From the Guidelines
Treating fecal incontinence typically involves a stepwise approach that starts with conservative management, including dietary changes and bowel habits training, which can benefit approximately 25% of patients 1.
Initial Management
- Dietary changes to manage stool consistency, such as increasing fiber intake, and
- Bowel habits training to establish a regular bowel routine are recommended as initial management strategies. For patients with fecal incontinence due to diarrhea, medications like loperamide (Imodium) can be prescribed, starting with a dose of 2 mg after each loose stool, up to a maximum of 16 mg per day 1. In cases of fecal incontinence associated with constipation, stool softeners or laxatives may be used under close supervision to avoid exacerbating the condition.
Biofeedback Therapy
Biofeedback therapy is also a recommended approach for treating fecal incontinence, aiming to help patients become aware of their bodily sensations and learn to control their anal sphincter muscles 1. This therapy typically involves 3-6 sessions, each lasting about an hour, conducted over several weeks.
Surgical Options
In more severe cases, or when conservative management fails, surgical options such as:
- Sacral nerve stimulation
- Sphincteroplasty
- Perianal bulking agents
- Barrier devices may be considered 1. It is crucial for patients to consult with a healthcare provider to determine the most appropriate treatment plan based on the underlying cause and severity of their fecal incontinence. Major anatomic defects should be rectified with surgery, and a colostomy may be considered in patients with severe fecal incontinence who have failed conservative treatment and other interventions 1.
From the Research
Treatment Options for Fecal Incontinence
The treatment of fecal incontinence can be divided into conservative interventions and surgical procedures 2. The goals of treatment are to decrease the frequency and severity of episodes as well as to improve quality of life 3.
Conservative Interventions: First-line therapy should be conservative and usually include:
- Dietary adjustments
- Fibre supplement
- Constipating agents
- Mini enemas 4
- Biofeedback therapy to improve external anal sphincter function, although the evidence for long-term effect is poor 4
- Colonic irrigation, which can reduce symptoms and improve quality of life, especially in patients with neurogenic faecal incontinence 4
Surgical Procedures: Surgical interventions should only be considered if conservative measures fail 4. These include:
- Sacral nerve stimulation, a minimally invasive procedure with a high rate of success 4
- Advanced surgical procedures, which should be restricted to highly selected patients and only performed at specialist centres 4
- Stoma formation, which should be considered if other treatment modalities fail 4
- Repair (sphincteroplasty)
- Stimulation (sacral nerve stimulation or posterior tibial nerve stimulation)
- Replacement (artificial bowel sphincter or muscle transposition)
- Diversion (stoma formation) 5
- Newer augmentation treatments such as radiofrequency energy delivery and injectable materials, which are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence 5
Individualized Approach
Treatment of fecal incontinence must be individualized to the patient, considering functional and quality of life related outcomes, as well as potential complications of the treatment 6, 5. The choice of treatment depends on the severity of the condition, the underlying cause, and the patient's overall health. A comprehensive evaluation and diagnosis are essential to determine the most effective treatment plan 2, 6.