Il paziente giunge alla nostra osservazione per disturbi di continenza anale.

È importante definire l’incontinenza fecale se per feci liquide o anche solide perché questo è spesso in relazione all’entità della lesione.

Altro aspetto è legato all’età della paziente in quanto l’incontinenza che compare nella giovane donna è spesso legata a lesioni traumatiche da parto per lesione dell’apparato sfinterico.

Nelle donne in età avanzata è spesso legata ad una slatentizzazione compatibile con pregresse lesioni sfinteri ali non più stabilizzate o più frequentemente compatibile con la presenza di voluminosi prolassi rettali che inibiscono il riflesso retto anale.

La diagnostica di scelta in questo caso è in prima istanza l’etg trans anale con sonda rotante.
Tale esame ci permette di identificare la lesione muscolare quantificandola.
Se l’esame è negativo si deve ricorrere ad una valutazione radiologica con la colpocistodefecografia per valutare la presenza di un prolasso rettale o una invaginazione rettoanale
La manometria ci serve per valutare l’entità del danno e soprattutto per il monitoraggio postchirurgico.
Gli interventi chirurgici per la riparazione sfinteriale sono l’overlapping sfinterico ossia la sezione dello sfintere nella zona lesionata e la successiva ricostruzione con sovrapposizione delle due branche.
Dopo questi interventi si deve eseguire possibilmente una rieducazione sfinterica con elettrostimolazione che verrà eseguita successivamente.

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