Abstract
Fecal incontinence (FI) is defined as the involuntary loss of feces. It results from by altered bowel habits (especially diarrhea) and/or conditions that affect the ability of the rectum and anus to hold stool. The clinical evaluation is very useful for assessing symptom severity and for guiding management. Testing is guided by clinical features and the response to therapy and generally begins with anorectal manometry. Additional tests (e.g., endoanal ultrasound, defecography, pelvic MRI, and anal electromyography) are useful in selected cases. In many patients, patient education and management of disordered bowel habits are very useful for improving fecal continence; pelvic floor retraining (biofeedback therapy) may be useful for patients who do not respond to these measures. Sacral nerve stimulation and other surgical options should be considered for patients who do not respond to conservative therapy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bharucha A. Fecal incontinence. Gastroenterology. 2003;124:1672–85.
Bharucha AE, Zinsmeister AR, Schleck CD, et al. Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterology. 2010;139:1559–66.
Bharucha AE, Fletcher JG, Melton LJ 3rd, et al. Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case-control study. Am J Gastroenterol. 2012;107:902–11.
Bharucha AE, Dunivan G, Goode PS, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110:127–36.
Bharucha AE, Rao SSC. An update on anorectal disorders for gastroenterologists. Gastroenterology. 2014;146:37–45.e2.
Heymen S, Scarlett Y, Jones K, et al. Randomized controlled trial shows biofeedback to be superior to alternative treatments for fecal incontinence. Dis Colon Rectum. 2009;52:1730–7.
Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272–5.
Bliss DZ, Savik K, Jung H-JG, et al. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014;37:367–78.
Markland AD, Burgio KL, Whitehead WE, et al. Loperamide versus Psyllium fiber for treatment of fecal incontinence: the fecal incontinence prescription (Rx) management (FIRM) randomized clinical trial. Dis Colon Rectum. 2015;58:983–93.
Sun WM, Read NW, Verlinden M. Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Scand J Gastroenterol. 1997;32:34–8.
Norton C, Chelvanayagam S, Wilson-Barnett J, et al. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125:1320–9.
Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med. 1984;310:1282–7.
Beeckman D, Van Damme N, Schoonhoven L, et al. Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database Syst Rev. 2016; doi:10.1002/14651858.CD011627.
Wald A. Clinical practice. Fecal incontinence in adults. N Engl J Med. 2007;356:1648–55.
Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9.
Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56:234–45.
Mellgren A, Matzel KE, Pollack J, et al. Long-term efficacy of NASHA Dx injection therapy for treatment of fecal incontinence. Neurogastroenterol Motil. 2014;26:1087–94.
Dehli T, Stordahl A, Vatten LJ, et al. Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial. Scand J Gastroenterol. 2013;48:302–10.
Knowles CH, Horrocks EJ, Bremner SA, et al. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet. 2015;386:1640–8.
Acknowledgments
This study was supported in part by USPHS NIH Grant R01 DK78924 from the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Chabkraborty, S., Bharucha, A.E. (2018). Fecal Incontinence. In: Bardan, E., Shaker, R. (eds) Gastrointestinal Motility Disorders . Springer, Cham. https://doi.org/10.1007/978-3-319-59352-4_37
Download citation
DOI: https://doi.org/10.1007/978-3-319-59352-4_37
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-59350-0
Online ISBN: 978-3-319-59352-4
eBook Packages: MedicineMedicine (R0)