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An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women

  • Pelvic Organ Prolapse (KL Noblett, Section Editor)
  • Published:
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Abstract

Fecal incontinence (FI) is a debilitating disorder that negatively impacts quality of life. The etiology often is multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI also can be hindered by a lack of understanding of the mechanisms and current options. This article provides a review of the evidence-based evaluation and management for FI.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Wald A. Fecal incontinence in adults. N Engl J Med. 2007;356:1648–55.

    Article  CAS  PubMed  Google Scholar 

  2. Markland AD, Richter HE, Burgio KL, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J. 2011;22(9):1151–7.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Lawrence JM, Lukacz ES, Nager CW, et al. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008;111:678–85.

    Article  PubMed  Google Scholar 

  5. Gleason JL, Markland AD, Greer WJ, et al. Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures. Int Urogynecol J. 2011;22(12):1587–92.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Varma MG, Brown JS, Creasman JM, et al. Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum. 2006;49:841.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58:1341.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kang HW, Jung HK, Kwon KJ, et al. Prevalence and predictive factors of fecal incontinence. J Neurogastroenterol Motil. 2012;18(1):86–93.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Brown HW, Wexner SD, Segall MM, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66(11):1101–8.

    Article  CAS  PubMed  Google Scholar 

  10. Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.10.

    Article  PubMed  Google Scholar 

  11. Brown HW, Wexner SD, Segall MM, et al. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract. 2012;66(11):1109–16.

    Article  CAS  PubMed  Google Scholar 

  12. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4.

    PubMed  Google Scholar 

  13. Rao SSC, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders. Am J Gasteroenterol. 1997;92:469–75.

    CAS  Google Scholar 

  14. Rao SSC. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence Am J Gastroenterol. 2004;99:1585–604.

    Article  Google Scholar 

  15. Watson NFS, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012;14(suppl3):29–33.

    Article  PubMed  Google Scholar 

  16. Thekkinkattil DK, Dunham RJ, O’Herlihy S, et al. Measurement of anal cushions in idiopathic faecal incontinence. Br J Surg. 2009;96:680–4.

    Article  CAS  PubMed  Google Scholar 

  17. Thekkinkattil DK, Lim M, Stojkovic SG, et al. A classification system for faecal incontinence based on anorectal investigations. Br J Surg. 2008;95:222–8.

    Article  CAS  PubMed  Google Scholar 

  18. Stojkovic SG, Lim M, Burke D, et al. Intra-anal collagen injection for the treatment of faecal incontinence. Br J Surg. 2006;93:1514–8.

    Article  CAS  PubMed  Google Scholar 

  19. Hayden DM, Weiss EG. Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg. 2011;24(1):64–70. This article provides a comprehensive review on current recommendations regarding evaluation and treatment of fecal incontinence from the colorectal surgery prospective.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Madoff RD, Parker SC, Varma MG, et al. Fecal incontinence in adults. Lancet. 2004;364:621.

    Article  PubMed  Google Scholar 

  21. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, et al. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review BJOG. 2008;115:421.

    CAS  Google Scholar 

  22. Nelson RL, Furner SE, Westercamp M, Farquhar C. Cesarean delivery for the prevention of anal incontinence. Cochrane Database Syst Rev 2010;CD006756.

  23. Handa VL, Blomquist JL, Knoepp LR, et al. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777.

    PubMed Central  PubMed  Google Scholar 

  24. MacArthur C, Glazener C, Lancashire R, et al. Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. BJOG. 2011;118:1001.

    Article  CAS  PubMed  Google Scholar 

  25. Hehir MP, O’Connor HD, Higgins S, et al. Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers. J Matern Fetal Neonatal Med. 2013;26(15):1514–6. This prospective observational study from 2003 to 2010 compares the incident rates based on potential risk factors for obstetric anal sphincter injury (OASIS) and demonstrates that OASIS remains a significant cause of maternal morbidity.

    Article  PubMed  Google Scholar 

  26. Baumann P, Hammoud AO, McNeeley SG, et al. Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:985.

    Article  PubMed  Google Scholar 

  27. Minaglia SM, Ozel B, Gatto NM, et al. Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1399.

    Article  PubMed  Google Scholar 

  28. Sultan AH, Kamm MA, Hudson CN, et al. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ. 1994;308(6933):887.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Nager CW, Helliwell JP. Episiotomy increases perineal laceration length in primiparous women. Am J Obstet Gynecol. 2001;185:444.

    Article  CAS  PubMed  Google Scholar 

  30. Fenner DE, Genberg B, Brahma P, et al. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol. 2003;189:1543.

    Article  PubMed  Google Scholar 

  31. Sultan AH, Kamm MA, Hudson CN, et al. Anal sphincter disruption during vaginal delivery. New Engl J Med. 1993;329:1905–11.

    Article  CAS  PubMed  Google Scholar 

  32. Varma A, Gunn J, Gardiner A, et al. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum. 1999;42:1261–4.

    Article  CAS  PubMed  Google Scholar 

  33. Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:917.

    Article  PubMed  Google Scholar 

  34. Cesarean delivery on maternal request. Committee Opinion No 559. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:904–7

  35. Elfaghi I, Johansson-Ernste B, Rydhstroem H. Rupture of the sphincter ani: the recurrence rate in second delivery. BJOG. 2004;111:1361.

    Article  PubMed  Google Scholar 

  36. McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003;189:1251.

    Article  PubMed  Google Scholar 

  37. Brink CA, Wells TJ, Sampselle CM, et al. A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res. 1994;43(6):352–6.

    Article  CAS  PubMed  Google Scholar 

  38. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am. 1987;16:17.

    CAS  PubMed  Google Scholar 

  39. Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum. 2010;53:1656.

    Article  PubMed  Google Scholar 

  40. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SGM. Investigation of anorectal function. Br J Surg. 1988;75:53–5.

    Article  CAS  PubMed  Google Scholar 

  41. Eckhardt VF, Kanzler G. How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis. 1993;8:95–7.

    Article  Google Scholar 

  42. Hill J, Corson RJ, Brandon H, et al. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(5):473–7.

    Article  CAS  PubMed  Google Scholar 

  43. Rao SSC. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Gastroenterol Hepatol. 2008;2:323–5.

    Google Scholar 

  44. Zutshi M, Salcedo L, Hammel J, et al. Anal physiologic testing in fecal incontinence: is it of any value? Int J Colorectal Dis. 2010;25(2):277–82.

    Article  PubMed  Google Scholar 

  45. Wexner SD, Jorge JM. Colorectal physiological tests: use or abuse of technology? Br J Surg. 1994;160:167–74.

    CAS  Google Scholar 

  46. Keating JP, Stewart PJ, Eyers AA, et al. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum. 1997;40:896.

    Article  CAS  PubMed  Google Scholar 

  47. Costilla VC, Foxx-Orenstein AE, Mayer AP, et al. Office-based management of fecal incontinence. Gastroenterol Hepatol. 2013;9(7):423–33. This article attempts to provide an up-to-date comprehensive review of office-based management of fecal incontinence from the gastroenterology perspective.

    Google Scholar 

  48. Barnett JL, Hasler WL, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques. American Gastroenterological Association Gastroenterology. 1999;116:732.

    CAS  Google Scholar 

  49. Remes-Troche JM, Rao SSC. Neurophysiological testing in anorectal disorders. Gastroenterol Hepatol. 2008;2:323–35.

    Google Scholar 

  50. Gurland B, Hull T. Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg. 2008;21(3):157–66.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Rao SSC, Sun WM. Current techniques of assessing defecation dynamics. Dig Dis. 1997;15(Suppl1):64–7.

    Article  PubMed  Google Scholar 

  52. Rao SSC, Hatfield R, Leistikow J, et al. Manometric tests of anorectal function in healthy humans. Am J Gastroenterol. 1999;116:735–60.

    Google Scholar 

  53. Jones MP, Post J, Crowell MD. High-resolution manometry in the evaluation of anorectal disorders: A simultaneous comparison with water-perfused manometry. Am J Gastroenterol. 2007;102:850–5.

    Article  PubMed  Google Scholar 

  54. Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–4.

    Article  CAS  PubMed  Google Scholar 

  55. Bartrum C. Radiological evaluation of anorectal disorders. In: Rao SCC, ed. Disorders of anorectum. Gastroenterol Clin North Am. W.B. Saunders, 2001;30(1):55–76

  56. Williams AB, Bartram CI, Halligan S, et al. Anal sphincter damage after vaginal delivery using three dimensional endosonography. Obstet Gynecol. 2001;97:770–5.

    Article  CAS  PubMed  Google Scholar 

  57. Sentovich SM, Wong WD, Blatchford GJ. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury. Dis Colon Rectum. 1998;41:1000–4.

    Article  CAS  PubMed  Google Scholar 

  58. Oberwalder M, Thaler K, Baig M, et al. Anal ultrasound and endo sonographic measurements of perineal body thickness: a new evaluation for fecal incontinence in females. Surg Endosc. 2004;18:650–4.

    Article  CAS  PubMed  Google Scholar 

  59. Rose S, Magnotta J, Kim R. Anorectal manometry pressures do not predict the results of endoanal ultrasound in patients with fecal incontinence (abstract). Gastroenterology. 1996;110:747.

    Google Scholar 

  60. Voyvodic F, Rieger N, Skinner S, et al. Endosonographic imaging of anal sphincter injuries: does the size of the tear correlate with the degree of dysfunction? Dis Colon Rectum. 2003;46:735–41.

    Article  PubMed  Google Scholar 

  61. Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007;22(7):783–90.

    Article  PubMed  Google Scholar 

  62. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85(1015):865–75. The endoanal ultrasound is currently considered the gold standard for evaluating anal sphincter pathology in evaluation of anal incontinence. The article provides a comprehensive review of the different ultrasound modalities in evaluating anal sphincter integrity based on a MEDLINE literature search.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Remes-Troche JM, Paulson J, Attaluri A, et al. A comprehensive assessment of the efferent motor pathways to the anorectum in humans. Neuorgastroenterol Motil. 2007;19:A330.

    Google Scholar 

  64. Hobson AR, Aziz Q. Brain imaging and functional gastrointestinal disorders: has it helped our understanding? Gut. 2004;53:1198–206.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  65. Hobday DI, Hobson AR, Sarkar S, et al. Cortical processing of human gut sensation: an evoked potential study. Am J Physiol Gastrointest Liver Physiol. 2002;283:335–9.

    Google Scholar 

  66. Chan YK, Herkes GK, Badcock C, et al. Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome. Am J Gastroenterol. 2001;96:2413–7.

    Article  CAS  PubMed  Google Scholar 

  67. Sinhamahaptra P, Saha SP, Chowdhury A, et al. Visceral afferent hypersensitivity in irritable bowel syndrome – evaluation by cerebral evoked potential after rectal stimulation. Am J Gastroenterol. 2001;96:2150–7.

    Google Scholar 

  68. Wang JY, Abbas MA. Current management of fecal incontinence. Perm J. 2013;17(3):65–73.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for fecal incontinence: Review. Dis Colon Rectum. 2006;50:641–9.

    Article  Google Scholar 

  70. Read M, Read NW, Barber DC, Duthie HL. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982;27:807.

    Article  CAS  PubMed  Google Scholar 

  71. Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6, CD002116.

    PubMed  Google Scholar 

  72. Palmer KR, Corbett CL, Holdsworth CD. Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology. 1980;79:1272.

    CAS  PubMed  Google Scholar 

  73. NICHD Pelvic Floor Disorders Network. Controlling Anal Incontinence by Performing Anal Exercises with Biofeedback or Loperamide (CAPABLe). NCT02008565. Retrieved March 20, 2014, from clinicaltrials.gov.

  74. Cheetham MJ, Kamm MA, Phillips RK. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut. 2001;48:356.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  75. Byrne CM, Solomon MJ, Young JM, et al. Biofeedback for fecal incontinence: short-term outcomes of 513 consecutive patients and predictors of successful treatment. Dis Colon Rectum. 2007;50:417.

    Article  PubMed  Google Scholar 

  76. Norton C. Cody, JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults Cochrane Database Syst Rev. 2012;6, CD002111.

    Google Scholar 

  77. Moscovitz I, Rotholtz NA, Baig MK, et al. Overlapping sphincteroplasty: does preservation of the scar influence immediate outcome? Colorectal Dis. 2002;4(4):275–9.

    Article  PubMed  Google Scholar 

  78. Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: A systematic review. Dis Colon Rectum. 2012;55:482–90. A systematic review of long-term outcomes beyond 5 years of anal sphincter repair for fecal incontinence. Although continence deteriorated over the long-term (no patients remained continence at 10 year followup), patient QOL and satisfaction remained relatively high.

    Article  PubMed  Google Scholar 

  79. Oom DM, Gosselink MP, Schouten WR. Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation. Dis Colon Rectum. 2009;98:234–8.

    Google Scholar 

  80. Tjandra JJ, Han WR. Goh J, et al. Direct repair vs overlapping sphincter repair: a randomized controlled trail Dis Colon Rectum. 2003;46(7):937–43.

    CAS  Google Scholar 

  81. Garcia V, Rogers RG, Kim SS, et al. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol. 2005;192(5):1697.

    Article  PubMed  Google Scholar 

  82. Farrell SA, Flowerdew G, Gilmour D, 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.

    Google Scholar 

  83. Khaikin M, Wexner SD. Treatment strategies in obstructed defecation and fecal incontinence. World J Gastroenterol. 2006;12:3168.

    PubMed Central  PubMed  Google Scholar 

  84. Matzel KE. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis. 2011;13 Suppl 2:10–4.

    Article  PubMed  Google Scholar 

  85. Al-Sannan B, Banakhar M, Hassouna MM. The role of sacral nerve stimulation in female pelvic floor disorders. Curr Obstet Gynecol Rep. 2013;2:159–68.

    Article  Google Scholar 

  86. Patton V, Wiklendt L, Arkwright JW, et al. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg. 2013;100:959–68. This prospective double-blind randomized crossover trail compares distal colonic motility in patients with FI using SNS vs sham. The study suggests that SNS improves continence by modulating colonic motility in patients with urge FI.

    Article  CAS  PubMed  Google Scholar 

  87. Mowatt G, Glazener C, Jarrett M. Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodynam. 2008;27:155–61.

    Article  CAS  Google Scholar 

  88. Bharucha AE, Rao SSC. An update on anorectal disorders for gastroenterologists. Gastroenterol. 2014;146:37–45.

    Article  Google Scholar 

  89. Wexner SD, Coller JA, Devroede G, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9. This multi-center (16 centers in North America and Australia), prospective trial investigated the safety and efficacy of SNS at 12 months post-implant compared with the baseline. The study reported a high degree of efficacy with a nominal and acceptable rate of morbidity.

    Article  PubMed  Google Scholar 

  90. Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56:234–45. This multicenter, prospective study included 67 patients to assess the long-term outcome (a minimum of 5 years) of SNS. The study showed the therapeutic effect and improved QOL was maintained > 5 years after SNS.

    Article  PubMed  Google Scholar 

  91. Chiarioni G, Palsson OS, Asteria CR, et al. Neuromodulation for fecal incontinence: an effective surgical intervention. World J Gastroenterol. 2013;19(41):7048–54.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Thin NN, Horrocks EJ, Hotouras A, et al. Systematic review of the clinical effectiveness of Neuromodulation in the treatment of faecal incontinence. Br J Surg. 2013;100:1430–47. This systematic review explored the current evidence on the clinical effectiveness of neuromodulation treatments for FI, including SNS, PTNS, and transcutaneous nerve stimulation(TTNS). The clinical effectiveness of PTNS is shown to be comparable to that of SNS at 12 months. There is currently a paucity of evidence available for the effectiveness of TTNS.

    Article  CAS  PubMed  Google Scholar 

  93. Hotouras A, Murphy J, Walsh U, et al. Outcome of percutaneous tibial nerve stimulation (PTNS) for fecal incontinence: A prospective cohort study. Ann Surg. 2013;00:1–5. This prospective cohort study of 115 patients investigated the outcome of PTNS for FI. The study showed that PTNS is a well-tolerated treatment with high acceptability, with a sustained improvement with a median follow up of 26 months (up to 42).

    Article  Google Scholar 

  94. Marti L. Comparison of Sacral Nerve Modulation and Pudendal Nerve Stimulation in Treatment of Fecal Incontinence. NCT 01069016. Retrieved March 28, 2014, from clinicaltrials.gov.

  95. Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilized hyaluronic acid for treatment of faecal incontinence: a randomized, sham-controlled trial. Lancet. 2011;377:997–1003.

    Article  CAS  PubMed  Google Scholar 

  96. Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2, CD007959.

    PubMed  Google Scholar 

  97. Parisien CJ, Corman ML. The Sicca® procedure for the treatment of fecal incontinence: Definitive therapy or short-term solution. Clin in Colon Rectal Surg. 2005;18(1):371.

    Article  Google Scholar 

  98. Takahashi-Monroy T, Morales M, et al. SECCA procedure for the treatment of fecal incontinence: Results of five-year follow-up. Dis Colon Rectum. 2008;51(3):355–9.

    Article  PubMed  Google Scholar 

  99. National Institute for Health and Clinical Excellence (NICE). Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence. Interventional Procedure Guidance 393. London, UK: NICE; May 2011. Retrieved March 22, 2014, from http://www.nice.org.uk

  100. Tan JJ, Chan M, Tjandra JJ. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007;50:1950.

    Article  PubMed  Google Scholar 

  101. Frudinger A, Kolle D, Schwaiger W, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010;59:55–61.

    Article  CAS  PubMed  Google Scholar 

  102. Autologous myoblast intrasphincteric injection for fecal incontinence (MIAS). NCT01523522. Retrieved March 20, 2014, from clinicaltrials.gov.

  103. Deutekom M, Dobben AC. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4, CD005086.

    PubMed  Google Scholar 

  104. Renew Medical. A study to evaluate the safety, tolerability, and effectiveness of the Renew Insert in treating accidental bowel leakage (REST). NCT01475474. Retrieved March 29, 2014, from clinicaltrials.gov.

  105. Lukacz ES, Segall MM, Wexner SD. A novel, convenient, and safe non surgical approach to the management of accidental bowel leakage. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC

  106. Richter HE, Matthews CA, Varma M, et al. Clinical efficacy and safety evaluation of a vaginal bowel control (VBC) device for the treatment of fecal incontinence. Abstract. American Urogynecologic Society/International Urogynecological Association 2014 Scientific Meeting. Presentation at the July 2014, Washington, DC)

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Acknowledgments

Partially supported by the National Institutes of Diabetes and Digestive and Kidney Diseases, 2 K24-DK068389.

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Conflict of Interest

Holly E. Richter reports receiving travel reimbursement from National Institute of Diabetes and Digestive and Kidney Diseases; personal consultant fees from Pelvalon; and royalties from UpToDate.

Isuzu Meyer declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA

    Isuzu Meyer & Holly E. Richter

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Meyer, I., Richter, H.E. An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women. Curr Obstet Gynecol Rep 3, 155–164 (2014). https://doi.org/10.1007/s13669-014-0085-8

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