- 2k Downloads
Fecal incontinence is a complex chronic disease. Determining an optimal treatment plan begins with a thorough history and directed physical examination. Further testing is individualized, and the exact role of anal physiology testing remains unclear. However, anal endosonography is useful to provide a road map for treatment and surgery. Most treatment begins with conservative measures. Nonsurgical options such as biofeedback also may improve patients. Other nonsurgical options to consider include the anal plug, radiofrequency treatment, and injectable agents. For patients with an anterior sphincter defect, an overlapping sphincter repair has been advocated, but the poor long-term results have led investigators to seek superior surgical treatments. The artificial bowel sphincter and sacral nerve stimulation both are complex procedures, which when successful can improve patient’s quality of life.
New treatments are also being investigated that may prove superior to currently available choices, but the key premise of an individual treatment plan may include a combination of treatments, which is important to remember when caring for these patients.
KeywordsFecal Incontinence Internal Sphincter Sacral Nerve Stimulation Incontinent Episode Sphincter Defect
Sacral nerve stimulation stages I and II (Video by Tracy Hull, MD The Cleveland Clinic Foundation Cleveland, Ohio) (MPG 289602 kb)
- 2.O’Donnell LJD, Heaton KW. Pseudo-diarrhea in the irritable bowel syndrome: patients’ records of stool form reflect transit time while stool frequency does not. Gut. 1988;29:A1455.Google Scholar
- 11.Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2012;(7):CD002111.Google Scholar
- 12.Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;(4):CD005086.Google Scholar
- 15.Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2010;(5):CD007959.Google Scholar
- 18.Melgren A, Matzel KE, Pollack J, Hull T, Bernstein M, Graf W, forthe Solesta Study Groups. Long term efficacy of NASATM Dx injection therapy (Solesta R) for treatment of fecal incontinence. Podium presentation American Society of Colon and Rectal Surgeons, San Antonio, Texas. June 5, 2012.Google Scholar
- 23.Farrell SA, Flowerdew G, Gilmour D, Turnbull GK, Schmidt MH, Baskett TF, et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year follow-up of a randomized controlled trial. Obstet Gynecol. 2012;120(4):803–8.PubMedCrossRefGoogle Scholar
- 44.Hull TL, Floruta C, Halverson AL. Improvement in fecal incontinence scores is the same for sphincteroplasty combined with major urogynecologic procedures versus sphincteroplasty alone. J Pelvic Surg. 2001;7(4):201–4.Google Scholar
- 51.Brown SR, Wadhawan H, Nelson RL. Surgery for faecal incontinence in adults. Cochrane Database Syst Rev. 2010;(9):CD001757.Google Scholar