From the Guidelines
Passive bowel incontinence evaluation should begin with a thorough history and physical examination, focusing on stool consistency, frequency, and associated symptoms, as recommended by the British Society of Gastroenterology guidelines 1.
Initial Evaluation
The initial evaluation should include:
- A digital rectal examination to assess sphincter tone
- Basic laboratory tests including complete blood count, comprehensive metabolic panel, and thyroid function tests
- Assessment of cognitive function and mobility, particularly in elderly patients This comprehensive approach helps identify the underlying cause, which could range from sphincter damage, neurological disorders, inflammatory bowel disease, or medication side effects, allowing for targeted treatment planning.
Specialized Testing
Specialized testing, such as:
- Anorectal manometry to measure sphincter pressures
- Endoanal ultrasound to evaluate sphincter integrity
- Defecography to assess pelvic floor function during defecation should only be instigated once conservative measures for faecal incontinence have been exhausted and surgical intervention is contemplated, as suggested by the guidelines 1. Colonoscopy may be necessary to rule out structural abnormalities or inflammatory conditions. Neurological testing, such as pudendal nerve terminal motor latency, may be indicated if neurogenic causes are suspected.
Treatment Planning
Early and thorough evaluation is essential as treatment outcomes are generally better when intervention occurs promptly after symptom onset. A stepwise approach should be followed for management of fecal incontinence, starting with conservative therapies, such as diet, fluids, and bowel training program, as recommended by the Clinical Gastroenterology and Hepatology guidelines 2. Pelvic floor retraining with biofeedback therapy is recommended for patients with fecal incontinence who do not respond to conservative measures 2.
From the Research
Evaluation of Passive Bowel Incontinence
The evaluation of passive bowel incontinence involves a comprehensive approach to diagnose and manage the condition.
- A focused history and physical examination are essential in the initial clinical evaluation of fecal incontinence 3.
- Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment 3.
- Invasive diagnostic testing and imaging are generally not needed to initiate treatment but may be considered in complex cases 3.
Treatment Options
Various treatment options are available for managing passive bowel incontinence, including:
- Conservative management and biofeedback therapy, which can help create a manageable situation and improve quality of life 4.
- Medications such as loperamide, which can increase anal sphincter tone and improve fecal continence 5.
- Combination therapy with biofeedback, loperamide, and stool-bulking agents, which has been shown to be effective in treating fecal incontinence 6.
- Pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and colonic diversion 3.
- The use of the Qufora mini irrigation system, which has been found to be comfortable and effective in improving symptoms in patients with passive faecal incontinence and/or evacuation difficulty 4.
Effectiveness of Treatment Options
The effectiveness of treatment options for passive bowel incontinence varies, with:
- Conservative measures and biofeedback therapy being modestly effective 7.
- Combination therapy with biofeedback and medical treatment being superior to single treatments in terms of symptoms and functions 6.
- The Qufora mini irrigation system being found to be comfortable and effective in improving symptoms in patients with passive faecal incontinence and/or evacuation difficulty 4.
- Sacral nerve stimulation being shown to have reasonable short-term effectiveness, but also having some complications 7.