ABSTRACT
INTRODUCTION: Amitriptyline, a tricyclic antidepressant agent with anticholinergic and serotoninergic properties has been used empirically in the treatment of idiopathic fecal incontinence with good results. METHODS: An open study was conducted to test the response to amitriptyline 20 mg daily for four weeks by 18 patients (2 males) of median age 66 years with idiopathic fecal incontinence Incontinence scores, number of bowel movements, computerized ambulatory anorectal pressures, and pudendal nerve terminal motor latencies were evaluated before and after four weeks of therapy. Twenty-four control subjects (10 males) of median age 61 years were also assessed RESULTS: Amitriptyline improved incontinence scores (median pretreatment score = 16 vs. median posttreatment score = 3; P < 0.001) and reduced the number of bowel movements per day (P < 0.001). Amitriptyline also decreased the frequency (median pretreatment frequency = 4.5 per hour vs. median immediate posttreatment frequency = 1.2 per hour (P < 0.05); control median frequency = 0.3 per hour) and the amplitude of rectal motor complexes (median pretreatment rectal pressure = 94 cm H2O vs. median immediate posttreatment rectal pressure = 58 cm H2O (P < 0.05); control median rectal pressure = 36 cm H2O) and improved anal pressures during these events (P < 0.001). CONCLUSIONS: Amitriptyline improved symptoms in 89 percent of patients with fecal incontinence. The data support that the major change with amitriptyline is a decrease in the amplitude and frequency of rectal motor complexes. The second conclusion is that drug increases colonic transit time and leads to the formation of a firmer stool that is passed less frequently. These in combination may be the source of the improvement in continence.
Subject(s)
Amitriptyline/administration & dosage , Antidepressive Agents, Tricyclic/administration & dosage , Fecal Incontinence/diagnosis , Fecal Incontinence/drug therapy , Administration, Oral , Adult , Aged , Aged, 80 and over , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Probability , Statistics, Nonparametric , Treatment OutcomeABSTRACT
This study was designed to determine functional outcomes of restorative resections for carcinoma of the rectum. Between 1992 and 1995, 16 patients (8 male) of median age 75 (range 58-88) years underwent resection and coloanal anastomosis with J-colonic pouch reconstruction for rectal cancer. The distance of the lower border of tumor from the anal verge was 5 cm in 7 patients (43.70-0), 6 to 7 cm in 6 patients (37.0%) and 8 to 10 cm in 3 patients (18.7%). The Dukes staging was A in 4 patients (25%), B in 8 patients (50%) and C in 4 patients (25%). Coloanal anastomosis was performed by hand in 4 patients (25%) or with stapler in 12 patients (75%). Seven patients (43.7%) had diverting stoma. No patient died following surgery. Pelvic sepsis and anastomotic dehiscence that required pouch excision occurred in two patients (12.5%). Fourteen patients were evaluated. The mean follow-up was 15 (range 5-23) months. No patient developed recurrent pelvic tumor. Satisfactory fecal continence was achieved by 85.7% of patients. Stool frequency was 1-2 per day in 12 patients (85.7%). Three patients (21.4%) had minor soiling. Five patients (35.7%) occasionally complained urgency. There was no apparent difference between the patients with manual or stapled coloanal anastomosis. Coloanal anastomosis with J-colonic pouch is associated with an excellent long-term outcome.
