Contents

**Preface XI**



#### **Section 3 Therapy and Outcome 105**

Chapter 7 **Pelvic Floor Rehabilitation in Anal Incontinence 107** Claudia Regina de Souza Santos, Tania das Graças de Souza Lima, Fernanda Mateus Queiroz Schmidt and Vera Lúcia Conceição de Gouveia Santos

Preface

*"A good reliable set of bowels is worth more to a man than any quantity of brains" [Josh Billings]* The normal functioning of the gastrointestinal tract is one of the most pivotal yet under-appreci‐ ated aspects of good health. Often it is only when something goes wrong that we begin to glimpse the importance of what goes into being well. This is only too true of normal bowel function. The effective and safe management of human waste has been a critical pillar for the development of much of what we have in society today. Once huge mortalities associated with cholera or infantile gastroenteritis are largely forgotten in most western societies. At an individ‐ ual level, the control of fecal continence is seen as a crucial developmental step in human matu‐

ration, with enormous ramifications for self-esteem if it is either not achieved or lost.

conditions. The individual authors come with a rich variety of experiences.

difficult to achieve normal physiological functioning with surgery.

and to be able to meaningfully evaluate the pathophysiology.

way toward defining future directions for research.

Although control of fecal continence superficially appears to be a relatively simple concept, it is surprisingly complex and can be extraordinarily difficult to manage. This book address‐ es the causes, evaluation, management and outcome for continence of a number of different

The normal acquisition of bowel control in childhood is seen as a crucial developmental step and there is enormous pressure on families whose child is identified as being "slow". This is usually related to variations in physiological development, but can be secondary to anatomi‐ cal abnormalities such as after the repair of congenital anorectal malformations. It is very

A second very important cause of fecal incontinence is that of childbirth-induced traumatic injuries to the pelvic floor with subsequent long-term loss of bowel control. This continues

Before proceeding to any effective treatment, it is crucial to understand normal functioning

The range of different treatment options that are potentially available can be extremely con‐ fusing. They include physiological retraining techniques, injectables to supplement sphinc‐ ter function, and surgery. Defining the correct initial approach can be challenging, but it can be even more difficult to define the next line of management for treatment failures. Many

Good quality clinical research in this area is also surprisingly sparse. Whether it is in defin‐ ing normal maturation, the advantages or limitations of investigations, or critical evaluation of treatment options, this is clearly an important area to encourage. This book goes some

> Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital Professorial Fellow, Department of Paediatrics, University of Melbourne, Australia

**Anthony G. Catto-Smith**

to be an important health issue in the developing world and is covered in the book.

practitioners simply cross their fingers, hoping that it will improve in time.

