[Therapy of fecal incontinence from the internal medicine viewpoint]

Despite a general belief is fecal incontinence a symptom rather than a diagnosis, usually occurring as a consequence of an underlying disease. Treatment of fecal incontinence, thus, is primarily treatment of this underlying disorder. If this causal treatment is not possible or effective, symptomatic treatment may become the goal. Furthermore, conservative management has to utilize all its possibilities before surgery may become a therapeutic option. This, however, is restricted by the limited number of conservative options available: Only a very few drugs act directly on the anal sphincter mechanism to increase the tone, all other medication may be contra-indicated. Laxatives are no treatment option at all in fecal incontinence, and the efficacy of electric stimulation of pelvic floor muscles has not been proven so far. Therefore, pelvic floor exercises have become treatment of choice, most effective with biofeedback support. This is supported by a variety of studies published in the past years.