Anorectal conditions: fecal incontinence

Although fecal incontinence occurs in all age groups, it is more common among older adults, especially nursing home residents, and it is more common among women than men. It often is associated with urinary incontinence. Etiologies are broadly categorized to include anatomic/physiologic changes due to trauma, surgery, vaginal deliveries, radiation, or disease states; neurologic disorders; drugs; and functional impairments. Evaluation is aimed at identifying etiologies, and scoring systems can be used to estimate severity and monitor outcomes. The first step in treatment is managing possible etiologies and implementing conservative measures, including increasing dietary fiber intake, using antidiarrheal drugs, removing fecal impactions, and using biofeedback. If these measures fail to control incontinence, further testing can characterize specific defects. Tests include endorectal ultrasound, anorectal manometry, and pudendal nerve terminal motor latency. After the defect is characterized, management options include injecting biocompatible material to bulk up a rectal sphincter with a defined defect, suture repair of sphincter defects, transfer of gracilis or gluteal muscle to create a new sphincter, implanting an artificial sphincter or neurostimulator, creating an ostomy through which retrograde enemas can be administered, and colostomy to prevent feces from reaching the rectum. Anal plugs are a last resort.