[ role of pelvic floor muscle dysfunction in subjects with fecal incontinence and efficacy of pelvic floor muscle retraining in treatment: a literature review]

Fecal incontinence is defined as the involuntary loss of fecal material. Fecal incontinence is a particularly embarrassing and distressing condition with significant medical, social and economic implications. The purpose of this article is to review the relevant the role of pelvic floor muscle dysfunction in fecal incontinence. We performed a literature search in PubMed, Scopus, Elsevier, Ovid, CINAHL, Science Direct, ProQuest, Google Scholar, Thompson, EMBASE and Medline databases for the period of 1985-2013. The following keywords were used: puborectalis muscle, anal incontinence, fecal incontinence, pelvic floor muscles, biofeedback, pelvic floor exercise, electrical stimulation. Out of 56 papers, 23 met the criteria for this study. We divided these studies into three categories: 1] the role of pelvic floor muscles in the maintenance of anal continence, 2] the role of pelvic floor muscle dysfunction in fecal incontinence, and 3] the role of pelvic floor muscle retraining in management of fecal incontinence. The results indicate there is adequate evidence to support the role of the pelvic floor muscles in the maintenance of anal continence and any damage or dysfunction to these muscles can affect proper disposal and may lead to incontinence. Prevention of incontinence should attempt at preserving the pelvic floor musculature, particularly in patients with impaired defecatory maneuver, which may play a pathophysiological role in the process. The pelvic floor muscles should be considered a goal of treatment in incontinence and improvement in their function should be included as a key outcome in the evaluation of treatment

12 year old boy with recurrent episodes of pneumonia: triple A syndrome

Triple A syndrome [Allgrove syndrome] is a rare inherited autosomal recessive disease with a typical triad including adrenocorticotrophic-hormone-resistant glucocorticoid insufficiency, reduced or absent tearing [alacrima] and achalasia and a wide range of symptoms can be detected due to multi organ involvement. This report describes the case of a Triple Asyndrome, a12 year-old boy with a history of recurrent episodes of pneumonia and growth retardation due to failure to timely diagnosis of his problem