Incontinence and anorectal dysfunction in patients with diabetes mellitus

The elucidation of the pathogenesis of faecal incontinence in patients with advanced diabetes mellitus has progressed during the last 15 years. In contrast to earlier concepts which promoted the concept that high stool volumes overwhelm normal continence mechanisms, recent studies indicate that the vast majority of diabetic patients with faecal incontinence have normal or only moderately increased daily stool volumes, but also exhibit multiple abnormalities of anorectal sensory and motor functions. These changes are not observed in continent diabetic patients. Treatment consists of pharmacologic and dietary interventions to modulate diarrhoea, and biofeedback techniques to improve rectal sensory thresholds and striated muscle responsiveness of continence mechanisms. This dual approach is often successful and is free of risks.