Assessing and treating patients with complex fecal incontinence

Fecal incontinence is the involuntary loss of gas, liquid, and/or solid stool. It affects 2.2% of the general population. Because fecal incontinence can be socially and psychologically devastating, and is not easily discussed, this figure is probably understated. Patients presenting with fecal incontinence need to be properly assessed, including physiological testing of the pelvic floor muscles and nerves. Identifying any abnormal anatomy or physiology in the pelvic floor helps the clinician develop a care plan that best suits the patient's etiology. Knowledge of the physiology of the pelvic floor musculature and its effects on continence is improving. Treatment options also have broadened. This article describes the current techniques of assessment and treatment, including the "gold standard," and newer investigational procedures offered to patients with complex fecal incontinence.