From the Guidelines
I strongly recommend that your wife consults her primary care physician to rule out any underlying medical conditions that may be causing her nocturnal fecal incontinence, and then consider a stepwise approach to management, starting with conservative therapies such as diet, fluids, and bowel training program, as suggested by the most recent and highest quality study 1. The primary care physician can evaluate for potential medical causes such as bowel incontinence, medication side effects, or neurological conditions, and refer to specialists like gastroenterologists or neurologists if necessary. Some key considerations for managing nocturnal fecal incontinence include:
- Conservative therapies, such as diet, fluids, and bowel training program, which can benefit approximately 25% of patients 1
- Pelvic floor retraining with biofeedback therapy, which is recommended for patients with fecal incontinence who do not respond to conservative measures 1
- Practical measures, such as establishing a regular bathroom schedule before bed and using waterproof mattress protectors, can help manage the condition while waiting for professional help. It is essential to approach this issue with compassion and understanding, as nocturnal fecal incontinence can be a symptom of an underlying medical condition that requires professional attention, rather than a matter of personal control or habit. The use of biofeedback therapy has been shown to be successful in treating fecal incontinence, with improvements in rectoanal coordination during defecation and symptoms of constipation 2. However, the most recent and highest quality study 1 suggests a stepwise approach to management, starting with conservative therapies, and reserving more invasive treatments, such as sacral nerve stimulation, for patients with moderate or severe fecal incontinence who do not respond to conservative measures and biofeedback therapy.
From the FDA Drug Label
Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. To help your wife stop experiencing nocturnal fecal incontinence, Loperamide may be beneficial as it increases the tone of the anal sphincter, which can help reduce incontinence and urgency. However, it is essential to consult a healthcare provider before administering any medication, especially to discuss the appropriate dosage and potential interactions with other medications. 3
From the Research
Approaches to Managing Nocturnal Fecal Incontinence
To help manage nocturnal fecal incontinence, several approaches can be considered:
- Identifying and treating underlying problems, as this may improve incontinence 4
- General approaches such as: + Stimulation of defecation at intervals to empty the rectum under supervised conditions + Treatment of diarrhea, if present + Addressing coexisting psychologic problems, such as depression + Use of continence aids, such as adult diapers + Perineal skin care to prevent skin breakdown 4
- Drug therapy, including the use of constipating drugs such as loperamide or diphenoxylate, to impede the gastrocolic reflex and limit rectal filling and the likelihood of incontinence 4, 5, 6
- Biofeedback training, which can be useful in patients with some ability to sense rectal distention and to contract the external anal sphincter 4, 6, 7
- Pelvic floor muscle exercises (PFME), which can improve fecal incontinence severity and quality-of-life scores 8
Specific Treatments
Specific treatments that have been studied include:
- Methylcellulose and loperamide, which have been shown to be effective in managing fecal incontinence 5
- Anal sphincter exercises with biofeedback, which are being investigated as a potential treatment for fecal incontinence 7
- Sphincteroplasty, which may be an option for patients with an isolated muscle defect 4, 6
- Muscle transposition to create a neosphincter, which should be offered only by surgeons with extensive experience performing this surgery 6
Lifestyle Modifications
Lifestyle modifications that may help manage nocturnal fecal incontinence include:
- Exclusion of foods that precipitate the problem
- Increased use of fiber
- Drug therapy with loperamide 6