{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 16, Ep 3 of 3: Fecal Incontinence and Benign Anorectal Disorders","html":"","width":"100%","height":180,"duration":877,"description":"Episode three covers fecal incontinence managed in a fixed sequence and the benign anorectal disorders anchored to the dentate line. Incontinence rarely fails for a single reason, so the workup canvasses the whole continence stack and the treatment runs from optimizing the modifiable factor through loperamide and biofeedback to sacral neuromodulation, which has displaced sphincteroplasty as first-line surgery for refractory disease. The benign disorders follow the anatomy: above the dentate line means painless bleeding, below it means sharp pain, and that landmark predicts management for hemorrhoids, anal fissure, and pruritus ani. Manometry, endoanal ultrasound, the seventy-two-hour rule, and the atypical-fissure workup throughout.\n \nTopics covered\n\nThe continence stack and multifactorial failure\nEtiologic grid: sphincter, rectal, neurologic, consistency, overflow\nHistory and targeted testing with manometry and endoanal ultrasound\nFixed treatment sequence from modifiable factors to loperamide and biofeedback\nSacral neuromodulation versus sphincteroplasty\nInternal and external hemorrhoids and the dentate line\nAnal fissure mechanism and atypical-location workup\nPruritus ani as a symptom, not a diagnosis\n \n \nKey decisions\n\nEndoanal ultrasound is the test of choice for sphincter integrity, mapping anterior defects from obstetric trauma the exam misses, while anorectal manometry is the most informative single test and changes management in most cases.\nSoluble fiber like psyllium is the counterintuitive first move in leakage of liquid stool because firm stool is easier to retain than soft stool even with a damaged sphincter, alongside treating impaction and any diarrheal disease.\nLoperamide is the drug that follows, a peripheral opioid agonist that slows transit, raises internal sphincter tone, and inhibits the rectoanal inhibitory reflex, all three helping.\nFor refractory fecal incontinence, sacral nerve stimulation is the favored answer and has displaced...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}