cm.
Measurement
after correction for delayed sensation and premature RAIR
Flow Index = 1.07 cc Barium Sulphate /S = Grade VI p. (Passive
solid incontinence).
Planning
for treatment and predicting outcome:
1.
Accordingly the mechanical factors namely IRP, ACL AND ACD, do
not contribute to the incontinence accordingly sphincter repairs
are not indicted.
2. Delayed first sensation and premature profound RAIR being responsible
for incontinence are in need of sensory biofeedback in order to
shift the point of first sensation before 120 ml water (i.e. before
the threshold rectal volume causing premature profound RAIR)
3. According to the measurement of IRP the insufflation of 120
ml. Air causes an increase in IRP of 10.79 mmHg. the rectal compliance
= 0.089 mmHg/ml. Anti-cholinergics which would decrease recta
compliance more than 10% may result in Post-treatment passive
solid fecal soiling instead of pre-treatment frank soild stool
incontinence.
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