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Intervention Review

Plugs for containing faecal incontinence

  1. Marije Deutekom1,*,
  2. Annette C Dobben2

Editorial Group: Cochrane Incontinence Group

Published Online: 20 JUL 2005

Assessed as up-to-date: 11 AUG 2009

DOI: 10.1002/14651858.CD005086.pub2


How to Cite

Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005086. DOI: 10.1002/14651858.CD005086.pub2.

Author Information

  1. 1

    Academic Medical Center, Department of Social Medicine k2-207, Amsterdam, Netherlands

  2. 2

    Department of Radiology, G1-223, Academic Medical Center, 1100 DE Amsterdam, Netherlands

*Marije Deutekom, Department of Social Medicine k2-207, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands. m.deutekom@amc.uva.nl.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JUL 2005

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This is not the most recent version of the article. View current version (18 APR 2012)

 

Abstract

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

Background

Faecal incontinence is a distressing disorder with high social stigma. Not all people with faecal incontinence can be cured with conservative or surgical treatment and they may need to rely on containment products, such as anal plugs.

Objectives

To assess the performance of different types of anal plugs for containment of faecal incontinence.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 23 June 2009). Reference lists of identified trials were searched and plugs manufacturers were contacted for trials. No language or other limitations were imposed.

Selection criteria

Types of studies: This review was limited to randomised and quasi-randomised controlled trials (including crossovers) of anal plug use for the management of faecal incontinence.

Types of participants: Children and adults with faecal incontinence.

Types of interventions: Any type of anal plug. Comparison interventions might include no treatment, conservative (physical) treatments, nutritional interventions, surgery, pads and other types or sizes of plugs.

Data collection and analysis

Two reviewers independently assessed methodological quality and extracted data from the included trials. Authors of all included trials were contacted for clarification concerning methodological issues.

Main results

Four studies with a total of 136 participants were included. Two studies compared the use of plugs versus no plugs, one study compared two sizes of the same brand of plug, and one study compared two brands of plugs. In all included studies there was considerable dropout (in total 48 (35%) dropped out before the end of the study) for varying reasons. Data presented are thus subject to potential bias. 'Pseudo-continence' was, however, achieved by some of those who continued to use plugs, at least in the short-term. In a comparison of two different types of plug, plug loss was less often reported and overall satisfaction was greater during use of polyurethane plugs than polyvinyl-alcohol plugs.

Authors' conclusions

The available data were limited and incomplete, and not all pre-specified outcomes could be evaluated. Consequently, only tentative conclusions are possible. The available data suggest that anal plugs can be difficult to tolerate. However, if they are tolerated they can be helpful in preventing incontinence. Plugs could then be useful in a selected group of people either as a substitute for other forms of management or as an adjuvant treatment option. Plugs come in different designs and sizes; the review showed that the selection of the type of plug can impact on its performance.

 

Plain language summary

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

Plugs for preventing the loss of stool in patients with faecal incontinence

Faecal incontinence is defined as the involuntary passage of faecal material through the anal canal and is a common and embarrassing problem. Different treatments exist, including dietary measures, drugs, specialized physiotherapy of the pelvic floor and surgery. However, not all patients can be cured. These patients might be helped by using anal plugs. Different types of anal plugs are known, all aiming to block the loss of stool to control their incontinence. Aim of this review was to assess the performance of different types of anal plugs for containment of faecal incontinence.

Four studies with a total of 136 participants were included. Two studies compared the use of plugs versus no plugs. The involuntary loss of stool was effectively blocked (pseudo-continence) in six (38%) participants who continued to use the plugs, at least in the short-term. One study compared two sizes of the same brand of plug, due to the high dropout in this study and the incomplete data, no results concerning this comparison are available. In one study a comparison of two different brands of plug was made. Loss of plug was reported by 7 patients (30%) with a polyurethane (PU) plug and by 15 patient (65%) with the polyvinyl-alcohol (PVA) plug. Overall satisfaction, defined as patients' opinion that the plug was good to very good, was reported more often for the PU plug (n=17) than for the PVA plug (n=8).

In all included studies there was considerable dropout; in total 48 participants (35%) dropped out before the end of the study for varying reasons. Data presented are thus subject to potential bias, and only tentative conclusions are possible. The available data suggest that anal plugs can be difficult to tolerate. However, if they are tolerated they can be helpful in preventing incontinence. Plugs could then be useful in a selected group of people either as a substitute for other forms of management or as an adjuvant treatment option. Plugs come in different designs and sizes; the review showed that the selection of the type of plug can impact on its performance.

 

摘要

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

背景

針對大便失禁的肛門塞

大便失禁是一個令人痛苦的問題,常導致社交上的羞愧。因為不是所有的病患大便失禁都可以由保守或手術治療以治愈,他們可能需要依靠某些遏制性的產品,如肛門塞。

目標

評估不同類型的肛門塞來遏制大便失禁的表現。

搜尋策略

我們搜尋the Cochrane Incontinence Group Specialised Register (2009年6月23日搜尋)。試驗的引用文獻皆被搜尋且確認與肛門塞的製造商進行了接觸。沒有語言或其他因素被限制。

選擇標準

研究類型:這些文獻侷限於以隨機和半隨機控制試驗(包括交叉試驗)研究肛門塞對大便失禁的應用。 受試者類型:有大便失禁困擾的兒童與成人 介入方式類型:任何類型的肛門塞。被比較的介入方式可能包括未治療,保守(物理)治療,營養調整,外科手術,紗布墊及其他類型或尺寸的肛門塞。

資料收集與分析

本文二位作者從符合條件的的試驗進行研究方法的評估及分析數據的取得。接觸了所有試驗相關的作者、釐清所有有關方法學的問題。

主要結論

總共4個研究符合篩選標準,其中共有136位參加者。兩項研究比較使用肛門塞和不使用,一個研究相同品牌不同大小的肛門塞,另一個則研究相比兩個不同品牌的肛門塞。 在所有列入研究有相當比例的退出率(在共計48(35 %)在研究結束前退出)原因不一。數據因此受到潛在性的誤差。“假性的不失禁”使的部分人至少在短期內繼續使用肛門塞。在比較兩種不同類型的肛門塞時,聚氨酯肛門塞較聚醇肛門塞在肛門塞遺失的情況少發生,整體滿意度也較好。

作者結論

現有的數據是有限且不完整的,而且並非所有事先詳述的成果都可進行評估。因此,只有初步暫時的結論。 現有資料顯示肛門塞可能難以容忍。不過,若能忍受其不適,肛門塞的確可以防止大便失禁。肛門塞對有用的人來說,無論是作為代替其他形式處置或作為輔助治療的選擇都是可以的。不同的設計和大小的肛門塞:檢討結果顯示,不同類型的肛門塞可以影響其性能。

翻譯人

本摘要由中國醫藥大學附設醫院林奕伶翻譯。

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

總結

肛門塞是為了防止有大便失禁的患者在非自願的情況下排出大便,這是一種常見但對患者來說是極為尷尬的問題。 目前存在不同的處理方法,包括飲食改變、藥物,專業骨盆腔肌肉的物理治療和手術。 然而,並不是所有的病人可以治愈。有些病人用肛門塞只可能有些幫助。 現有許多不同類型的肛門塞,它們都旨在阻止糞便溢出,以控制失禁。這份文獻是評估不同類型 肛門塞對防止遏制大便失禁的表現。 4研究共有136參加者。兩項研究中比較使用肛門塞與不使用肛門塞。使用肛門塞者有六人(38 %)失禁的現象得到有效的改善(包括假性的不失禁),至少可以短期的不失禁。 一項研究比較兩個相同品牌不同大小的肛門塞,但由於高放棄率即失去追蹤,所以在這方面的研究和數據不完整,沒有關於這比較的結果。 另一項研究中比較兩個不同牌子的肛門塞。其中肛門塞遺失情形在聚氨酯(PU)材質發表的有7例(30 %),而聚醇(聚乙烯醇)材質發表的有15位病人(65 %)。 總滿意度,定義為病人主觀認為肛門塞是好或非常好的,PU材質的有17例勝過PVA材質的8例。 在所有列入研究有相當的退出率,共計有48位受試者(35 %)因為各種不同的原因在研究結束前退出。數據因此受到潛在的偏見,只能提供初步結論。 現有數據表明肛門塞可能不適難以忍受,但若能忍受的病患,多可有效的大便失禁。 肛門塞對特定的某一組人是有用的,無論是作為代替其他形式的處置或作為輔助治療的選擇皆有效。 不同的設計和大小的肛門塞在文獻回顧顯示,對不同類型的肛門塞的選擇可以影響其性能。