From the Guidelines
Percutaneous nerve stimulation should not be used as a first-line treatment for iatrogenic fecal incontinence, and instead, a stepwise approach starting with conservative therapies should be followed. Treatment options for iatrogenic fecal incontinence include both conservative and surgical approaches based on severity and underlying cause. Initial management typically involves conservative measures such as dietary modifications, pelvic floor muscle exercises, and biofeedback therapy to improve sphincter control 1.
Key Considerations
- Conservative therapies will benefit approximately 25% of patients and should be tried first 1.
- Pelvic floor retraining with biofeedback therapy is recommended for patients with fecal incontinence who do not respond to conservative measures 1.
- Sacral nerve stimulation should be considered for patients with moderate or severe fecal incontinence in whom symptoms have not responded after a 3-month or longer trial of conservative measures and biofeedback therapy 1.
- Other treatment options, such as perianal bulking agents, anal sphincter repair, and colostomy, may be considered for patients who do not respond to conservative and biofeedback therapy 1.
Treatment Approach
When conservative measures fail, surgical interventions may be considered, including sphincteroplasty to repair damaged sphincters, or injection of bulking agents to increase anal canal resistance. The choice of treatment depends on the specific cause of iatrogenic incontinence, whether it resulted from surgical trauma to sphincters, nerve damage during procedures, radiation therapy effects, or medication side effects. A thorough evaluation including anorectal manometry and endoanal ultrasound is essential to determine the exact mechanism of injury before selecting the appropriate treatment approach.
Important Considerations
- Percutaneous tibial nerve stimulation should not be used for managing fecal incontinence in clinical practice, according to best practice advice 1.
- Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions 1.
From the FDA Drug Label
Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. The patient with iatrogenic fecal incontinence may be indicated for Loperamide (PO) treatment, as it increases the tone of the anal sphincter, which can help reduce incontinence and urgency 2.
- Key benefits of loperamide for this patient include:
- Reducing incontinence
- Reducing urgency
- Increasing intestinal transit time
- Increasing the tone of the anal sphincter
From the Research
Treatment Options for Iatrogenic Fecal Incontinence
- Sacral nerve stimulation is a valid treatment option for fecal incontinence, including iatrogenic cases, as it can improve continence by modulating afferent stimulation of the autonomous neural system, inhibiting the rectal detrusor, activating the internal anal sphincter, and modulating sacral reflexes that regulate rectal sensitivity and motility 3.
- Percutaneous nerve evaluation (PNE) is a minimally invasive procedure that can be used to test the effectiveness of sacral nerve stimulation in patients with fecal incontinence, and it has been shown to be effective in reducing incontinence episodes in patients with iatrogenic fecal incontinence 3, 4.
- Biofeedback is another non-surgical treatment option that has been shown to be effective in managing fecal incontinence, although its effectiveness may vary depending on the underlying cause of the incontinence 5.
- Other treatment options for fecal incontinence include anal sphincter repair, artificial bowel sphincter, and percutaneous tibial nerve stimulation (PTNS), although the effectiveness of these options may vary depending on the individual patient and the underlying cause of the incontinence 5, 6.
Percutaneous Nerve Stimulation for Fecal Incontinence
- Percutaneous nerve stimulation, including sacral nerve stimulation and PTNS, has been shown to be effective in reducing incontinence episodes in patients with fecal incontinence, including those with iatrogenic causes 3, 4, 6.
- PNE is a less-invasive alternative to the traditional staged approach for sacral neuromodulation, and it has been shown to have similar success rates with lower rates of infection 7.
- The effectiveness of percutaneous nerve stimulation may depend on various factors, including the underlying cause of the incontinence, the severity of the incontinence, and the individual patient's response to treatment 3, 4, 6.