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Fecal Incontinence

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Functional and Motility Disorders of the Gastrointestinal Tract

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Abstract

Fecal incontinence (FI) is a socially and emotionally devastating disorder. The prevalence of FI among institutionalized persons reaches 45 %. Prevalence rates are similar between men and women, 7.7 % and 8.9 %, respectively, and increase with age, reaching 15.3 % in those 70 years of age or older. Due to social perception, many patients do not seek treatment, which likely leads to an underestimation of prevalence. Thirty-six percent of primary care patients reported episodes of FI but only 2.7 % of these patients had a documented diagnosis. Healthcare costs are 55 % higher in FI than continent patients, amounting to an estimated $11 billion annually. Most patients achieve significant improvement in symptoms through proper treatment. Early diagnosis may prevent complications that reduce quality of life.

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Key References

  1. Bharucha AE, Zinsmeister AR, Schleck CD, Melton 3rd LJ. Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterology. 2010;139(5):1559–66. A nice study that evaluates risk factors for FI.

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  2. Madoff RD. Surgical treatment options for fecal incontinence. Gastroenterology. 2004;126(1 Suppl 1):S48–54. A nice summary of treatment options for FI.

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  3. Rao SS. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol. 2010;8(11):910–9.e2. This paper details the diagnostic testing that may be done in fecal incontinence patients.

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  4. Rao SS. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 2004;99(8):1585–604. An older but still valuable article on the diagnosis of FI.

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  5. Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126(1 Suppl 1):S14–22. Reviews the pathophysiology of fecal incontinence.

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  6. Shah BJ, Chokhavatia S, Rose S. Fecal incontinence in the elderly: FAQ. Am J Gastroenterol. 2012;107(11):1635–46. Nice review with focus on the elderly.

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Recommended Reading

  1. Drossman DA, Dumistrascu DL. Rome III: New standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis 2006;15:237–41

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA

    Vanessa C. Costilla M.D.

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA

    Amy E. Foxx-Orenstein D.O.

Authors
  1. Vanessa C. Costilla M.D.
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  2. Amy E. Foxx-Orenstein D.O.
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Corresponding author

Correspondence to Amy E. Foxx-Orenstein D.O. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

    Brian E. Lacy

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

    Michael D. Crowell

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

    John K. DiBaise

Teaching Questions

Teaching Questions

  1. 1.

    A G3P3 41-year-old woman states she is having “accidents” at work. She has started to use pads for her bowel “leakage.” She reports having watery stools but no melena or hematochezia. Past medical history includes three c-sections twice, obesity with a BMI of 30, and hyperlipidemia.

    What is her greatest risk factor for fecal incontinence?

    1. (A)

      Multiple traumatic deliveries

    2. (B)

      Age

    3. (C)

      Obesity

    4. (D)

      Diarrhea

  2. 2.

    A 26-year-old man with twice daily, loose bowel movements is referred for bothersome perianal moisture. An anal plug was not tolerated. He wipes excessively after bowel movements without a sustained drying effect. On visual inspection there is minor hemorrhoid irritation, perianal moisture, and hemorrhoids. Flexible sigmoidoscopy was notable for hemorrhoids. Anorectal manometry and defecography studies were normal.

    If conservative methods are not effective, what treatment is recommended to treat persistent fecal seepage?

    1. (A)

      Anal sphincter botulinum toxin

    2. (B)

      Dynamic graciloplasty sphincteroplasty

    3. (C)

      Tap water enemas

    4. (D)

      Fleet enema or glycerin suppository prn

  3. 3.

    A 73-year-old woman with Alzheimer’s dementia presents for evaluation of diarrhea. She has had diarrhea more frequently and now is soiling herself intermittently. This is adding significant stress to her daughter and caregiver. The patient ambulates slowly with a front-wheel walker. She senses the urge to defecation, but cannot always get to the bathroom in time.

    Which of the following would you advise?

    1. (A)

      Decrease intake sugary foods, drinks, and caffeine

    2. (B)

      Increase fiber intake

    3. (C)

      Decrease fiber intake

    4. (D)

      A and C

    5. (E)

      A and B

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Costilla, V.C., Foxx-Orenstein, A.E. (2015). Fecal Incontinence. In: Lacy, B., Crowell, M., DiBaise, J. (eds) Functional and Motility Disorders of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1498-2_19

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  • DOI: https://doi.org/10.1007/978-1-4939-1498-2_19

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1497-5

  • Online ISBN: 978-1-4939-1498-2

  • eBook Packages: MedicineMedicine (R0)

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