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Idiopathic constipation and fecal incontinence

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Opinion Statement

Patients with constipation or fecal incontinence have great potential for remediation. Both disorders warrant a thorough diagnostic evaluation to search for remediable causes, especially to identify defecation disorders. Constipation should be treated by relieving any impactions an then starting a course of fiber supplementation of at least 20 g per day. If not successful, other agents such as lactulose, polyethylene glycol solutions, or stimulants can be added. Biofeedback may be very helpful. If all else fails, several surgical procedures are available. Fecal incontinence should be treated by fiber supplements, encouragement of regularity, and enemas as needed. Kegel exercises and biofeedback are often helpful, but surgery may be needed and is most effective in recent onset or traumatically induced incontinence.

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References and Recommended Reading

  1. Krevsky B: A practical approach to managing constipation. Family Practice Recertification 1995, 17:41–48. This is a broad review of the diagnosis and evaluation of constipation, including details on many of the diagnostic tests such as colonic transit scintigraphy, fecal defecograpy, etc.

    Google Scholar 

  2. Talley NJ, Fleming KC, Evans JM, et al.: Constipation in an elderly community: a study of prevalence and potential risk factors. Am J Gastroenterol 1996, 91:19–25.

    PubMed  CAS  Google Scholar 

  3. Johanson JF and Lafferty J: Epidemiology of fecal incontinence: The silent affliction. Am J Gastroenterol 1996, 91:33–36.

    PubMed  CAS  Google Scholar 

  4. Floch MH, Dowd J: Incontinence and constipation: pelvic floor disorders of gastrointestinal motility and urodynamics. J Clin Gastroenterol 1998, 27:4–5. An excellent editorial summarizing the state-of-the-art knowledge about how constipation and fecal incontinence are disorders are motility, and how their evaluation and management are best handled from a motility point of view.

    Article  PubMed  CAS  Google Scholar 

  5. Romero Y, Evans JM, Fleming KC, et al.: Constipation and fecal incontinence in the elderly population. Mayo Clin Proc 1996, 71:81–92. Comprehensive review and bibliography for fecal incontinence and constipation, with particular attention to the special conditions and needs of the elderly. Includes assessment and treatment.

    Article  PubMed  CAS  Google Scholar 

  6. Rao SS, Patel RS: How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997, 92:469–75.

    PubMed  CAS  Google Scholar 

  7. Chiotakakou-Faliakou E, Kamm MA, Roy AJ, et al.: Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Gut 1998, 42:517–21.

    Article  PubMed  CAS  Google Scholar 

  8. Gilliland R, Heymen S, Altomare DF, et al.: Outcome and predictors of success of biofeedback for constipation. Br J Surg 1997, 84:1123–6.

    Article  PubMed  CAS  Google Scholar 

  9. Loening-Baucke V: Biofeedback training in children with functional constipation. A critical review. Dig Dis Sci 1996, 41:65–71.

    Article  PubMed  CAS  Google Scholar 

  10. Rao SS, Welcher KD, Pelsang RE: Effects of biofeedback therapy on anorectal function in obstructive defecation. DDS 1997, 42:2197–205.

    CAS  Google Scholar 

  11. Rao SSC, Welcher KD, Leistikow JS: Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998, 93:1042–1050. A landmark article that documents the anorectal motility defects in constipation caused by defecatory disorders, and how biofeedback training rectified the problem.

    Article  PubMed  CAS  Google Scholar 

  12. Christiansen J, Rasmussen OO: Colectomy for severe slowtransit constipation in strictly selected subjects. Scand J Gastroenterol 1996, 31:770–3.

    PubMed  CAS  Google Scholar 

  13. Ghosh S, Papachrysostomou M, Batool M, Eastwood MA: Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol 199, 31:108 –1091

  14. Nyam DC, Pemberton JH, Ilstrup DM, Rath DM: Longterm results of surgery for chronic constipation. Dis Colon Rectum 1997, 40:273–9.

    Article  PubMed  CAS  Google Scholar 

  15. Pfeifer J, Agachan F, Wexner SD: Surgery for constipation: a review. Dis Colon Rectum 1996, 39:444–60. Review of the various surgical options for severe constipation. Includes not only indiopathic constipation, but also Hirschprung’ Disease, megacolon, etc.

    Article  PubMed  CAS  Google Scholar 

  16. Pluta H, Bowes KL, Jewell LD: Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum 1996, 39:160–166.

    Article  PubMed  CAS  Google Scholar 

  17. Gerharz EW, Vik V, Webb G, et al.: The value of the MACE (Malone antegrade colonic enema) procedure in adults. J Am Coll Surg 1997, 185:544–7.

    Article  PubMed  CAS  Google Scholar 

  18. Hensle TW, Reiley EA, Chang DT: The Malone antegrade continence enema procedure in the management of patients with spina bifida. J Am Coll Surg 1998, 186:669–74.

    Article  PubMed  CAS  Google Scholar 

  19. Schell SR, Toogood GJ, Dudley NE: Control of fecal incontinence: continued success with the Malone procedure. Surgery 1997, 122:626–31.

    Article  PubMed  CAS  Google Scholar 

  20. Alexander AA, Liu JB, Merton DA, Nagle DA: Fecal incontinence: transvaginal US evaluation of anatomic causes. Radiology 1996, 199:529–32.

    PubMed  CAS  Google Scholar 

  21. Ternent CA, Shashidaharan M, Blatchford GJ, et al.: Transanal ultrasound and anorectal physiology findings affecting continence after sphincteroplasty Dis Colon Rectum 1997, 40:462–7.

    Article  PubMed  CAS  Google Scholar 

  22. Ko CY, Tong J, Lehman RE, et al.: Biofeedback is effective therapy for fecal incontinence and constipation. Arch Surg 1997, 132:829–33.

    PubMed  CAS  Google Scholar 

  23. Corazziari E, Badiali D, Habib FI, et al.: Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci 1996, 41:1636–42.

    Article  PubMed  CAS  Google Scholar 

  24. Staiano A, DelGiudice E, Simeone D, et al.: Cisapride in neurologically impaired children with chronic constipation. Dig Dis Sci 1996, 41:870–4.

    Article  PubMed  CAS  Google Scholar 

  25. Verne GN, Eaker EY, Davis RH, Sninsky CA: Colchicine is an effective treatment for patients with chronic constipation: an open-label trial. Dig Dis Sci 1997, 42:1959–63.

    Article  PubMed  CAS  Google Scholar 

  26. Donnelly V, O’Connell PR, O’Herlihy C: The influence of oestrogen replacement on faecal incontinence in postmenopausal women. Br J Obstet Gynecol 1997, 104:311–5.

    CAS  Google Scholar 

  27. Sykes NP: An investigation of the ability of oral naloxone to correct opioid-related constipation in patients with advanced cancer. Palliat Med 1996, 10:135–44.

    PubMed  CAS  Google Scholar 

  28. Fukuinaga K, Kimura K, Lawrence JP, et al.: Button device for antegrade enema in the treatment of incontinence and constipation. J Pediatr Surg 1996, 31:1038–9.

    Article  Google Scholar 

  29. Sun WM, Read NW, Verlinden M: Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Scand J Gastroenterol 1997, 32:34–8.

    Article  PubMed  CAS  Google Scholar 

  30. Lowry AC: Surgical treatment of fecal incontinence. Practical Gastroenterology July 1998:11–13. A nice, brief, review of the surgical options for fecal incontinence.

  31. Christiansen J, Rasmussen OO: Dynamic graciloplasty for severe anal incontinence. Br J Surg 1998, 85:88–91.

    Article  PubMed  CAS  Google Scholar 

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Krevsky, B. Idiopathic constipation and fecal incontinence. Curr Treat Options Gastro 1, 20–26 (1998). https://doi.org/10.1007/s11938-998-0004-z

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  • DOI: https://doi.org/10.1007/s11938-998-0004-z

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