[Diagnosis and therapy of stool incontinence]

Incontinence may have different causes. First it is necessary to diagnose any underlying muscular defects. Neurologic lesions and coordinative disturbances should also be excluded. A great variety of methods are available for treatment. In fact conservative therapy alone will very often be successful. In all traumatic lesions of the sphincter muscle, surgical reconstruction is the method of choice if the defect is not too large. In cases of extensive sphincter destruction, an artificial anorectal sphincter implant or dynamic graciloplasty may be options. In all cases with no or only small muscular defects, sacral nerve stimulation should be offered to the patient. Plicating techniques such as pre- or postanal repair have lost their therapeutic attractiveness at present. Therefore in any case of incontinence, the correctly structured stoma still has a place. To date it is not possible to confirm how much new methods such as bulking agents may contribute to the treatment of incontinence.