Chronic obstetric anal sphincter injuries (OASIS), particularly grade IIIb and IV perineal lacerations, often cause persistent fecal incontinence and severely impaired quality of life. Conventional overlapping sphincteroplasty is limited for chronic injuries due to muscle atrophy, fibrosis, high local tension and insufficient soft tissue coverage. This study presents a modified cross-suturing technique (Cross-lap) to optimize sphincter reconstruction and lower adverse tension distribution.

Incontinence-associated dermatitis (IAD) is a form of moisture-associated skin damage caused by prolonged exposure to urine and/or faeces. It is associated with pain, skin breakdown and reduced quality of life. This guide outlines the causes, prevention, assessment and management of IAD, and explores the role of structured skin care regimens, including skin cleansers, barrier creams and barrier films, such as the CliniShield Advance range.

ObjectiveTo investigate the associations of accelerated biological aging and its component biomarkers with chronic diarrhea (CD) and fecal incontinence (FI).MethodsThis cross-sectional study analyzed data from 5,443 participants in the 2005-2010 National Health and Nutrition Examination Survey (NHANES). PhenoAge was calculated using nine clinical biomarkers, and phenotypic age acceleration (PhenoAgeAccel) was derived from residuals obtained by regressing PhenoAge on chronological age (CA). Weighted t-tests and chi-square tests were used to compare baseline characteristics, and weighted logistic regression and restricted cubic splines (RCS) were used to analyze the associations. Subgroup analyses were performed to evaluate potential effect modification, and sensitivity analyses were conducted to assess the consistency of the main findings.ResultsPhenoAgeAccel was positively associated with FI, whereas no significant association was detected between PhenoAgeAccel and CD. Participants with FI had higher CA, PhenoAge and PhenoAgeAccel (P<0.05). FI prevalence increased across higher quartiles of PhenoAge and PhenoAgeAccel (P for trend<0.05). Fully adjusted models showed that Q4 of PhenoAge was associated with higher odds of FI than Q1 (OR = 2.559, 95% CI 1.012-6.468, P = 0.037). Similarly, Q4 of PhenoAgeAccel was associated with higher odds of FI than Q1 (OR = 1.571, 95% CI 1.097-2.250, P = 0.014). Participants with accelerated PhenoAge also had higher odds of FI than those with decelerated PhenoAge (OR = 1.417, 95% CI 1.084-1.851, P = 0.011). RCS analyses supported a significant positive linear association between PhenoAgeAccel and FI. Nine clinical biomarkers were evaluated for associations with FI. ALB (albumin), CRP (C-reactive protein), and RDW (red cell distribution width) showed significant linear associations with FI (all P for nonlinearity > 0.05), whereas LYM% (lymphocyte percentage) and MCV (mean corpuscular volume) showed significant nonlinear associations (all P for nonlinearity < 0.05). Creatinine (Cr), glucose (Glu), alkaline phosphatase (ALP), and white blood cell count (WBC) exhibited no significant associations with FI (all P for overall association > 0.05). Significant interactions were observed for age (P for interaction < 0.001) and diabetes status (P for interaction = 0.034), indicating that the PhenoAgeAccel-FI association varied according to these factors. Sensitivity analyses supported the robustness of the continuous PhenoAgeAccel-FI association, although statistical evidence weakened for quartile-based analyses.ConclusionsPhenoAgeAccel was significantly and linearly associated with FI in a nationally representative sample of U.S. adults, whereas no significant association was observed between PhenoAgeAccel and CD. Prospective studies are needed to confirm this association and clarify its temporal relationship.

Bowel urgency (BU), a burdensome ulcerative colitis (UC) symptom, impacts quality of life. It is associated with higher levels of disease severity, corticosteroid use, hospitalization, and colectomy. Despite its prevalence and clinical significance, BU is underassessed in clinical practice and infrequently included as a clinical trial end point. This review evaluates the strengths and limitations of available patient-reported outcome (PRO) measures assessing BU in UC to inform future directions for its assessment. A literature review was conducted using PubMed, Google Scholar, and Embase to identify publications through October 31, 2024, using the key terms "ulcerative colitis assessment" and "bowel urgency." Publications assessing BU in UC using PRO scales developed according to Food and Drug Administration guidance were included. Five tools met the inclusion criteria. The Urgency Numeric Rating Scale provides a simple and time-efficient tool for clinical use, while multi-item tools such as the Symptoms and Impacts Questionnaire for Ulcerative Colitis and the Ulcerative Colitis-Symptom Questionnaire include comprehensive symptom tracking but impose greater burdens for clinical practice. Diary-based tools, including the Ulcerative Colitis-Patient-Reported Outcomes/Signs and Symptoms Diary and Patient-Reported Outcomes-Ulcerative Colitis Diary, allow detailed symptom monitoring in clinical trials but are less practical for routine clinical use. Some dimensions of BU are missing from the tools reviewed. Incorporating validated BU measurement into routine clinical care and research is essential for advancing patient-centered, comprehensive disease management and improving outcomes in patients with UC.

This study evaluates the effect of a structured perianal skin protection protocol based on individualized nutritional intervention on diarrhea-related incontinence-associated dermatitis (IAD) in patients with active Crohn's disease (CD). This retrospective cohort study included 200 active CD patients with diarrhea admitted from January 2023 to December 2025. Based on protocol implementation timing, patients were divided into a control group (January 2023-June 2024, n = 123) receiving routine perianal care, and an observation group (July 2024-December 2025, n = 77) receiving structured skin care plus individualized nutritional intervention. Propensity score matching yielded 65 matched pairs. IAD incidence, severity, perianal skin score, pain score, nutritional indicators, hospital stay, and costs were compared. Multivariate logistic regression analyzed IAD risk factors. After matching, the observation group showed significantly lower IAD incidence (30.8% vs 49.2%, P = .032) and better severity distribution (P = .031). Perineal skin condition score (5.1 ± 1.7 vs 8.3 ± 2.2) and pain NRS score (2.0 ± 1.0 vs 3.7 ± 1.4) were significantly lower in the observation group (P < .001). At discharge, albumin (38.5 ± 4.2 g/L vs 34.2 ± 4.1 g/L) and prealbumin (242.1 ± 50.3 mg/L vs 190.2 ± 46.5 mg/L) were significantly higher in the observation group (P < .001). Hospital stay was significantly shorter in the observation group (12.8 ± 4.1 days vs 16.5 ± 5.0 days, P < .001), with no significant difference in costs (P = .133). The observation protocol was an independent protective factor against IAD (OR = 0.38, 95%CI: 0.19-0.74, P = .004). The structured perianal skin protection protocol incorporating individualized nutritional support was associated with reduced IAD incidence and improved clinical outcomes in active CD patients with diarrhea.

Type 1 Wolfram syndrome is a rare, neurodegenerative pathology characterized by the association of insulin-dependent diabetes and optic atrophy. Other symptoms include diabetes insipidus, hearing loss and neurological damage. Fecal incontinence was recently recognized as a new symptom. Its pathophysiological mechanism remains unknown. We plan to collect data on the severity of the syndrome at the onset of fecal incontinence, the frequency of signs suggestive of pons volume reduction, and the frequency of urinary disturbances. Based on this information, we will investigate the possible location of the neurological involvement causing this symptom.