Fecal incontinence is involuntary defecation. Diagnosis is clinical. Treatment is a bowel management program and perineal exercises, but sometimes colostomy is needed.
(See also Evaluation of Anorectal Disorders.)
Fecal incontinence can result from
Injuries or diseases of the spinal cord
Congenital abnormalities
Accidental injuries to the rectum and anus
Rectal prolapse (procidentia)
Diabetes
Severe dementia
Fecal impaction
Extensive inflammatory processes
Tumors
Obstetric injuries
Operations involving division or dilation of the anal sphincters
Diagnosis of Fecal Incontinence
Clinical evaluation
Sometimes imaging tests, pelvic floor electromyography, and anorectal manometry
Physical examination should evaluate gross sphincter function and perianal sensation and rule out a rectal mass or rectal prolapse.
Anal sphincter endoscopic ultrasonography, pelvic and perineal MRIs, pelvic floor electromyography, and anorectal manometry are also useful.
Treatment of Fecal Incontinence
Program of stool regulation
Perineal exercises, sometimes with biofeedback
Sometimes a surgical procedure
(See also the American Society of Colon and Rectal Surgeons’ 2015 clinical practice guideline for the treatment of fecal incontinence.)
Simple perineal exercises, in which the patient repeatedly contracts the sphincters, perineal muscles, and buttocks, may strengthen these structures and contribute to continence, particularly in mild cases. Biofeedback (to train the patient to use the sphincters maximally and to better appreciate physiologic stimuli) should be considered before recommending surgery in well-motivated patients who can understand and follow instructions and who have an anal sphincter capable of recognizing the cue of rectal distention. About 70% of such patients respond to biofeedback.
A defect in the sphincter as assessed by endoscopic ultrasonography can be sutured directly.
When there is insufficient residual sphincter for repair, particularly in patients < 50 years of age, a gracilis muscle can be transposed. However, the positive results of these procedures typically do not last long. Some centers attach a pacemaker to the gracilis muscle, whereas others use an artificial sphincter; these or other experimental procedures are available in only a few centers in the US, as research protocols.
Sacral nerve stimulation has shown promise in the treatment of fecal incontinence (1).
When all else fails, a colostomy can be considered.
Treatment reference
1. Bordeianou LG, Thorsen AJ, Keller DS, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Fecal Incontinence. Dis Colon Rectum. 2023;66(5):647-661. doi:10.1097/DCR.0000000000002776
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
American Society of Colon and Rectal Surgeons: Clinical practice guideline for the treatment of fecal incontinence (2015)
