Fecal Incontinence: Etiology, Evaluation, and Treatment

Abstract

Fecal incontinence is a debilitating problem facing 2.2% of the U.S. general population over 65 years of age. Etiologic factors include traumatic, neurologic, congenital, and iatrogenic. Most commonly, obstetric trauma causes fecal incontinence as well as poorly performed anorectal surgery or pelvic radiation. Several severity scores and quality of life indexes have been developed to quantify incontinent symptoms. There are several nonsurgical and surgical options for the treatment of fecal incontinence. Biofeedback is among the most successful nonoperative strategies. Depending on the cause, anal sphincter repair, artificial bowel sphincter, and sacral nerve stimulation are used to treat fecal incontinence with some success. Unfortunately, fecal incontinence is an extremely difficult problem to manage: there has not been one, single treatment option that has proven to be both safe and effective in long-term studies.KEYWORDS: Fecal incontinence, anal sphincter repair, sacral nerve stimulation, artificial bowel sphincter, biofeedbackObjectives: On completion of this article, the reader should be able to summarize the causes and treatment options of fecal incontinence, including both surgical and nonoperative. BACKGROUNDFecal incontinence (FI) is a debilitating and embarrassing problem facing 2.2% of the U.S. general population over 65 years old. 1 This disorder is more prevalent in the elderly population and is one of the most common reasons for nursing home placement. 2,3 The etiology of FI is multifactorial and can be due to several factors including neuropathic, traumatic, congenital, and obstetric trauma, as well as iatrogenic injuries due to injudicious fistula surgery, hemorrhoidectomy, and lateral internal sphincterotomy among several others. FI symptoms can range from mild to severe and the work-up and treatments of this disorder are just as varied. Patients may complain of incontinence to flatus,

Functional Evaluation of Obese Patients with Symptoms of Fecal Incontinence Using Anorectal Electromanometry

“…Though affecting mostly elderly women, the prevalence of FI in the general population is highly variable, with reports ranging from 0.4% to 18% [2][3][4][5]. The actual prevalence is likely higher than this since many cases remain unreported due to embarrassment.…”

“…FI affects both genders but is more prevalent among women, especially the elderly [1]. The overall prevalence is 0.4-18% [2][3][4][5], but the condition is often unreported due to embarrassment, despite significant loss of quality of life [5,6].…”

Role of recto-anal biofeedback in management of fecal incontinence: early experience for prospective non-surgical management

“…The etiology of FI is multifactorial and can be due to several factors including neuropathic, traumatic, congenital, and obstetric trauma, as well as iatrogenic injuries due to injudicious fistula surgery, haemorrhoidectomy, and lateral internal Sphinctrotomy among several others. 12 Management of FI includes a variety of options ranging from conservative to surgical management, Conservative non-surgical measures include life style patient education, dietary management, Pharmacological agents, pelvic floor exercises, and biofeedback. 13 Biofeedback is cheap, generally safe, and effortlessly endured by most patients, and achievement rates can be as high as 100%.…”

Stellenwert der konservativen Therapie bei Stuhlinkontinenz

“…Die generelle Empfehlung einer ballaststoffreichen Ernährung ist allgegenwärtig, hat jedoch für die betroffenen Patienten keinen direkten kausalen Einfluss auf die Inkontinenzsymptome. Da bei der Mehrzahl der betroffenen, meist weiblichen Patienten eine Inkontinenz für Winde und/oder flüssigen Stuhl vorliegt, ist ein konservativer Therapieansatz gerechtfertigt, wobei medikamentöse Therapieoptionen (Beeinflussung der Stuhlkonsistenz und -passage) an erster Stelle stehen [14,15]. Hierbei kann Loperamid zur Stuhleindickung oder ein Macrogol-Präparat zur Stuhlregulation eingesetzt werden.…”