Fecal incontinence: A practical approach to evaluation and treatment

Fecal incontinence is a common problem and can have a major impact on the q uality of life of those affected. Various disease processes affecting stool consistency, rectal sensitivity, or the anal sphincters can cause fecal in continence. Obstetric trauma is now knowm to be a major cause of sphincter dysfunction. The evaluation of the patient with incontinence helps to deter mine the choice of therapy-medical or surgical. The two most important test s are anorectal manometry, which provides information on sphincter pressure s, and rectal sensation, and anal endosonography, which is currently the te st of choice for defining the anatomy of the anal sphincters. The choice of therapy depends on the etiology of incontinence, the anatomy of the sphinc ters, and also on the effect of incontinence on the quality of life of the patient. Control of diarrhea, regardless of the cause, should be attempted first. Biofeedback therapy is effective in the majority of patients and is particularly attractive because it is safe and well tolerated. Surgery is o ffered when medical therapy is unsuccessful or when the etiology is thought to respond best to surgery, such as in postobstetric trauma. Sphincter rep air, for treatment of selective sphincter defects, is the best surgical opt ion. Neoanal sphincters and implanted artificial sphincters are far less at tractive because of technical difficulties and low success rate. (C) 2000 b y Am. Coll. of Gastroenterology.