Patología Intestinal S 46 es superior al tratamiento tendiente a aumentar la presión del canal anal mediante inyección de elastómeros20. En una serie publicada por Van der Hagen y cols, el manejo orientado a un buen vaciamiento Patología an orrecta l funci ona l - D. Cisternas C. rectal mostró cerca de 80% de éxito21. Con todo esto, el ensuciamiento debe ser enfrentado en adultos de la misma manera que la encopresis en niños, facilitando el buen vaciamiento rectal. Referencias 1.- Müller-Lissner S, Tack J, Feng Y, Schenck F, Specht Gryp R. Levels of satisfaction with current chronic constipation treatment options in European internet survey. Aliment Pharmacol Ther 2013; 37: 137-45. 2.- Bharucha AE, Dorn SD, Lembo A, Pressman A. American Gastroenterological Association medical position statement on constipation. Gastroenterology 2013; 144: 211-7. 3.- Tack J, Muller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, et al. Diagnosis and treatment of chronic constipation-a European perspective. Neurogastroenterol Motil 2011; 23: 697- 710. 4.- Rao SS, Mudipalli RS, Stessman M, Zimmerman B. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil 2004; 16: 589-96. 5.- Zárate N, Knowles CH, Newell M, Garvie NW, Gladman MA, Lunniss PJ, et al. In patients with slow transit constipation, the pattern of colonic transit delay does not differentiate between those with and without impaired rectal evacuation. Am J Gastroenterol 2008; 103: 427-34. 6.- Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 2007; 5: 331-8. 7.- Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005; 129: 86-97. 8.- Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ. Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Dis Colon Rectum 2003; 46: 238-46. 9.- Gladman MA, Aziz Q, Scott SM, Williams NS, Lunniss PJ. Rectal hyposensitivity: pathophysiological mechanisms. Neurogastroenterol Motil 2009; 21: 508-16, e4-5. 10.- Sangwan YP, Coller JA. Fecal incontinence. Surg Clin North Am 1994; 74: 1377-98. 11.- Peticca L, Pescatori M. Outlet obstruction due to anismus and rectal hyposensation: effect of biofeedback training. Colorectal Dis 2002; 4: 67. 12.- Miner PB, Donnelly TC, Read NW. Investigation of mode of action of biofeedback in treatment of fecal incontinence. Dig Dis Sci 1990; 35: 1291-8. 13.- Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997; 92: 469-75. 14.- Lam TJ, Mulder CJ, Felt-Bersma RJ. Critical reappraisal of anorectal function tests in patients with faecal incontinence who have failed conservative treatment. Int J Colorectal Dis 2012; 27: 931-7. 15.- Abbott D, Atere-Roberts N, Williams A, Oteng-Ntim E, Chappell LC. Obstetric anal sphincter injury. BMJ 2010; 341: c3414. 16.- Starck M, Bohe M, Valentin L. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol 2006; 27: 188-97. 17.- Nordenstam J, Altman D, Brismar S, Zetterstrom J. Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 1029-35. 18.- Rao SS, Ozturk R, Stessman M. Investigation of the pathophysiology of fecal seepage. Am J Gastroenterol 2004; 99: 2204-9. 19.- Parellada CM, Miller AS, Williamson ME, Johnston D. Paradoxical high anal resting pressures in men with idiopathic fecal seepage. Dis Colon Rectum 1998; 41: 593-7. 20.- van der Hagen SJ, van der Meer W, Soeters PB, Baeten CG, van Gemert WG. A prospective non-randomized two-centre study of patients with passive faecal incontinence after birth trauma and patients with soiling after anal surgery, treated by elastomer implants versus rectal irrigation. Int J Colorectal Dis 2012; 27: 1191-8. 21.- van der Hagen SJ, Soeters PB, Baeten CG, van Gemert WG. Conservative treatment of patients with faecal soiling. Tech Coloproctol 2011; 15: 291-5. Gastroenterol. latinoam 2016; Vol 27, S upl Nº 1: S 44-S 46
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