Fecal Incontinence

  • Jung Ryul Oh


Anal continence is controlled by complex interaction of pelvic floor muscle, anal sphincter, rectal compliance, stool consistency, and cognitive function. The main causes of secondary fecal incontinence are birth injury and anal surgery of hemorrhoid, fistula, and fissure. Anorectal manometry and rectal sensory tests are good tools to determine the abnormalities of the internal and external sphincter function and sensory of the rectum. Operative treatment can be considered after the safe and simple methods like supportive therapy, medication treatment, and biofeedback therapy have failed. A number of treatment modalities are attempted, but still there’s lack of standard guideline on which treatment should be used in which cases.


Anal incontinence Sphincteroplasty Biofeedback therapy 


  1. 1.
    Nelson RL. Epidemiology of fecal incontinence. Gastroenterology. 2004;126(1 Suppl 1):S3–7.CrossRefGoogle Scholar
  2. 2.
    Ho YH, Muller R, Veitch C, Rane A, Durrheim D. Faecal incontinence: an unrecognised epidemic in rural North Queensland? Results of a hospital-based outpatient study. Aust J Rural Health. 2005;13:28–34.CrossRefGoogle Scholar
  3. 3.
    Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med. 1992;326:1002–7.CrossRefGoogle Scholar
  4. 4.
    Rao SS, American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 2004;99:1585–604.CrossRefGoogle Scholar
  5. 5.
    Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of fecal incontinence. Br J Surg. 1991;78:312–4.CrossRefGoogle Scholar
  6. 6.
    Woodfield CA, Krishnamoorthy S, Hampton BS, Brody JM. Imaging pelvic floor disorders: trend toward comprehensive MRI. AJR Am J Roentgenol. 2010;194:1640–9.CrossRefGoogle Scholar
  7. 7.
    Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques: American Gastroenterological Association. Gastroenterology. 1999;116:732–60.CrossRefGoogle Scholar
  8. 8.
    Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet. 2004;364:621–32.CrossRefGoogle Scholar
  9. 9.
    Wald A. Fecal incontinence. Curr Treat Options Gastroenterol. 2005;8:319–24.CrossRefGoogle Scholar
  10. 10.
    Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807–14.CrossRefGoogle Scholar
  11. 11.
    Santoro GA, Eitan BZ, Pryde A, Bartolo DC. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 2000;43:1676–81.CrossRefGoogle Scholar
  12. 12.
    MacLeod JH. Management of anal incontinence by biofeedback. Gastroenterology. 1987;93:291–4.CrossRefGoogle Scholar
  13. 13.
    Ryn AK, Morren GL, Hallböök O, Sjödahl R. Long-term results of electromyographic biofeedback training for fecal incontinence. Dis Colon Rectum. 2000;43:1262–6.CrossRefGoogle Scholar
  14. 14.
    Heymen S, Jones KR, Ringel Y, Scarlett Y, Whitehead WE. Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum. 2001;44:728–36.CrossRefGoogle Scholar
  15. 15.
    Leroi AM, Dorival MP, Lecouturier MF, Saiter C, Welter ML, Touchais JY, Denis P. Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum. 1999;42:762–9.CrossRefGoogle Scholar
  16. 16.
    Van Tets WF, Kuijpers JH, Bleijenberg G. Biofeedback treatment is ineffective in neurogenic fecal incontinence. Dis Colon Rectum. 1996;39:992–4.CrossRefGoogle Scholar
  17. 17.
    Ratto C, Parello A, Donisi L, Litta F, De Simone V, Spazzafumo L, Giordano P. Novel bulking agent for faecal incontinence. Br J Surg. 2011;98(11):1644–52.CrossRefGoogle Scholar
  18. 18.
    Luo C, Samaranayake CB, Plank LD, Bissett IP. Systematic review on the efficacy and safety of injectable bulking agents for passive faecal incontinence. Color Dis. 2010;12(4):296–303.CrossRefGoogle Scholar
  19. 19.
    Altomare DF, La Torre F, Rinaldi M, Binda GA, Pescatori M. Carbon-coated microbeads anal injection in outpatient treatment of minor fecal incontinence. Dis Colon Rectum. 2008;51(4):432–5.CrossRefGoogle Scholar
  20. 20.
    Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA. Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction. Gut. 2002;51(2):225–8.CrossRefGoogle Scholar
  21. 21.
    Felt-Bersma RJ. Temperature-controlled radiofrequency energy in patients with anal incontinence: an interim analysis of worldwide data. Gastroenterol Rep (Oxf). 2014;2(2):121–5.CrossRefGoogle Scholar
  22. 22.
    Takahashi-Monroy T1, Morales M, Garcia-Osogobio S, Valdovinos MA, Belmonte C, Barreto C, Zarate X, Bada O, Velasco L. SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up. Dis Colon Rectum. 2008;51(3):355–9.CrossRefGoogle Scholar
  23. 23.
    Ruiz D, Pinto RA, Hull TL, Efron JE, Wexner SD. Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up? Dis Colon Rectum. 2010;53(7):1041–6.CrossRefGoogle Scholar
  24. 24.
    Vaizey CJ, Kamm MA, Nicholls RJ. Recent advances in the surgical treatment of faecal incontinence. Br J Surg. 1998;85:596–603.CrossRefGoogle Scholar
  25. 25.
    Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA. Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum. 1984;27(11):720–2.CrossRefGoogle Scholar
  26. 26.
    Young CJ, Mathur MN, Eyers AA, Solomon MJ. Successful overlapping anal sphincter repair. Dis Colon Rectum. 1998;41(3):344–9.CrossRefGoogle Scholar
  27. 27.
    Halverson AL, Hull TL. Long-term outcome of overlapping anal sphincter repair. Dis Colon Rectum. 2002;45(3):345–8.CrossRefGoogle Scholar
  28. 28.
    Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long term results of overlapping anterior analsphincter repair for obstetric trauma. Lancet. 2000;355:260–5.CrossRefGoogle Scholar
  29. 29.
    Baxter NN, Bravo Guttierez A, Lowry AC, Parker SC, Madoff RD. Long-term results of sphincteroplasty for acquired fecal incontinence (abstr). Dis Colon Rectum. 2003;46:A21–2.CrossRefGoogle Scholar
  30. 30.
    Bravo Gutierrez A, Madoff RD, Lowry AC, Parker SC, Buie WD, Baxter NN. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004;47:727–32.CrossRefGoogle Scholar
  31. 31.
    Madoff RD. Surgical treatment options for fecal incontinence. Gastroenterology. 2004;126:S48–54.CrossRefGoogle Scholar
  32. 32.
    Leroi AM, Parc Y, Lehur PA, et al. Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg. 2005;242:662–9.CrossRefGoogle Scholar
  33. 33.
    Tjandra JJ, Chan MK, Yeh CH, Murray-Green C. Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum. 2008;51:494–502.CrossRefGoogle Scholar
  34. 34.
    Rosen HR, Urbarz C, Holzer B, Novi G, Schiessel R. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology. 2001;121:536–41.CrossRefGoogle Scholar
  35. 35.
    Wong MT, Meurette G, Stangherlin P, Lehur PA. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence. Dis Colon Rectum. 2011;54:773–9.CrossRefGoogle Scholar
  36. 36.
    Brouwer R, Duthie G. Sacral nerve neuromodulation is effective treatment for fecal incontinence in the presence of a sphincter defect, pudendal neuropathy, or previous sphincter repair. Dis Colon Rectum. 2010;53:273–8.CrossRefGoogle Scholar
  37. 37.
    Hetzer FH. Fifteen years of sacral nerve stimulation: from an open procedure to a minimally invasive technique. Color Dis. 2011;13(Suppl 2):S1–4.CrossRefGoogle Scholar
  38. 38.
    Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet. 1995;346:1124–7.CrossRefGoogle Scholar
  39. 39.
    Douglas JM, Smith LE. Recent concepts in fecal incontinence. Curr Womens Health Rep. 2001;1:67–71.PubMedGoogle Scholar
  40. 40.
    Spinelli M, Giardiello G, Arduini A, van den Hombergh U. New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. Eur Urol. 2003;43:70–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Jung Ryul Oh
    • 1
  1. 1.Colorectal Division, Department of SurgeryHansol HospitalSeoulSouth Korea

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