INKONTINENSIA ALVI

/ FEKAL
DEFINISI

Inkontinensia alvi (inkontinensia feses) adalah

ketidakmampuan untuk mengontrol buang air
besar, menyebabkan tinja (feses) bocor tak
terduga dari dubur. Inkonteinensia tinja juga
disebut inkontinensia usus. Inkontinensia tinja
berkisar dari terjadi sesekali saat duduk hingga
sampai benar-benar kehilangan kendali.
The muscular arrangement of the levator ani muscles
Factors necessary for maintenance of fecal continence
FISIOLOGI DEFIKASI
Fungsi normal defikasi :
 Kerja sfingter ani eksterna dan
interna : berkontraksi untuk
mencegah keluarnya feses dari
rektum
 Sensasi rektal : Memberikan
peringatan akan perlunya ke toilet
 Akomodasi rektal : akan memberikan
kemampuan untuk menahan
fesesbeberapa waktu dalam rektum,
sampai memungkinkan.
 NEUROFISIOLOGI ANOREKTAL

 SAI : Kontrol saraf otonom – arkus refleks

spinal cord
 Simpatis dari L5 Pleksus pelvikus, pleksus
hipogastrikus
 Parasimpatis dari S2-4 pleksus pelvikus
bersama simpatis
 SAE : Nervus pudendus (S2-4) secara bilateral
mll kanalis alcock
 Levator ani : sacral roots S2-4 dan tidak
mendapat persarafan langsung dari nervus
pudendus
Mekanisme Inkotinensia Anal
 ETIOLOGI

Multifaktorial
 Proses persalinan
 Miopati
 Neuropati
 Usia
 Trauma operasi
 Kelainan medis
 DM
 Stroke
 Trauma medula spinalis
 Proses degeneratif dan kelainan saraf Mobilitias
berkurang
 Konstipasi kronis
 PATOMEKANISME
INKONTINENSIA ANI
  Anamnesis
 Physical examinations
 Anal manometry
 Anorectal ultrasonography
 Proctography
 Proctosigmoidoscpy
 Anal electromyogrphy

DIAGNOSIS
 An ultrasound probe is placed in the anal
canal or transvaginally to detect sphincter
injuries and to evaluate pelvic floor
structures

Anal Endosonography
Normal anatomy as viewed by anal endosonography (a)
Normal anatomy as viewed by anal endosonography (b)
Normal anatomy as viewed by anal endosonography (c)
External anal sphincter showing normal narrowing anteriorly.
Fecal incontinence. Ultrasound of mid anal canal taken with the patient in
the low lithotomy position showing intact internal and external anal
sphincters.
Fecal incontinence. Internal anal sphincter at the level of the levators.
The levators are demonstrated by the U-shaped echogenic band
posteriorly
Fecal incontinence. External anal sphincter from a nulliparous
patient showing the normal anterior narrowing seen in
women.
Fecal incontinence. Ultrasound of the external anal sphincter
taken with the patient in the low lithotomy position showing
a defect from the 9- to the 3-o'clock position. The picture
also shows the superficial transverse perineum muscles
entering from lateral positions.
Fecal incontinence. Ultrasound taken with the patient in the lithotomy
position, at the mid anal canal, showing an internal anal sphincter
defect from the 10- to the 2-o'clock position.
Fecal incontinence. Ultrasound showing an internal anal sphincter defect.
. Fecal incontinence. Ultrasound taken with the patient in the
low lithotomy position showing a defect in the internal anal
sphincter at the level of the puborectalis muscle that can be
seen as a U-shaped echogenic mass posteriorly
 PENANGANAN INKONTINENSIA ANI

 Non Surgikal

• Modifikasi diet
• Farmakoterapi
• Enema dan irigasi rektum
• Terapi Biofeedback

 Surgikal

• Spingteroplasti anal
• Postanal pelvic floor repair
• Muscle transposition procedure
• Artificial anal spichnter
• Kolostomi atau illeostomi
TERIMAKASIH