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Intervention Review

Drug treatment for faecal incontinence in adults

  1. Mark J Cheetham2,
  2. Miriam Brazzelli3,
  3. Christine C Norton4,
  4. Cathryn MA Glazener1,*

Editorial Group: Cochrane Incontinence Group

Published Online: 22 JUL 2002

Assessed as up-to-date: 3 JUL 2007

DOI: 10.1002/14651858.CD002116


How to Cite

Cheetham MJ, Brazzelli M, Norton CC, Glazener CMA. Drug treatment for faecal incontinence in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002116. DOI: 10.1002/14651858.CD002116.

Author Information

  1. 1

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  2. 2

    Royal Shrewsbury Hospital, Department of General Surgery, Shrewsbury, UK

  3. 3

    University of Edinburgh, Division of Clinical Neurosciences, Edinburgh, UK

  4. 4

    St Mark's Hospital, Physiology Unit, Harrow, Middlesex, UK

*Cathryn MA Glazener, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. c.glazener@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JUL 2002

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This is not the most recent version of the article. View current version (11 JUN 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Faecal incontinence is a common symptom which causes significant distress and reduction in quality of life.

Objectives

To assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities.

Search methods

We searched the Cochrane Incontinence Group Specialised Register of Trials (searched 4 July 2007) and the reference lists of relevant articles.

Selection criteria

All randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults.

Data collection and analysis

Working independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data.

Main results

Thirteen trials were identified, including 473 participants. Eleven trials were of cross-over design. Nine trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea, following ileoanal pouch surgery or due to use of a weight-reducing drug). Two trials were amongst people with weak anal sphincters, one in participants with faecal impaction and bypass leakage, and one in geriatric patients.

Seven trials tested anti-diarrhoeal drugs to reduce faecal incontinence and other bowel symptoms (loperamide, diphenoxylate plus atropine and codeine). Four trials tested drugs enhancing anal sphincter function (phenylepinephrine gel and sodium valproate). Two trials evaluated osmotic laxatives (lactulose) for the treatment of faecal incontinence associated with constipation in geriatric patients. No studies comparing drugs with other treatment modalities were identified.

There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. Loperamide was associated with more adverse effects than placebo, such as constipation, abdominal pain, diarrhoea, headache, and nausea. However, the dose may be titrated to the patient's symptoms to minimise side effects while achieving continence. The drugs acting on the sphincter sometimes resulted in local dermatitis, abdominal pain or nausea. Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses. However, the trials were all small and of short duration.

Authors' conclusions

The small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Drug treatment for faecal incontinence in adults

Faecal incontinence (inability to control bowel movements or leakage of stool or faeces) is a common health care problem, affecting up to 1 in 10 of adults living at home. This affects daily activities in about 1 or 2 in 100 people. It is more common in people living in residential care. Leakage of urine often occurs as well. Faecal incontinence can be debilitating and embarrassing. Treatments include pelvic floor muscle training, electrical stimulation, surgery and drugs. This review looked at drugs. Drugs used to try to relieve faecal incontinence include anti-diarrhoeal drugs or laxatives to regulate stools, and drugs to try to enhance the tone of muscles around the anus. Thirteen small trials were found, including 473 people. The review of these trials found some evidence that anti-diarrhoea drugs may reduce faecal incontinence for people having liquid stools. There was some evidence that drugs to enhance the tone of the muscle around the anus may help, but more research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

成人大便失禁的藥物治療

大便失禁是一種會造成明顯窘迫並降低生活品質常見的症狀。目前可得的治療選擇包含了保守性治療(生物回饋、骨盆底肌肉訓練、飲食調整或藥物治療)、手術治療(例如擴約肌修復、後肛門區修復、擴約肌製造手術)。藥物治療不是單獨給予就是合併其他治療模式給予。

目標

1.分析藥物治療對於大便失禁的效果 (尤其是特定藥物和安慰劑或是其他藥 物的差別) 2.比較藥物治療與其他治療模式的差別

搜尋策略

我們搜尋了Cochrane的失禁群體試驗一文(2003年1月)與相關文章的參考文獻清單。離現在最近的研究日期為2003年1月

選擇標準

所有用藥物方式來治療成人大便失禁的隨機試驗或半隨機試驗

資料收集與分析

獨立工作,評論者從文獻中選擇研究, 分析每項試驗與摘錄資料中方法學上的品質。

主要結論

在這項回顧評論文獻中有涵蓋了11項試驗。其中有九項是屬於交叉模式。有七項所收取的是只有液態糞便時會失禁的人(這些病人不是慢性腹瀉就是在迴腸肛門囊袋手術後造成)。有三項試驗(總共含58位參與者)比較了局部phenylephrine凝膠與安慰劑的差別。兩項試驗(總共含56位參與者)比較loperamide與安慰劑的差別。一項試驗(有11位參與者)比較loperamide oxide與安慰劑的差別。一項試驗(有15位參與者)比較diphenoxylate加上atropine與安慰劑的差別。一項試驗(有17位參與者)比較sodium valproate與安慰劑的差別。一項試驗(有30位參與者)比較loperamide加上codeine與diphenoxylate加上atropine的差別。兩項進一步的試驗(共265位參與者)分析年長者對lactulose的使用。這些試驗中沒有試驗是比較藥物治療與非藥物治療的差別。對於有液狀糞便的病人,沒有足夠的證據證實止瀉藥和增加肛門擴約肌張力的藥物可以減少大便失禁的發生。然而,這些試驗的規模都很小而且實驗時間也不夠長。

作者結論

這項回顧評論中所涵蓋的小型試驗分析了一些不同的藥物對於各式各樣的病人群使用後的效果。所涵蓋的試驗中大多數的焦點都擺在治療腹瀉而不是大便失禁。很少證據可以指引臨床醫師選擇對於大便失禁病人的藥物選擇。我們仍然需要更大型,設計更完善且包含臨床上重要的結果評估方式的控制試驗。

翻譯人

本摘要由中國醫藥大學附設醫院羅嬅泠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

止瀉藥或增加肛門附近肌肉張力的藥物可以減少某些病人的大便失禁狀況,但是我們需要更多的研究。大便失禁(無法控制排便或是大便滲漏)可以是令人衰弱且尷尬的。治療包含骨盆肌肉訓練,電刺激,手術和藥物。用來嘗試減少大便失禁的藥物包含調整糞便的止瀉藥或軟便劑、增加肛門周圍肌肉張力的藥物。這篇回顧評論發現止瀉藥可能可以減少有液狀糞便的病人的失禁情況。有些研究證實增加肛門肌肉張力的藥物可能有些許幫助,但我們仍需要更多的研究。