Güncel Proktoloji: Anorektal Hastalıklar ve Modern Yaklaşımlar

guncelproktolojianorektalhastaliklarvemodernyaklasimlar-1-0-25kapak

FEKAL İNKONTİNANS

Dr. Hanife Şeyda ÜLGÜR GENÇ1
Dr. Murat KALIN2

1Cihanbeyli Devlet Hastanesi, Genel Cerrahi Kliniği, Konya, Türkiye
2SBÜ Sultan Abdülhamid Han EAH, Genel Cerrahi Kliniği, İstanbul, Türkiye

ÖZET

Fekal inkontinans, anorektal sfinkter kompleksinin nöromüsküler kontrolünün kaybı sonucunda meydana gelen istemsiz dışkı ve gaz kaçışı ile karakterize edilen bir klinik tablodur. Patofizyolojisi multifaktöriyel olup, doğum sonrası sfinkter hasarları, pelvik taban disfonksiyonları, nörolojik bozukluklar ve rektal dolum kapasitesinin azalması gibi çeşitli mekanizmalar inkontinansa yol açmaktadır. Anorektal sfinkterlerin nöromüsküler kontrolündeki bozukluk, internal ve eksternal sfinkterin, rektal kompliansın ve pudendal sinir fonksiyonlarının etkilenmesiyle sonuçlanmaktadır.

Fekal inkontinansın tanısı, klinik değerlendirme ile başlar; bu süreçte dikkatli bir anamnez, fizik muayene ve ileri görüntüleme teknikleri önemlidir. Endoanal ultrasonografi, anorektal manometri ve dinamik pelvik görüntüleme yöntemleri (defekografi) sfinkter ve pelvik taban fonksiyonlarını değerlendirmede temel tanı araçlarıdır. Rektal rezervuar kapasitesi ve duyusal disfonksiyonların saptanması, tedavi planlaması açısından önem arz eder. Patolojinin şiddeti ve mekanizmasına göre sınıflandırılması, tedavi stratejilerinin belirlenmesinde kilit rol oynamaktadır.

Fekal inkontinansın tedavisi, hastanın patofizyolojik durumu ve inkontinansın şiddetine göre şekillendirilir. İlk basamak tedavi konservatif yöntemlerdir: pelvik taban kaslarını güçlendirmeye yönelik egzersizler (Kegel egzersizleri), biofeedback ve dışkı kıvamını düzenleyici medikal tedaviler. Ayrıca sakral nöromodülasyon gibi ileri konservatif yaklaşımlar da özellikle nörolojik hasarı olan hastalarda etkili olabilir. Cerrahi tedaviler, sfinkter hasarı olan hastalarda tercih edilir; anterior sfinkteroplasti, anal sfinkter kompleksini restore etmede en yaygın kullanılan yöntemlerden biridir. Yapay anal sfinkter implantasyonu ve dinamik grasiloplasti gibi daha ileri cerrahi yöntemler tedaviye dirençli vakalarda uygulanmaktadır.

Son yıllarda nöromodülasyon ve rejeneratif tıp alanındaki gelişmeler, fekal inkontinans yönetiminde umut verici sonuçlar sunmaktadır. Tedavi sürecinin multidisipliner bir yaklaşımla, hastanın yaşam kalitesini maksimize edecek şekilde planlanması, tedavi başarısının anahtarıdır. Ayrıca, hastaların uzun dönem takip edilmesi ve tedaviye yanıtlarının objektif kriterlerle izlenmesi klinik sonuçların iyileştirilmesine katkıda bulunacaktır.

Anahtar Kelimeler: Anal kanal; Fekal inkontinans; Pelvik taban kusurları; Transkütanöz elektriksel sinir stimulasyonu; Kolostomi

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