Current management of fecal incontinence

To review the management of fecal incontinence, which affects more than 1 in 10 people and can have a substantial negative impact on quality of life.

The medical literature between 1980 and April 2012 was reviewed for the evaluation and management of fecal incontinence.

A comprehensive history and physical examination are required to help understand the severity and type of symptoms and the cause of incontinence. Treatment options range from medical therapy and minimally invasive interventions to more invasive procedures with varying degrees of morbidity. The treatment approach must be tailored to each patient. Many patients can have substantial improvement in symptoms with dietary management and biofeedback therapy. For younger patients with large sphincter defects, sphincter repair can be helpful. For patients in whom biofeedback has failed, other options include injectable medications, radiofrequency ablation, or sacral nerve stimulation. Patients with postdefecation fecal incontinence and a rectocele can benefit from rectocele repair. An artificial bowel sphincter is reserved for patients with more severe fecal incontinence.

The treatment algorithm for fecal incontinence will continue to evolve as additional data become available on newer technologies.