Guidelines for the evaluation and management of fecal incontinence have been updated since 2007 and published by the American Society of Colorectal Surgeons (ASCRS) in February 2023. diseases of the colon and rectum. Class I (Strong) recommendations are summarized below.
Assessment and risk assessment
A thorough medical history will be taken to determine the cause of incontinence and specific risk factors, clarify the duration and severity of primary symptoms, and gather details about secondary problems and associated medical conditions. Additionally, a thorough physical exam is essential.
Use validated measurements to assess how the nature, severity, and impact of fecal incontinence impact a patient’s quality of life.
Consider using anorectal physiology testing (manometry, anorectal sensation, volume tolerance, compliance) to characterize dysfunction and guide management.
Pudendal nerve terminal motor latency is an available option but is not routinely recommended due to its limited impact in the diagnosis and management of fecal incontinence.
If a sphincter injury is suspected, a sphincter defect can be confirmed by endoanal ultrasound.
conservative management
The first-line treatment for fecal incontinence is the use of conservative measures consisting of dietary and medical management.
Perform endoscopic evaluation for patients who meet general screening guidelines or have specific symptoms (e.g., diarrhea, bleeding, obstruction) that require further evaluation.
Consider biofeedback as initial treatment for incontinence while preserving some spontaneous sphincter contractions.
surgical intervention
Correct obvious anatomical defects (e.g., rectovaginal fistula, rectal/hemorrhoid prolapse, intraanal fistula, cloaca-like deformity).
In cases of symptomatic disease and obvious defects of the external anal sphincter, we offer sphincter repair (sphincteroplasty).
In general, repeat anal sphincter reconstruction after a failed duplication sphincteroplasty should be avoided unless other treatments are not feasible or ineffective.
The ASCRS does not recommend external anal sphincter plication (Parke retroanal repair).
Consider sacral neuromodulation as a first-line surgical option for patients with fecal incontinence, with or without sphincter deficiency.
Artificial intestinal sphincter grafts continue to be effective for some patients with severe fecal incontinence.
Creating a colostomy is an excellent surgical option for people with fecal incontinence who have not responded to other treatments or who do not want treatment.
Learn more about. fecal incontinence and Neurogenic intestinal dysfunction.