Incontinence

Faecal incontinence in patients with perianal Crohn's disease is common, occurring in 39% of patients [32]. Management of this condition is challenging because the cause is often multifactorial. The incontinence may be secondary to severe perineal Crohn's disease associated with chronic fibrosis and scarring of the anorectum resulting in loss of reservoir function. In this situation, faecal diversion or proctectomy is indicated. If the patient suffers from severe Crohn's-related muscle destruction, a colostomy is indicated. Diarrhoea from colonic disease or short-bowel syndrome also may lead to incontinence and may require a colostomy if diarrhoea and stool consistency cannot be controlled.

On the other hand, incontinence may be unrelated to Crohn's disease and may be caused by obstetric injury or an overly aggressive surgery such as fistulotomy. The cause may become evident based on medical history and physical examination. Complementary examinations such as anal manometry, electromyography, and transrectal ultrasonography will help in the choice of treatment. Some of these patients may benefit from sphincter repair when the Crohn's disease is in remission. Scott et al. [33] successfully treated five of six patients with this type of surgery. Keighley and Williams [34] reported a 100% success rate in eight patients who underwent sphincter repair. In all of these patients, a proximal covering stoma was used.

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