Fecal incontinence is the inability to control stool and gas at will, and the involuntary flow of stool out of the anus. Fecal incontinence is also known as anal incontinence. It does not include the occasional loss of control of the anus during diarrhea, the outflow of stool out of the anus, nor does it include the increased number of stools and mucus outflow during inflammation of the anorectum. A, etiology 1, congenital developmental malformations: such as cloacal malformations, congenital dementia, cerebrospinal bulge, multiple scleroderma, etc. can occur fecal incontinence. 2, trauma: due to trauma injury to the anal canal rectal ring, so that the sphincter muscle lost the sphincter function to fecal incontinence. Such as stab wounds, cuts, burns, frostbite and lacerations. 3, neurological lesions: mostly seen in traumatic brain injury, brain tumors, cerebral infarction, spinal cord tumors, spinal cord tuberculosis, cauda equina injury, etc. can lead to fecal incontinence. 4, anorectal disease: the most common is the anorectal tumor; such as rectal cancer, anal canal cancer, clonal disease invasion to the anorectal and involving the anal sphincter, or ulcerative colitis long-term diarrhea caused by anal canal inflammation, or rectal prolapse caused by anal flaccidity, and serious scarring around the anus affects the anal sphincter, so that the anal atresia can cause fecal incontinence. 5, medically induced injury: injury to the anal canal and rectal surgery, such as anal fistula, hemorrhoids, rectal prolapse, rectal cancer and other surgical damage to the anal sphincter muscle to cause fecal incontinence. Second, classification 1, according to the different degrees of fecal incontinence can be divided into complete and incomplete fecal incontinence. (1) Incomplete fecal incontinence: dilute stool and gas can not be controlled, but dry stool can be controlled. (2) complete fecal incontinence: dry stool, dilute stool and gas can not be controlled. 2, according to the nature of incontinence divided into sensory incontinence and motor incontinence. (1) sensory fecal incontinence: the morphology of the anal canal sphincter is normal, but the lower rectal sensory deficit, such as spinal cord or central brain nerve dysfunction caused by fecal incontinence; or fecal incontinence caused by low rectal compliance and a serious increase in the number of bowel movements. (2) Motor fecal incontinence: The damage to the external sphincter of the anal canal destroys the rectal ring of the anal canal, resulting in fecal incontinence caused by the patient’s inability to control the stool at will. Clinical manifestations: Patients cannot control defecation and exhaust at will, and feces and gas involuntarily spill out of the anus and pollute the underwear. As the perineum is often stimulated by fecal water, itching and erosion, ulceration and pain may occur on the perianal skin. A few patients abstain from eating and drinking in order to reduce stool, and lose weight and weight. Diagnosis 1. Medical history Ask whether there is any congenital anal malformation, surgery, history of trauma, whether female patients have a history of birth injury, whether there are diseases of the nervous system and urinary system, and whether they have received radiation therapy. The degree of fecal incontinence, the number of bowel movements and the nature of the stool, and whether there is a sense of bowel movement should also be understood. 2.Examination (1) Visual examination: In severe patients, the anal canal can be seen to be open in a round shape. Pay attention to the perianal area for fecal contamination, ulcers, eczema, scarring, defects, deformities, etc. If the buttock groove is separated by two thumbs, the rectal mucosa can be seen through the relaxed anus. In the case of partial anal canal defect scar formation, the rectal mucosa or rectal cavity can be seen from the defect. (2) Rectal palpation: the examiner feels that the anus is relaxed without a sense of urgency. When the patient is asked to contract the anus, the contraction of the anal canal sphincter is not obvious or there is no contraction at all; if there is a history of anal injury, the scar can be retrieved, and some patients can touch the contraction on one side of the anal canal, while there is no contraction on the other side. And pay attention to whether there are lumps and pressure pain in the rectum of the anal canal, etc. Observe whether the finger sleeve is with mucus and blood after the finger exits the anus. (3) Endoscopic examination: observe whether there are deformities, scarring in the anorectum or colon, erosion and ulceration in the skin of the anal canal and rectal mucosa, congestion and edema in the rectal mucosa, rectal polyps, rectal cancer and anorectal cancer, etc. (4) Defecography: this test can understand the function of the anal sphincter through dynamic observation such as forceful defecation, anal lifting and resting, etc. If the barium instilled into the rectum can be retained through anal lifting, it means that the anal sphincter has a certain function; if the barium instilled into the rectum does not flow out freely, it means that the anal incontinence. (5) Anal canal rectal pressure measurement: Patients with fecal incontinence show a decrease in pressure in the anal canal rectum, and the frequency slows down or disappears; the systolic pressure of the anal canal decreases; the rectal canal inhibition reflex disappears. If ulcerative colitis causes fecal incontinence patients rectal compliance is significantly reduced. (6) Rectal sensory measurement: a 4cmX6cm balloon with a catheter is placed into the rectum, and then water or air is injected into the balloon. The normal rectal sensory threshold is 45±5ml, and in patients with neurogenic fecal incontinence, the rectal sensory threshold disappears. (7) Balloon forcing out test: If the rectal sensation is dull, the normal volume cannot cause defecation reflex and cannot expel the balloon. This test can be used to determine both whether the rectal sensation is normal and the function of the anal sphincter. If the anal sphincter is damaged and has no sphincter function, and the balloon can slide out of the anus by itself, or the balloon can be expelled after a slight increase in abdominal pressure. (8) Pelvic floor electromyography: this test can understand the location and extent of sphincter deficiency. (9) Endorectal ultrasonography: Endorectal ultrasonography can clearly show the various levels of the anorectum, the internal sphincter and its surrounding tissue structures, which can assist in the diagnosis of fecal incontinence, such as observing whether the internal sphincter is intact, whether the external sphincter is defective, and the site and extent of the defect. This examination can not only assist in the diagnosis, but also provide some basis for the selection of the surgical incision. The treatment of fecal incontinence should be based on different causes, such as fecal incontinence caused by a disease, the original disease should be treated, such as fecal incontinence caused by brain or spinal cord tumors, should be treated brain or spinal cord tumors; such as fecal incontinence caused by damage to the cauda equina nerve, the first should restore the function of the cauda equina nerve; such as fecal incontinence caused by damage to the anal sphincter, can be surgically repaired sphincter or reconstruction Sphincter method to restore the function of the anal sphincter. 1, non-surgical treatment (1) regulate the diet: treat the inflammation of the anorectum, make the stool form, avoid diarrhea and constipation, eliminate the discomfort of inflammation of the anorectum. The common method is to eat more fiber-rich and nutritious food, and avoid irritating food. If there is inflammation in the anorectum, antibiotics can be taken as appropriate. If there is inflammation of the perianal skin, you should often keep the perianal area clean and keep it dry or use topical medication. (2) Exercise the anal sphincter: the method is to ask the patient to contract the anus (anal lifting), lifting the anus about 500 times a day, insisting on a few seconds each time, which can enhance the function of the anal sphincter. (3) Electrical stimulation therapy or acupuncture therapy: for neurogenic anal incontinence. Electrostimulation therapy is to place stimulating electrodes in the external sphincter and stimulate the anal sphincter and anal levator muscle with electricity to produce a regular contraction, which can be improved in some patients with fecal incontinence. Acupuncture therapy is the traditional medicine of the motherland, some patients can also achieve very good results, commonly used points are Changqiang, Baihui, Chengshan, etc. 2, surgical therapy: surgical treatment of fecal incontinence is mainly used for injury to the anal sphincter and congenital high anal atresia after surgery for fecal incontinence. (1) Anal sphincter repair: Applicable to patients with trauma-induced anal sphincter injury. The sphincter is usually repaired within 3 to 12 months after the injury; if the time is too long, the sphincter may produce disuse atrophy. The post-injury wound is mostly repaired within 3 months to 6 months for those without infection and within 6 to 12 months for those with infection. Up to 90% of those who can achieve basic self-control of stool after this surgery. (2) Folding of the anterior anal canal sphincter: for patients with relaxed sphincter. Method: A semicircular incision is made along the anal verge 1~2cm in front of the anus, the skin and subcutaneous tissue are cut, and the external sphincter is revealed by freeing a little between the subcutaneous tissue and the external sphincter, then the flap is turned backward to cover the anus, and the flap is pulled away, and the two external sphincters are seen to walk forward from both sides of the anus and toward the perineum. A triangular gap is seen between the external sphincter and internal sphincter on both sides, and the gap is closed with silk sutures on both sides of the external sphincter and a few muscle fibers to tighten the anal canal. The muscle fibers should not be over-sutured to prevent necrosis and fibrosis. The subcutaneous tissue and skin are sutured. (3) Transvaginal sphincter folding: for patients with a relaxed sphincter. A curved incision is made at the distal end of the posterior vaginal wall and the posterior vaginal wall is separated upward to reveal the anterior part of the external sphincter. The sphincter is lifted and folded with silk sutures for 3 to 4 stitches to tighten the sphincter. The index finger is then inserted into the anal canal to test the tension of the anal canal. The anal levator muscle proximal to the incision is then sutured, and finally the posterior vaginal wall is sutured. (4) Parks posterior pelvic floor repair of the anal canal: It is suitable for severe neurogenic anal incontinence and for those who still have heavy anal incontinence after rectal prolapse fixation. The procedure mainly restores the rectal angle of the anal canal to a normal angle and makes the exit point smaller, so excessive fecal force may destroy this repair, such as dry stools. A laxative may be given to prevent excessive straining to pass stool. After this procedure, 72% of patients can basically achieve self-control of stool. (5) Sphincteroplasty: For patients with fecal incontinence in which the sphincter cannot be repaired. Sphincteroplasty is usually performed by transplanting the tipped femoralis muscle or gluteus maximus muscle around the anal canal, using the stretching and contracting function of this muscle to achieve the purpose of sphinctering the anus. It has been proved that after sphincteroplasty, the thin femoral muscle or gluteus maximus muscle has some ability to control stool, but it cannot and will not replace the function of anal sphincter. For example, the effect may be better in the near future, but with the atrophy of the thin femoral muscle, the ability to control stool will become worse and worse as time goes on. Therefore, some scholars have recently used electrical stimulation of the femoral nerve to maintain a certain frequency and number of contractions of the thin femoral muscle every day, so that the thin femoral muscle remains strong and achieves a more desirable effect on bowel control.