Fecal Incontinence Management

Introduction to Fecal Incontinence Treatment

A stepwise approach should be followed for the management of fecal incontinence, beginning with conservative therapies before progressing to more invasive interventions, as recommended by the American Gastroenterological Association 1, 2

Dietary modifications to identify and eliminate poorly absorbed sugars and caffeine that may contribute to diarrhea can benefit approximately 25% of patients 3, 4
Fiber supplementation to improve stool consistency and reduce diarrhea-associated incontinence can benefit patients with fecal incontinence 3, 5
Scheduled toileting and bowel training programs to establish regular bowel habits are recommended for patients with fecal incontinence 1, 2
Pelvic floor exercises to strengthen musculature are recommended for patients with fecal incontinence 1, 6
Medications for diarrhea management, such as loperamide, bile acid sequestrants, and anticholinergic agents, can be used to manage symptoms of fecal incontinence 3, 5

Anorectal manometry to identify anal weakness, altered rectal sensation, or impaired rectal balloon expulsion is recommended for patients who don't respond to conservative measures and biofeedback 3, 5
Anal imaging (ultrasound or MRI) to identify sphincter defects, atrophy, and patulous anal canal is recommended for patients who don't respond to conservative measures and biofeedback 3, 5

Perianal bulking agents (dextranomer microspheres) may be considered when conservative measures and biofeedback therapy fail, with 52% of patients showing ≥50% improvement in incontinence episodes at 6 months, as reported by the American Gastroenterological Association 1, 2, 5
Sacral nerve stimulation for moderate to severe fecal incontinence after failed conservative and biofeedback therapy is recommended, with continuous pulsed electrical stimulation of sacral nerves 1, 2, 7

Anal sphincter repair (sphincteroplasty) for postpartum women with fecal incontinence, patients with recent sphincter injuries, and patients with sphincter damage unresponsive to conservative and biofeedback therapy is recommended, as suggested by the American Society of Colon and Rectal Surgeons 1, 6
Artificial anal sphincter or dynamic graciloplasty for severe, medically-refractory fecal incontinence who have failed other treatments is recommended, as suggested by the American Society of Colon and Rectal Surgeons 1, 6

Inadequate trial of conservative therapy can lead to premature progression to invasive treatments, and a meticulous characterization of bowel habits and circumstances surrounding fecal incontinence is essential, as emphasized by the American Gastroenterological Association 3, 5
Failure to identify underlying causes, such as evacuation disorders with overflow of retained stool, can lead to inadequate treatment, and recognizing the impact of fecal incontinence on quality of life is crucial, as reported by the American Gastroenterological Association 3, 5, 6