From the Guidelines
Treatment for fecal incontinence typically begins with conservative approaches, and a stepwise approach should be followed for management, with conservative therapies tried first, followed by pelvic floor retraining with biofeedback therapy, and then surgical options if necessary. The most recent and highest quality study 1 emphasizes the importance of anorectal manometry in identifying key pathophysiological abnormalities and its critical component in biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence.
Conservative Approaches
- Dietary modifications, such as avoiding caffeine, alcohol, spicy foods, and artificial sweeteners
- Fiber supplementation (20-30g daily) to improve stool consistency
- Scheduled bowel movements to establish a regular bowel routine
- Pelvic floor muscle exercises (Kegel exercises), performed 3 sets of 10 contractions daily, to strengthen the muscles controlling bowel movements
- Biofeedback therapy, which provides visual feedback on muscle activity, to help patients learn to better control these muscles over 4-6 sessions
Medications
- Loperamide (Imodium) 2-4mg daily to reduce stool frequency and increase consistency
- Fiber supplements like psyllium (Metamucil) 1 tablespoon 1-3 times daily to add bulk to stool
Surgical Options
- Sphincteroplasty to repair damaged sphincter muscles
- Sacral nerve stimulation, which uses electrical impulses to improve sphincter function
- Colostomy in extreme cases
Additional Considerations
- A meticulous characterization of the bowel habits, circumstances surrounding FI, and prior treatment for FI 1
- Identification and management of underlying conditions, such as diarrhea or constipation, with appropriate medications and therapies
- Anorectal testing, including anorectal manometry and imaging, to identify evacuation disorders and guide treatment 1
The underlying cause of incontinence determines the most appropriate treatment, with options ranging from addressing muscle weakness, nerve damage, or structural problems. Most patients experience significant improvement with a combination of these approaches tailored to their specific condition, as supported by the evidence from 1.
From the FDA Drug Label
Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. Loperamide prolongs the transit time of the intestinal contents It reduces daily fecal volume, increases the viscosity and bulk density, and diminishes the loss of fluid and electrolytes.
Treatments for Fecal Incontinence (FI) may include loperamide, which can help reduce incontinence and urgency by increasing the tone of the anal sphincter and prolonging the transit time of intestinal contents.
- Loperamide can reduce daily fecal volume and increase the viscosity and bulk density of stool, which may also help alleviate FI symptoms. 2
From the Research
Treatment Options for Fecal Incontinence
The treatments for fecal incontinence (FI) can be categorized into non-operative and surgical options.
- Non-operative treatments include:
- Surgical treatments include:
- Sphincteroplasty, which is limited to patients with an isolated defect of the external sphincter 3, 4, 7
- Sacral nerve stimulation (SNS), which is considered the gold standard for treating FI due to its efficacy and low comorbidity 3, 4, 7
- Injectable implants and radiofrequency energy delivery, which are minimally invasive tools that may be used before proceeding to surgery in some patients with mild FI 3, 4
- Dynamic graciloplasty and artificial bowel sphincter, which are no longer commonly used due to their invasiveness and relevant comorbidity 7
- Stoma formation, which can be avoided in most cases 3
Combination Therapy
Combination therapy with biofeedback, loperamide, and stool-bulking agents has been shown to be effective for the treatment of FI in women, with significant improvements in symptoms and functions 6.
Individualized Treatment
The treatment of FI must be individualized to the patient, taking into account the severity of the condition, the patient's overall health, and the potential complications of the treatment 4, 7.