***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Bowel dysfunction in patients with spinal cord injury often causes constipation , fecal incontinence , or a combination of both with a significant impact on quality of life .  Transanal irrigation improves bowel function in selected patients . However , controlled trials of different bowel management regimens are lacking . The aim of the present study was to compare transanal irrigation with conservative bowel management ( best supportive bowel care without irrigation ) . METHODS In a prospect i ve , r and omized , controlled , multicenter trial involving 5 specialized European spinal cord injury centers , 87 patients with spinal cord injury with neurogenic bowel dysfunction were r and omly assigned to either transanal irrigation ( 42 patients ) or conservative bowel management ( 45 patients ) for a 10-week trial period . RESULTS Comparing transanal irrigation with conservative bowel management at termination of the study , the mean ( SD ) scores were as follows : Clevel and Clinic constipation scoring system ( range , 0 - 30 , 30 = severe symptoms ) was 10.3 ( 4.4 ) versus 13.2 ( 3.4 ) ( P = .0016 ) , St. Mark 's fecal incontinence grading system ( range , 0 - 24 , 24 = severe symptoms ) was 5.0 ( 4.6 ) versus 7.3 ( 4.0 ) ( P = .015 ) , and the Neurogenic Bowel Dysfunction Score ( range , 0 - 47 , 47 = severe symptoms ) was 10.4 ( 6.8 ) versus 13.3 ( 6.4 ) ( P = .048 ) . The modified American Society of Colorectal Surgeon fecal incontinence scores ( for each subscale , range is 0 - 4 , 4 = high quality of life ) were : lifestyle 3.0 ( 0.7 ) versus 2.8 ( 0.8 ) ( P = .13 ) , coping/behavior 2.8 ( 0.8 ) versus 2.4 ( 0.7 ) ( P = .013 ) , depression/self perception 3.0 ( 0.8 ) versus 2.7 ( 0.8 ) ( P = .055 ) , and embarrassment 3.2 ( 0.8 ) versus 2.8 ( 0.9 ) ( P = .024 ) . CONCLUSIONS Compared with conservative bowel management , transanal irrigation improves constipation , fecal incontinence , and symptom-related quality of life Background and Purpose — Despite its high prevalence in stroke survivors , there is little clinical research on bowel dysfunction in this population . This is the first r and omized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors . Methods — Stroke patients with constipation or fecal incontinence were identified by screening question naire ( 122 community , 24 stroke rehabilitation in patients ) and r and omized to intervention or routine care ( 73 per group ) . The intervention consisted of a 1-off structured nurse assessment ( history and rectal examination ) , leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations ( after consultation with geriatrician ) to patient ’s general practitioner (GP)±ward physician . Results — Percentage of bowel movements ( BMs ) per week grade d as “ normal ” by participants in a prospect i ve 1-week stool diary was significantly higher in intervention versus control patients at 6 months ( 72 % versus 55 % ; P=0.027 ) , as was mean number of BMs per week ( 5.2 versus 3.6 ; P=0.005 ) . There was no significant reduction in fecal incontinence , although numbers were small . At 12 months , intervention patients were more likely to be modifying their diets ( odds ratio [ OR ] , 3.1 [ 1.2 to 8.0 ] ) and fluid intake ( OR , 4.2 [ 1.4 to 12.2 ] ) to control their bowels and to have visited their GP for their bowel problem ( OR , 5.0 [ 1.4 to 17.5 ] ) . GP prescribing of laxatives and suppositories was significantly influenced at 12 months . Conclusions — A single clinical /educational nurse intervention in stroke patients  effectively improved symptoms of bowel dysfunction up to 6 months later , changed bowel-modifying lifestyle behaviors up to 12 months later , and influenced patient – GP interaction and physician prescribing patterns INTRODUCTION : Fecal incontinence is experienced by some patients with an ileoanal reservoir pouch . Theα1-adrenergic agonist phenylephrine raises resting anal sphincter pressure in healthy volunteers and may be of value in these patients . METHODS : Twelve patients ( 7 female ) , median age 44 ( range , 29–67 ) years were studied . All had fecal incontinence despite a noninflamed pouch of normal size and ultrasonographically structurally normal anal sphincter muscles . Patients were treated with topical 10 percent phenylephrine and placebo gels , allocated in r and om order in a double-blind , crossover study for two four-week periods . Before and during treatment , maximum resting anal sphincter pressure and anodermal blood flow were measured , a symptom question naire was completed , and incontinence score was determined using a vali date d scale . RESULTS : Six of 12 ( 50 percent ) patients improved subjectively after phenylephrine compared with one on placebo ( P=0.07 ) . Four patients had complete cessation of incontinence with active treatment . Phenylephrine significantly reduced the incontinence score ( P=0.015 ) . It also result ed in a significant rise in mean maximum resting anal sphincter pressure when compared with placebo ( P=0.012 ) . For all 12 patients , mean percent subjective improvement was higher after phenylephrine compared with placebo ( P=0.04 ) . There were no side effects . CONCLUSIONS : Topical phenylephrine significantly improves fecal continence in patients with an ileoanal pouch . In some patients it totally eliminates nocturnal episodes . The mechanism of benefit is likely to be one of altered neural sphincter control . This is the first study of the use of a topical pharmacologic agent to treat fecal incontinence and may have a wider application Background Anal incontinence is experienced by some patients with rectal cancer who received low anterior resection . This study was to examine the efficacy and adverse effects of the alpha-1 adrenergic agonist phenylephrine , which causes contraction of the internal anal sphincter and raises the resting pressure in these patients . Patients and methods Thirty-five patients with anal incontinence were treated with 30 % phenylephrine or a placebo r and omly allocated in a double-blind study . The efficacy of the drug was assessed by changes in the following st and ardized question naire scores : the fecal incontinence severity index ( FISI ) , fecal incontinence quality of life ( FIQL ) scales , and a global efficacy question . Anal sphincter function was evaluated using anorectal manometry . Results Phenylephrine did not improve either the FISI score or any of the four FIQL scores . Five of 17 ( 29 % ) patients reported subjective improvement after phenylephrine compared with 4 of 12 ( 33 % ) using the placebo . The maximum resting anal pressure did not differ between baseline and after 4 weeks application of phenylephrine ( 30.0 to 27.3 mmHg ) . In the phenylephrine group , allergic dermatitis was developed in five patients and headache in two . Conclusion In the patients with anal incontinence after low anterior resection for rectal cancer , phenylephrine gel did not seem to be helpful in relieving symptoms with some adverse effects Aim In a r and omized double‐blind study the therapeutic effect of a novel zinc – aluminium ointment was compared with placebo in patients with faecal incontinence OBJECTIVE to evaluate whether faecal incontinence can be improved by treatment of constipation in elderly patients with faecal incontinence associated with impairment of rectal emptying . DESIGN a prospect i ve r and omized study with a 2-month follow-up . SETTING five long-term care units . SUBJECTS 206 patients with daily faecal incontinence associated with chronic rectal emptying impairments such as faecal impaction received either a single osmotic laxative ( group I ) or an osmotic agent along with a rectal stimulant and weekly enemas ( group II ) . MEASUREMENTS episodes of faecal incontinence and associated details of soiled laundry ( used as indicators of the workload for caregivers ) . We performed periodic digital rectal examinations on group II patients to evaluate whether treatment result ed in complete and long-lasting rectal emptying . We compared data between groups and in group II between persistently constipated patients and patients with complete  rectal emptying . RESULTS the frequency of faecal incontinence did not significantly differ between the two groups . The 23 patients in group II who had complete rectal emptying had 35 % fewer episodes of faecal incontinence and 42 % fewer incidents of soiled laundry than the rest of the group . CONCLUSIONS when long-lasting and complete rectal emptying is achieved by laxatives , the number of episodes of faecal incontinence as well as the workload for caregivers is reduced Continence problems during treatment with orlistat ( a lipase inhibitor ) are caused when susceptible patients are exposed to increased volumes of loose , fatty stool . Aim : To investigate the dose-response effects of loperamide on continence and anorectal function in subjects susceptible to continence problems on orlistat .  Method : Ten obese subjects enterred a r and omized controlled , double-blind study of loperamide at placebo , 2 , 4 , and 6 mg/day in a factorial design . Continence problems during orlistat treatment were self-assessed by patient diary . Anorectal function and continence were assessed by barostat , manometry , and retention testing . Results : Loperamide increased stool consistency with dose ( p = 0.07 ) and this effect reduced continence problems during orlistat treatment ( p < 0.05 ) . A bell-shaped dose-response relationship was present with anal sphincter function ( p < 0.01 ) and anorectal sensitivity ( p < 0.01 ) . Conclusion : Loperamide has beneficial effects on stool consistency and continence in obese subjects taking orlistat .  The effect on stool consistency appeared more important than effects on anorectal function Background Human studies have shown that dietary fiber affects stool composition and consistency . Because fecal incontinence has been shown to be exacerbated by liquid stools or diarrhea , management strategies that make stool consistency less loose or liquid may be useful . Objective To compare the effects of a fiber supplement containing psyllium , gum arabic , or a placebo in community-living adults who were incontinent of loose or liquid stools . Mechanisms underlying these effects ( e.g. , fermentation of the fibers and water-holding capacity of stools ) were examined . Methods Thirty-nine persons with fecal incontinence of loose or liquid stools prospect ively recorded diet intake and stool characteristics and collected their stools for 8 days prior to and at the end of a 31-day fiber supplementation period . During the fiber supplementation period , they ingested psyllium , gum arabic , or a placebo by r and om assignment . Results In the baseline period , the groups were comparable on all variables measured . In the fiber supplementation period , ( a ) the proportion of incontinent stools of the groups ingesting the fiber supplements was less than half that of the group ingesting the placebo , ( b ) the placebo group had the greatest percentage of stools that were loose/unformed or liquid , and ( c ) the psyllium group had the highest water-holding capacity of water-insoluble solids and total water-holding capacity . The supplements of dietary fiber appeared to be completely fermented by the subjects as indicated by non-significant differences in total fiber , short chain fatty acids and pH in stools among the groups in the baseline or fiber supplementation periods . Conclusions Supplementation with dietary fiber from psyllium or gum arabic was associated with a decrease in the percentage of incontinent stools and an improvement of stool consistency . Improvements in fecal incontinence or stool consistency did not appear to be related to unfermented dietary fiber BACKGROUND AND AIMS Many patients with complete spinal cord injury ( SCI ) exhibit demyelinated and poorly myelinated nerve fibers traversing the lesion site . Conventional doses of 4-aminopyridine ( 4-AP , 30 mg/day ) have shown to provide no or minor functional improvement in these patients . We undertook this study to test the functional effect of high doses of 4-AP on patients with chronic complete SCI with cord continuity at the site of injury demonstrated by magnetic resonance imaging . METHODS Fourteen patients were included in a double-blind , r and omized , placebo-controlled trial followed by an open label long-term follow-up . Initially , patients received 4-AP or placebo orally , with 4-AP being increased gradually ( 5 mg/week ) to reach 30 mg/day . For long-term treatment , 4-AP was increased 10 mg periodically according to negative electroencephalogram and blood test abnormalities and minor adverse reactions . Pre-treatment , 12 and 24 weeks of the controlled trial , and 6 and 
    Output:
    
There was limited evidence that antidiarrhoeal drugs and drugs that enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools .
Loperamide was associated with more adverse effects ( such as constipation , abdominal pain , diarrhoea , headache and nausea ) than placebo .
However , the dose may be titrated to the patient 's symptoms to minimise side effects while achieving continence .
The drugs acting on the sphincter sometimes result ed in local dermatitis , abdominal pain or nausea .
Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses .
Zinc-aluminium ointment was associated with improved quality of life , with no reported adverse effects .
However , the observed improvement in quality of life was seen in the placebo group as well as the treatment group .
The small number of trials identified for this review assessed several different drugs in a variety of patient population s. The focus of most of the included trials was on the treatment of diarrhoea , rather than faecal incontinence .
There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence .