From the Guidelines
Fecal incontinence should be managed with a stepwise approach, starting with conservative therapies such as dietary modifications, bowel training, and management of diarrhea and constipation, which can benefit approximately 25% of patients 1. The treatment of fecal incontinence depends on the underlying cause, and a thorough evaluation by a healthcare provider is essential to determine the specific cause and develop an appropriate treatment plan.
Key Considerations
- Conservative therapies, including dietary modifications, bowel training, and management of diarrhea and constipation, 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 who have not responded to conservative measures and biofeedback therapy 1.
- Surgical options, such as sphincter repair or colostomy, may be considered for patients who have failed conservative and medical interventions 1.
Treatment Options
- Dietary modifications: increase fiber intake gradually to 20-30 grams daily, avoid foods that trigger symptoms like caffeine, alcohol, and spicy foods.
- Bowel training: establish a regular bowel routine, ideally after meals when the gastrocolic reflex is strongest.
- Pelvic floor exercises (Kegel exercises): perform 3 times daily with 10-15 repetitions each session to strengthen the muscles that control defecation.
- Biofeedback therapy: with a trained therapist over 4-6 sessions to improve muscle coordination.
- Sacral nerve stimulation: for patients with moderate or severe fecal incontinence who have not responded to conservative measures and biofeedback therapy.
- Surgical options: sphincter repair or colostomy for patients who have failed conservative and medical interventions.
Recent Evidence
A recent study published in 2023 highlights the importance of anorectal manometry in diagnosing and treating fecal incontinence, and biofeedback therapy as a critical component of treatment 1. Another study published in 2017 provides best practice advice for the management of fecal incontinence, including the use of conservative therapies, biofeedback therapy, sacral nerve stimulation, and surgical options 1.
From the Research
Definition and Prevalence of Fecal Incontinence
- Fecal incontinence is defined as the involuntary loss or passage of solid or liquid stool in patients 2
- The incidence of fecal incontinence increases with age and often goes unreported to healthcare providers 2
Diagnosis and Evaluation
- Evaluation and management of fecal incontinence are tailored to specific symptoms and characteristics of the incontinence 2
- Diagnostic tests include anal manometry, endosonography, defecography, and pudendal nerve latency testing to assist physicians in the workup of patients and aid in the selection of appropriate treatment options 3
Treatment Options
- Conservative measures including dietary measures and biofeedback are often offered as initial treatment options 3
- Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women 4
- Surgical options such as sacral nerve stimulation and anal sphincter augmentation are considered if conservative methods fail to improve symptoms 2
- Loperamide and anal exercises with biofeedback may be combined as a first-line treatment for fecal incontinence, but this is likely to result in only negligible improvement over individual therapies 5
Efficacy of Treatment Options
- The combination treatment of biofeedback and medical treatment was superior to both single treatments in terms of symptoms and functions 4
- There was no significant difference between loperamide versus placebo, biofeedback versus education, and loperamide and biofeedback versus placebo and biofeedback or loperamide plus education 5
- Constipation was the most common grade 3 or higher adverse event reported in patients treated with loperamide and biofeedback 5