Treatment options for fecal incontinence

Area of Science:

• Gastroenterology and Colorectal Surgery
• Patient Care and Management

Background:

• Fecal incontinence affects a significant portion of adults and nursing home residents.
• Physician awareness of effective fecal incontinence treatments is often limited.
• A multidisciplinary consensus conference was convened to address treatment options.

Framework:

• Consensus statements were developed through expert discussions from various disciplines.
• The process involved drafting, circulation, and revision of statements based on participant input.

Implementation:

• Initial management includes addressing diarrhea with medications (loperamide, diphenoxylate) or bile acid binders, and fecal impaction with laxatives and habit training.
• Diagnostic tools like anorectal manometry and endoanal ultrasound aid in differentiating causes in refractory cases.
• Biofeedback therapy shows benefit in approximately 75% of patients, particularly those with neurologic injury.
• Surgical options include sphincter plication for structural defects and salvage procedures like gracilis muscle transposition or colostomy for severe cases.
• Antegrade enemas are effective for children with myelomeningocele.
• Investigational treatments include nerve stimulators and artificial sphincters.

Implications:

• Treatment selection should consider patient factors such as mental status, mobility, and bowel habits.
• Further research is crucial to elucidate mechanisms, assess treatment efficacy, and improve care for nursing home residents.
• Developing predictors of outcome will refine treatment strategies for fecal incontinence.