Management of Bowel Incontinence by Colorectal Surgeons
Yes, colorectal surgeons play a central role in the management of bowel incontinence, particularly when conservative measures have failed or when surgical intervention is required. 1
Stepwise Management Approach
Colorectal surgeons implement a structured approach to bowel incontinence:
First-Line Management (Conservative Therapy)
- Diet modification and fiber supplementation to improve stool consistency
- Fluid management
- Scheduled toileting and bowel training programs
- Pelvic floor muscle exercises
- Medications for diarrhea management, particularly loperamide (2 mg) starting 30 minutes before breakfast and titrated up to 16 mg daily 1, 2
Conservative measures benefit approximately 25% of patients and should always be tried first before considering surgical options 1.
Second-Line Management
- Pelvic floor retraining with biofeedback therapy for patients who don't respond to conservative measures 1
- This approach helps strengthen pelvic floor muscles, improve sensation, and coordinate muscle function
Third-Line Management (Minimally Invasive Procedures)
When conservative and biofeedback therapy fail, colorectal surgeons may offer:
- Perianal bulking agents (intraanal injection of dextranomer) 1
- Sacral nerve stimulation for moderate to severe fecal incontinence after 3+ months of failed conservative treatment 1
Fourth-Line Management (Surgical Interventions)
Colorectal surgeons perform various surgical procedures when less invasive approaches fail:
- Anal sphincter repair (sphincteroplasty) - particularly effective for postpartum women and patients with recent sphincter injuries 1
- Artificial anal sphincter or dynamic graciloplasty for severe cases 1
- Surgical correction of anatomic defects (rectovaginal fistula, full-thickness rectal prolapse, etc.) 1
- Colostomy as a last resort for severe, refractory cases 1
Special Considerations
Anatomical Defects
Colorectal surgeons are specifically trained to identify and correct structural abnormalities:
- Rectal prolapse requiring surgical intervention (perineal or abdominal approaches) 1
- Rectoceles and other pelvic floor abnormalities 1
Post-Surgical Incontinence
Patients who develop fecal incontinence after colorectal cancer surgery represent a special population often managed by colorectal surgeons 3.
Common Pitfalls and Caveats
Inadequate conservative management: Many patients are referred for surgery without having received an optimal trial of conservative therapy 1
Overestimating surgical success: Patients must be counseled that symptoms like pain and bloating may persist even after successful surgical correction of incontinence 4
Inappropriate patient selection: Patients with gastrointestinal dysmotility syndrome or significant psychiatric disorders generally have poor surgical outcomes 4
Focusing only on anatomical repair: The underlying functional disorder (impaired pelvic floor relaxation, excessive straining) may not be corrected by surgery alone 1
Limited evidence for some interventions: Percutaneous tibial nerve stimulation should not be used for managing fecal incontinence in clinical practice until further evidence is available 1
Colorectal surgeons are uniquely qualified to manage the full spectrum of bowel incontinence, from conservative approaches through advanced surgical techniques, making them essential specialists in the comprehensive care of patients with this condition.