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.
KeywordsFatigue Catheter Dust Neuropathy Diarrhea
Sacral nerve stimulation stages I and II (Video by Tracy Hull, MD The Cleveland Clinic Foundation Cleveland, Ohio) (MPG 289602 kb)
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