Diagnostic work-up for faecal incontinence in daily clinical practice in the Netherlands

To study variation in Dutch hospitals in applying diagnostic and treatment options for faecal incontinence.

Surgeons, gastroenterologists, internists and gynaecologists were contacted by phone or mail and requested to complete a questionnaire. The questionnaire asked for general information about patients with faecal incontinence, the use and availability of diagnostic techniques, the use of incontinence scores and therapeutic options.

In total 306 specialists were contacted and data were collected from 203 specialists from 86 hospitals (response rate 66%). The most frequently applied diagnostics were sigmoidoscopy (64%), endoanal sonography (58%), evacuation proctography (56%) and/or anorectal manometry (51%). The choice seemed to be related to the availability of the techniques. Sigmoidoscopies were performed significantly more often in local hospitals (p < 0.001), while in medical academic centres significantly more endoanal MRI examinations were conducted (p < 0.05). The most stated treatment option was physiotherapy (90%), followed by dietary measures (83%), medicating (71%) and surgery (68%). However, in general, combinations of treatment options were used.

A substantial variety exists in the diagnostic work-up of faecal incontinence. In general, at least one anorectal functional test and an imaging technique are the diagnostic techniques of choice. Pelvic floor physiotherapy is the first choice in conservative treatment.