From the Guidelines
Fecal and urinary incontinence can be effectively managed with a stepwise approach, starting with conservative therapies such as dietary modifications, pelvic floor exercises, and bladder training, as recommended by the most recent and highest quality study 1.
Management of Fecal Incontinence
For fecal incontinence, the following steps can be taken:
- Start with dietary modifications by increasing fiber intake (20-30g daily) and avoiding trigger foods like caffeine, alcohol, and spicy items.
- Pelvic floor exercises (Kegel exercises) performed 3 sets of 10 contractions daily can strengthen relevant muscles.
- Medications like loperamide (Imodium) 2-4mg before meals can reduce stool frequency and increase consistency.
- If conservative measures fail, pelvic floor retraining with biofeedback therapy is recommended, as suggested by 1.
Management of Urinary Incontinence
For urinary incontinence, the following steps can be taken:
- Bladder training involves scheduled voiding every 2-3 hours and gradually increasing intervals.
- Pelvic floor exercises are equally important here.
- Medications such as oxybutynin (5mg twice daily), tolterodine (2mg twice daily), or mirabegron (25-50mg daily) may help with urge incontinence.
- According to 1, nonpharmacologic management, such as pelvic floor muscle training (PFMT) for stress UI, bladder training for urgency UI, and PFMT with bladder training for mixed UI, is effective and has few adverse effects.
Advanced Treatments
If symptoms persist, more advanced treatments including biofeedback therapy, nerve stimulation, or surgical interventions may be necessary, as recommended by 1 and 1.
Lifestyle Modifications
Maintaining a voiding/bowel diary for 3-7 days helps identify patterns and triggers. Weight loss if overweight, smoking cessation, and managing chronic cough can significantly improve symptoms. It is essential to seek medical evaluation if symptoms persist, as a comprehensive approach can significantly improve quality of life, as highlighted by 1.
From the FDA Drug Label
Oxybutynin chloride thus decreases urgency and the frequency of both incontinent episodes and voluntary urination. Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency.
Fecal and Urine Incontinence:
- Oxybutynin decreases the frequency of incontinent episodes and voluntary urination.
- Loperamide reduces incontinence and urgency by increasing the tone of the anal sphincter. 2 and 3
From the Research
Fecal Incontinence
- Fecal incontinence is a debilitating problem affecting approximately 2.2% of the U.S. general population over 65 years of age 4.
- Etiologic factors include traumatic, neurologic, congenital, and iatrogenic causes, with obstetric trauma being a common cause 4.
- Several severity scores and quality of life indexes have been developed to quantify incontinent symptoms, and treatment options include nonsurgical and surgical methods 4.
- Biofeedback is among the most successful nonoperative strategies, while anal sphincter repair, artificial bowel sphincter, and sacral nerve stimulation are used to treat fecal incontinence with some success 4, 5.
Urine Incontinence
- Urge and mixed urinary incontinence can be treated with transdermal oxybutynin, which has been shown to reduce the number of weekly incontinence episodes and improve quality of life 6.
- A dose of 3.9 mg. daily oxybutynin TDS significantly reduced the number of weekly incontinence episodes and improved quality of life compared with placebo 6.
Treatment Options
- Conservative approaches, including dietary modifications, medications, muscle-strengthening exercises, and biofeedback, have been shown to provide short-term benefits for fecal incontinence 5.
- Sacral nerve stimulation has shown reasonable short-term effectiveness, but may be associated with complications and lacks randomized, controlled trials 5.
- Bulking agents, such as dextranomer microspheres in non-animal stabilized hyaluronic acid (NASHA Dx), may be an appropriate alternative therapy to consider before more aggressive therapies in patients who fail conservative therapies 5.
- For the treatment of fecal incontinence, invasive procedures, including sacral nerve stimulation, may be considered, but they are associated with complications and lack randomized, controlled trials 5, 7.