Chronic liver disease, ascites, anal incontinence, and driving

Chronic liver disease and liver encephalopathy

In some situations, mild or moderate hepatocellular insufficiency occurs, such as fatty liver in pregnancy, acute viral hepatitis, stasis liver, medicinal hepatitis, etc. Liver function is reestablished completely when the cause disappears.

In other cases, the liver function impairment developed chronically and progressed to become irreversible, as in cirrhosis.

Latent or compensated cirrhosis has no associated symptoms or involves nonspecific symptoms of dyspepsia, flatulence, pain in the right hypochondrium, anorexia and muscle weakness.

Decompensated cirrhosis of the liver occurs as complications including jaundice, ascites, liver encephalopathy, digestive bleeding, etc.

Liver encephalopathy is characterized by central nervous system disorders, with reduction of consciousness, from somnolence and confusion to stupor and coma, inversion of sleep rhythm, cognitive disorders with bradypsychia, inability to maintain attention, temporo-spatial disorientation, and personality disorders with euphoria, depression, aggressiveness and behavior disorders.

Neuromuscular disorders are also frequent, with asterixis, hypertonia, seizures, tremor, ataxia, amimia, choreoathetosis, spastic paraplegia, etc.

The treatment of these patients is complex and multidisciplinary and requires expert physicians in order to prevent all types of complications.

Liver transplant has given life to many of these patients.

Advice on Chronic liver disease and liver encephalopathy

• Patients with mild or moderate liver insufficiency with symptoms only of dyspepsia can drive.
• If the underlying disease is chronic and progressive, sometimes during its progression the patient will start to suffer neurological disorders loss of attention and somnolence, that will disable him for driving.
• The patient with advanced liver disease cannot fulfill his daily life activities, including driving.
• The transplant returns life and many of these patients can drive again, when their physician considers it appropriate and reports favorably for it.

Ascites

Fluid accumulation in the abdominal cavity can be due to many reasons, but the most frequent are liver diseases causing portal hypertension such as liver cirrhosis.

Ascites not due to liver disease includes inflammatory conditions in the peritoneum, abdominal tumors compressing major vessels and lymphatic ones, gynecological conditions, hypoalbuminemia, AIDS, etc.

The small quantities of ascites are asymptomatic, but as the volume of fluid increases, the patient starts to notice abdominal distention. When ascites is of tension, dyspnea appears.

If possible, the cause of ascites will be treated. In liver cirrhosis bed rest, diet measures, diuretics, paracentesis of evacuation, surgical procedures of porto-systemic derivation and liver transplant are recommended.

Advice on Ascites

• Although the amount of fluid in the abdominal cavity does not cause major symptoms, ascites is frequently associated with significant diseases, that indeed advise against driving.
• Large-volume ascites prevents physically from driving, particularly if it causes dyspnea.

Anal incontinence

The inability to delay the defecation until the appropriate place and time for it are found affects 2.2% of the population.

Starting at 50 years, more than 20% of women and 10% of men suffer anal incontinence.

Advice on Anal incontinence

• The patients where anal incontinence prevents them from fulfilling a normal social and professional life cannot drive.
• These incontinent conductors, in order not to lose their freedom to move, drive with a diaper, tampon, or sanitary napkin. During driving, they are sometimes more concerned for their problems and do not pay attention to the car, the road, and environment.
• It is important that we diagnose through a quality of life questionnaire, the incontinence scale. We will thus be able to advise more safely the indications, care, and warn of the safety risks when driving.
• The patient who suffers mild incontinence fears the situations where he has no toilet near to defecate. This fear causes nervousness and speeds up intestinal rhythm enhancing defecation.
• It is frequently an occult disease for its intimacy, that worsens on driving.
• The driver with incontinence in a traffic jam or a longer trip can be distressed with the situation and be distracted only for looking for a toilet while driving.
• The patient that cannot drive for this cause is depressed, given the greater evidence of his social disability and lack of freedom.
• The assistance of the physician is essential, indicating habits that reduce incontinence and recommending mechanisms so that the patient can drive most comfortably and without the risks of lack of safety of these patients.
• They should be recommended not to have coffee, tea, mint, cola and energetic drinks, irritants, fats, spicy food, and of course, that they do not smoke or drink alcohol.
• In selected cases, bulk-forming products, astringents such as loperamide and opiate derivatives, enemas and anal obturators will be indicated.
• Loperamide does not affect mental alertness, but in some cases can cause somnolence, tiredness, and dizziness, so driving is not recommended in these cases, even if diarrhea disappears.
• Sphincter rehabilitation or biofeedback in motivated patients and with experienced medical staff obtains 60-80% improvement. This enables to recover the ability to drive for many patients.
• In the selected cases, neurostimulation of sacral roots and silicone implants will be indicated, and on other cases, surgery will be required.
• The favorable evolution of the patient will allow the expert for informing the possibility to drive again, with the maximum safety for the driver and for all.