Problems and solutions for faecal incontinence: theme of discussion at the first SICCR interregional congress at Treviso

On the 20th June the first SICCR interregional congress Veneto- Friuli Venezia Giulia on “New therapeutic diagnostic developments in faecal incontinence” organized by the regional representatives Dr. Giulio Santoro and Dr. A. Delbello was held at the regional hospital of Treviso.
This meeting, which dealt with one theme only, intrigued specialists from various fields of medicine, from surgery to gastroenterology, and physiotherapy. The multidisciplinary approach in faecal incontinence is in fact of fundamental importance in trying to improve to the uttermost, the management of this neglected ,and sometimes ill-recognised and underestimated pathology but of extreme social and economic importance.
In his intervention Professor Pucciani shed light on the numerous factors of the pathology underlining the muscular and or sensorial dysfunction at its basis. Different are the numeric scores that have been proposed in literature in order to define the severity of the complaint, but although some of these are extremely detailed and complex, there isn’t a simple classification that is at the same time exhaustive and unanimously accepted. Instrumental investigations utilised so far, such as anorectal manometry and electromyography, cited by Dr, Masin, were placed side by side by new methodologies such as endoanal ultrasonography which has become a necessary instrument for the definition of the type of muscular lesion of the sphincteral apparatus as reported by Dr Santoro. The three dimensional reconstruction of the images of the anal canal allows a precise identification of the presence or not of sphincteral damages both of traumatic origin as in post-partum as well as iatrogenic, which allowed the following therapeutic approach appropriate to the type of incontinence. From the surgical point of view, as explained by Dr Trompetto, various are the methodologies available (direct sphincteral repair, electrostimulated graciloplastic,artificial sphincter, Malone’s procedure) each one of which has limits and percentages of a successful outcome that are not always long-lasting. The real innovation for the therapy of idiopatic faecal incontinence and without doubt represented by sacral neuromdulation that as reported by Prof. Infantino, even though with mechanisms that still are not clear, may act on the colic and anorectal dynamics leading to the improvement of the symptoms in appropriately selected cases .Dr. Melega illustrated the new therapeutic approach in the case of alteration of the internal anal sphincter. Radiofrequency (SECCA) is able to modify the collagen of the submucosa of the anal canal during twelve months , while the injections of the so called bulking agents are more practical possibly in the endoanal seat, controlled by ultrasonography,.The last theme treated was the rehabilitation presented by Dr Soncin, who illustrated the various methodologies chinesitherapy, electrostimulation and biofeedback. The rehabilitation approach is already an integrating part of the therapeutic algorithm of faecal incontinence both associated to medical therapy and coadjuvant in the surgical approach.
The final discussion was particularly lively, chaired well by Prof. Delaini and Dr Tagon, who concluded this interesting congress that reached its objective which is the clarification of the state of the art of the knowledge in the field of faecal incontinence.

Dr Beatrice Salvioli
Dipartimento di Medicina Interna e Gastroenterologia
Università degli Studi di Bologna
Policlinico S.Orsola-Malpighi