[Fecal incontinence: evaluation, treatment concept and new therapeutic approaches]

Faecal incontinence is more frequent than generally assumed. The pathophysiological ground for faecal incontinence are injuries as well as infraclinic post childbirth injuries. However, faecal incontinence is frequently ideopathic by women probably due to weakness of the pelvic floor muscles. Interdisciplinary diagnosis include endoluminal-sonography, sphincter-manometry and in selected cases MR video-defaecography. Results of surgical sphincter repair combined with anterior anal repair may be excellent in up to 70% of the cases, however long-term results may become disappointing. Dynamic gracilis plastic is today a recognized therapy as sphincter replacement. However, provided that the sphincter-muscles remain intact, permanent sacral nerve-stimulation is a very promising emerging therapy. The initial results are very encouraging with recovery from faecal incontinence in up to 70-80% of the treated cases.