View source for Fecal incontinence

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==Overview==
Fecal incontinence is a condition in which an individual experiences loss of control over [[defecation]] leading to the involuntary release of feces. This condition leaves an impact on an individual's social life and also impairing the quality of life. The factors leading to fecal incontinence include structural abnormalities of the anus and rectum, damage to the pelvic muscles, nerve injury or [[neuropathies]], [[cognitive deficit]], consistency of the stool, advancing age and at times may be idiopathic. Many individuals may refrain from expressing their concern regarding their condition due to the stigma associated with it.

==Pathophysiology==
*Fecal incontinence occurs as a result of structural and fucntional abnormalities of the [[anal sphincter]] and the surrounding muscles and nerves. It is usually multifactorial as a result of the underlying pathology.<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref> <ref name="pmid25533002">{{cite journal| author=Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA et al.| title=Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. | journal=Am J Gastroenterol | year= 2015 | volume= 110 | issue= 1 | pages= 127-36 | pmid=25533002 | doi=10.1038/ajg.2014.396 | pmc=4418464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25533002  }} </ref>
*The resting anal pressure is provided by the internal anal sphincter (IAS) which is then supplemented by the external anal sphincter (EAS) along with the mucosal folds and endovascular cushions of the anus.<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref>
*Malfunctioning of the external anal sphincter (EAS) may lead to the urge type or diarrhea type of fecal incontinence.<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref>
*Impairment of the anorectal sampling reflex may result in ineffective anal seal mechanism as a result of damage to the endovascular cushions.<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref>
*Damage to the [[pudendal nerve]] may impair rectal sensations which may lead to [[fecal impaction]], enlarged [[rectum]] and overflow of the fecal matter.<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref>
*During childbirth the [[anal sphincter]] may be disrupted which may result in individual or combined damage to the [[pudendal nerve]], external anal sphincter (EAS), internal anal sphincter (IAS).<ref name="pmid14978634">{{cite journal| author=Rao SS| title=Pathophysiology of adult fecal incontinence. | journal=Gastroenterology | year= 2004 | volume= 126 | issue= 1 Suppl 1 | pages= S14-22 | pmid=14978634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978634  }} </ref>

==Causes==
*Fecal Incontinence may be caused due to the following: <ref name="pmid22908765">{{cite journal| author=Ness W| title=Faecal incontinence: causes, assessment and management. | journal=Nurs Stand | year= 2012 | volume= 26 | issue= 42 | pages= 52-4, 56, 58-60 | pmid=22908765 | doi=10.7748/ns2012.06.26.42.52.c9162 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22908765  }} </ref> <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref> <ref name="pmid24976729">{{cite journal| author=Muñoz-Yagüe T, Solís-Muñoz P, Ciriza de los Ríos C, Muñoz-Garrido F, Vara J, Solís-Herruzo JA| title=Fecal incontinence in men: causes and clinical and manometric features. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 24 | pages= 7933-40 | pmid=24976729 | doi=10.3748/wjg.v20.i24.7933 | pmc=4069320 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976729  }} </ref>
**Anal sphincter dysfunction/damage
**[[Rectal prolapse]]
**Surgical procedures of the rectum and anus may lead to muscle or nerve injuries.
**Anorectal surgical procedures such as [[hemorrhoidectomy]], fistula surgery and [[sphincterotomy]] may lead to fecal incontinence. <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
**Impaired rectal sensation
**[[Rectocele]]
**Damage to the nerves
**[[Diarrhea]]
**[[Inflammatory bowel disease]]
**[[Constipation]]
**[[Hemorrhoids]]
**Neurologic abnormalities such as multiple sclerosis and pudendal neuropathy
**Decreased compliance of the rectum

==Differentiating Fecal incontinence from Other Diseases==
*Fecal incontinence must be differentiated from other diseases such as:
**[[Crohn's disease]]
**[[Acute diarrhea]]
**[[Chronic diarrhea]]
**[[Traveler's diarrhea]]
**[[Colorectal cancer]]
**[[Ulcerative colitis]]
**[[Fistulae]]

==Epidemiology and Demographics==
*The prevalence of fecal Incontinence is approximately 2000-3000 per 100,000 individuals worldwide. <ref name="pmid7629985">{{cite journal| author=Nelson R, Norton N, Cautley E, Furner S| title=Community-based prevalence of anal incontinence. | journal=JAMA | year= 1995 | volume= 274 | issue= 7 | pages= 559-61 | pmid=7629985 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7629985  }} </ref>
*In the US, the prevalence of fecal Incontinence is similar in women and men and increases with age, with the prevalence of 8900 per 100,000 individuals in women and 7700 per 100,00 individuals in men. <ref name="pmid19410574">{{cite journal| author=Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A et al.| title=Fecal incontinence in US adults: epidemiology and risk factors. | journal=Gastroenterology | year= 2009 | volume= 137 | issue= 2 | pages= 512-7, 517.e1-2 | pmid=19410574 | doi=10.1053/j.gastro.2009.04.054 | pmc=2748224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410574  }} </ref>
*In the US, fecal Incontinence affects 2600 per 100,000 individuals in the age group of 20 to 29 years and in elderly people up to 15,300 per 100,000 individuals who are over the age of 70 years. <ref name="pmid19410574">{{cite journal| author=Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A et al.| title=Fecal incontinence in US adults: epidemiology and risk factors. | journal=Gastroenterology | year= 2009 | volume= 137 | issue= 2 | pages= 512-7, 517.e1-2 | pmid=19410574 | doi=10.1053/j.gastro.2009.04.054 | pmc=2748224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410574  }} </ref>
*There is no racial predilection to fecal Incontinence.<ref name="pmid19410574">{{cite journal| author=Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A et al.| title=Fecal incontinence in US adults: epidemiology and risk factors. | journal=Gastroenterology | year= 2009 | volume= 137 | issue= 2 | pages= 512-7, 517.e1-2 | pmid=19410574 | doi=10.1053/j.gastro.2009.04.054 | pmc=2748224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410574  }} </ref>

==Risk Factors==
*Common risk factors in the development of Fecal incontinence include: <ref name="pmid19410574">{{cite journal| author=Whitehead WE, Borrud L, Goode PS, Meikle S, Mueller ER, Tuteja A et al.| title=Fecal incontinence in US adults: epidemiology and risk factors. | journal=Gastroenterology | year= 2009 | volume= 137 | issue= 2 | pages= 512-7, 517.e1-2 | pmid=19410574 | doi=10.1053/j.gastro.2009.04.054 | pmc=2748224 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19410574  }} </ref> <ref name="pmid19844202">{{cite journal| author=Rey E, Choung RS, Schleck CD, Zinsmeister AR, Locke GR, Talley NJ| title=Onset and risk factors for fecal incontinence in a US community. | journal=Am J Gastroenterol | year= 2010 | volume= 105 | issue= 2 | pages= 412-9 | pmid=19844202 | doi=10.1038/ajg.2009.594 | pmc=3189687 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19844202  }} </ref> <ref name="pmid28209529">{{cite journal| author=Staller K, Townsend MK, Khalili H, Mehta R, Grodstein F, Whitehead WE et al.| title=Menopausal Hormone Therapy Is Associated With Increased Risk of Fecal Incontinence in Women After Menopause. | journal=Gastroenterology | year= 2017 | volume= 152 | issue= 8 | pages= 1915-1921.e1 | pmid=28209529 | doi=10.1053/j.gastro.2017.02.005 | pmc=5447480 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28209529  }} </ref> <ref name="pmid27783401">{{cite journal| author=Andy UU, Vaughan CP, Burgio KL, Alli FM, Goode PS, Markland AD| title=Shared Risk Factors for Constipation, Fecal Incontinence, and Combined Symptoms in Older U.S. Adults. | journal=J Am Geriatr Soc | year= 2016 | volume= 64 | issue= 11 | pages= e183-e188 | pmid=27783401 | doi=10.1111/jgs.14521 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27783401  }} </ref> <ref name="pmid25110978">{{cite journal| author=Matthews CA| title=Risk factors for urinary, fecal, or double incontinence in women. | journal=Curr Opin Obstet Gynecol | year= 2014 | volume= 26 | issue= 5 | pages= 393-7 | pmid=25110978 | doi=10.1097/GCO.0000000000000094 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25110978  }} </ref>
**'''Age factor:''' Mostly seen in middle-age and older adult population.
**'''Gender:''' Females are more likely to have fecal incontinence when compared to men. The major risk factor being the complications during childbirth that damage the [[anal sphincter]] and injure the pelvic floor muscles and nerves such as:
***[[Episiotomy]]
***[[Forceps delivery]]
***Prolonged second stage of labor
***Occipitoposterior presentation of the fetus
***Pelvic floor injury resulting in significant tears and higher birth-weight of the infant
**'''Nerve injury/neuropathy:''' Damage to the [[pudendal nerve]]/pudendal neuropathy
**'''[[Alzheimer's disease]] and [[Dementia]]:''' Fecal incontinence is usually seen in individuals with [[Alzheimer's disease]](advanced stage) and Dementia.
**[[Multiple sclerosis]]
**Anorectal congenital abnormalities
**Radiation therapy of the pelvis
**[[Rectal prolapse]]
**'''Hormone therapy:''' In post-menopausal women, fecal incontinence may be due to hormonal therapy.

==Screening==
*There is insufficient evidence to recommend routine screening for fecal incontinence.
*However, a physician should rule out the symptoms in conditions which may pose as risk factors for developing fecal incontinence.

==Natural History, Complications, and Prognosis==
*If left untreated, patients with Fecal incontinence may progress to develop complications such as:
**Pain and itching in the anal region leading to rashes and ulcers
**Social withdrawal
**Emotional distress
**[[Depression]]
**[[Insomnia]]
*Prognosis is generally good. After sphincteroplasty, the success rate is 64–90% initially which then declines as the years progress. By the end of 7 to 8 years after the surgery, only around half of the patients have observed better outcomes. <ref name="pmid24409050">{{cite journal| author=Van Koughnett JA, Wexner SD| title=Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. | journal=World J Gastroenterol | year= 2013 | volume= 19 | issue= 48 | pages= 9216-30 | pmid=24409050 | doi=10.3748/wjg.v19.i48.9216 | pmc=3882396 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24409050  }} </ref> <ref name="pmid12068192">{{cite journal| author=Halverson AL, Hull TL| title=Long-term outcome of overlapping anal sphincter repair. | journal=Dis Colon Rectum | year= 2002 | volume= 45 | issue= 3 | pages= 345-8 | pmid=12068192 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12068192  }} </ref> <ref name="pmid8064190">{{cite journal| author=Londono-Schimmer EE, Garcia-Duperly R, Nicholls RJ, Ritchie JK, Hawley PR, Thomson JP| title=Overlapping anal sphincter repair for faecal incontinence due to sphincter trauma: five year follow-up functional results. | journal=Int J Colorectal Dis | year= 1994 | volume= 9 | issue= 2 | pages= 110-3 | pmid=8064190 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8064190  }} </ref>

==Diagnosis==
===Diagnostic Study of Choice===
*Reliable scoring systems for the assessment of fecal incontinence based on symptoms and the response received as a result of interventions are:<ref name="pmid14668583">{{cite journal| author=Baxter NN, Rothenberger DA, Lowry AC| title=Measuring fecal incontinence. | journal=Dis Colon Rectum | year= 2003 | volume= 46 | issue= 12 | pages= 1591-605 | pmid=14668583 | doi=10.1097/01.DCR.0000098906.61097.1C | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14668583  }} </ref> <ref name="pmid9862829">{{cite journal| author=Vaizey CJ, Carapeti E, Cahill JA, Kamm MA| title=Prospective comparison of faecal incontinence grading systems. | journal=Gut | year= 1999 | volume= 44 | issue= 1 | pages= 77-80 | pmid=9862829 | doi= | pmc=1760067 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9862829  }} </ref>
**The American Medical System Score
**The Vaizey Score
**The Wexner Score

===History and Symptoms===
*A thorough and detailed history is crucial while obtaining a history from a patient experiencing fecal incontinence. <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*The history taking should be focused mainly on obstetrical and surgical history apart from medication history and other associated medical conditions if any. <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*Symptoms should be categorized based on the onset, duration, severity and the type of incontinence. <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*Soiling of undergarments is a common symptom observed in individuals with fecal incontinence wherein stains of stool are observed on the undergarments.
*Symptoms of fecal incontinence vary acoording to the type of incontinence such as the urge fecal incontinence and passive fecal incontinence.
*Symptoms in individuals with urge fecal incontinence, the patient realizes the need to defecate but lacks control over it and may pass the stool even before reaching the restoom. <ref name="pmid26544817">{{cite journal| author=van Meegdenburg MM, Heineman E, Broens PM| title=Pudendal Neuropathy Alone Results in Urge Incontinence Rather Than in Complete Fecal Incontinence. | journal=Dis Colon Rectum | year= 2015 | volume= 58 | issue= 12 | pages= 1186-93 | pmid=26544817 | doi=10.1097/DCR.0000000000000497 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26544817  }} </ref> <ref name="pmid25351694">{{cite journal| author=Buhmann H, Nocito A| title=[Update on fecal incontinence]. | journal=Praxis (Bern 1994) | year= 2014 | volume= 103 | issue= 22 | pages= 1313-21 | pmid=25351694 | doi=10.1024/1661-8157/a001831 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25351694  }} </ref>
*Symptoms in individuals with passive fecal incontinence, the patient doesn't realize nor does have control over the passage of stools and hence it happens without their knowledge.<ref name="pmid25351694">{{cite journal| author=Buhmann H, Nocito A| title=[Update on fecal incontinence]. | journal=Praxis (Bern 1994) | year= 2014 | volume= 103 | issue= 22 | pages= 1313-21 | pmid=25351694 | doi=10.1024/1661-8157/a001831 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25351694  }} </ref>

===Physical Examination===
*Physical examination includes:
**'''Inspection of the perianal area:''' To check for anocutaneous reflex (anal wink sign). Absence of this reflex indicates nerve damage.
**'''Digital rectal examination:''' It is done to evaluate for anal pathology and assess anal resting tone.
*Procedures that may help in determining the underlying cause of fecal incontinence are:
**Colonoscopy
**Sigmoidoscopy
**Anoscopy

===Laboratory Findings===
Stool testing may be helpful in determining the underlying cause of diarrhea.

===Electrocardiogram===
There are no ECG findings associated with fecal incontinence.
===X-ray===
There are no x-ray findings associated with fecal incontinence.
===Ultrasound/MRI===
*[[Ultrasound]] or magnetic resonance imaging may be helpful in the diagnosis of fecal incontinence. An ultrasound or magnetic resonance imaging may be helpful in determining the underlying abnormalities of the pelvic floor muscles, structural abnormalities of the anal sphincter and abnormalities of the wall of the rectum.
===Other Diagnostic Studies===
*Anorectal manometry may be helpful in the diagnosis of fecal incontinence. This procedure helps in determining the anal sphincter tone and also the sensation and reflexes of the rectum.
*Balloon expulsion test may be more helpful in determining defecation disorders in the elderly patients who sufffer from fecal incontinence secondary to fecal impaction.

==Treatment==
===Medical Therapy===
*Medical management of fecal incontinence involves medical therapy along with supportive measures that are focused at symptom control and also resolving the underlying conditions such as the stool consistency, rectal prolapse and other underlying associated medical conditions, if any.<ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*The first-line of management inn case of the affected patients would be the streamlining of conservative measures. Symptom control approach that includes dietary modification along with behavioral modification, usage of pads, skin care and pharmacotherapy. The patients in whom behavioral changes are suggested, should be made aware of the gastrocolic reflex.<ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*Dietary habits have to be assessed inorder to minimize the negative impacts of the food on stool consistency and volume.<ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*Inclusion of fiber rich foods or supplements may help in minimizing loose stools but, such foods should be used cautiously in patients with baseline formed stools, because the softer consistency and increased volume of the stools may result in the symptoms getting deteriorated.<ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
*Medical therapy includes the use of drugs such as diphenoxylate/atropine, loperamide, cholestyramine, ondansetron, and/or amitriptyline. In order to reduce diarrhea and slightly increase the internal sphincter tone, diphenoxylate/atropine or loperamide are frequently used.<ref name="pmid7105952">{{cite journal| author=Read M, Read NW, Barber DC, Duthie HL| title=Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. | journal=Dig Dis Sci | year= 1982 | volume= 27 | issue= 9 | pages= 807-14 | pmid=7105952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7105952  }} </ref> Amitriptyline may also be used as an alternative for treating diarrhea, and it may also be used to reduce rectal urgency.<ref name="pmid11156450">{{cite journal| author=Santoro GA, Eitan BZ, Pryde A, Bartolo DC| title=Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. | journal=Dis Colon Rectum | year= 2000 | volume= 43 | issue= 12 | pages= 1676-81; discussion 1681-2 | pmid=11156450 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156450  }} </ref>
*In order to reduce episodes of incontinence in patients with fecal impaction and overflow incontinence, enema is suggested to facilitate stool elimination and reduce the stool load. <ref name="pmid10791451">{{cite journal| author=Chassagne P, Jego A, Gloc P, Capet C, Trivalle C, Doucet J et al.| title=Does treatment of constipation improve faecal incontinence in institutionalized elderly patients? | journal=Age Ageing | year= 2000 | volume= 29 | issue= 2 | pages= 159-64 | pmid=10791451 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10791451  }} </ref>
*Supportive measures such as perianal skin care with barrier creams and restraining from over-the-counter topical creams without prescription.
*Physical therapy and biofeedback may help strengthen pelvic floor and sphincter muscles as they serve as exercises thereby helping the muscles to recordinate. <ref name="pmid19966605">{{cite journal| author=Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE| title=Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. | journal=Dis Colon Rectum | year= 2009 | volume= 52 | issue= 10 | pages= 1730-7 | pmid=19966605 | doi=10.1007/DCR.0b013e3181b55455 | pmc=3855426 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19966605  }} </ref>

===Surgery===
*Surgical management involves the following procedures: <ref name="pmid26268955">{{cite journal| author=Alavi K, Chan S, Wise P, Kaiser AM, Sudan R, Bordeianou L| title=Fecal Incontinence: Etiology, Diagnosis, and Management. | journal=J Gastrointest Surg | year= 2015 | volume= 19 | issue= 10 | pages= 1910-21 | pmid=26268955 | doi=10.1007/s11605-015-2905-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26268955  }} </ref>
**Procedures to correct anatomical abnormalities
**Repair of the anal sphincter and pelvic floor muscles <ref name="pmid10796816">{{cite journal| author=Bachoo P, Brazzelli M, Grant A| title=Surgery for faecal incontinence in adults. | journal=Cochrane Database Syst Rev | year= 2000 | volume=  | issue= 2 | pages= CD001757 | pmid=10796816 | doi=10.1002/14651858.CD001757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10796816  }} </ref>
**Sacral nerve stimulation (SNS) by neuromodulatory procedures <ref name="pmid7475602">{{cite journal| author=Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP| title=Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. | journal=Lancet | year= 1995 | volume= 346 | issue= 8983 | pages= 1124-7 | pmid=7475602 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7475602  }} </ref>
**Creation of a new anal sphincter by transposition of the muscles and use of an artificial bowel sphincter. 
**Procedures involving increasing the anal sphincter function

===Primary Prevention===
*Effective measures for the primary prevention of Fecal incontinence include:
**Avoid constipation by exercising regularly and maintaining healthy food habits by drinking plenty water and including foods rich in fiber in the diet
**Avoiding straining or forceful defecation which may effect the anal sphincter and damage the related muscles and nerves which may lead to fecal incontinence.
**Treating Diarrhea by managing the underlying cause such as the gastrointestinal infection.
**In cases of fecal incontinence related to pregnancy, pelvic floor muscle training may help in prevention and reversal of the condition following the first year of delivery. <ref name="pmid18268289">{{cite journal| author=Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ et al.| title=National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. | journal=Ann Intern Med | year= 2008 | volume= 148 | issue= 6 | pages= 449-58 | pmid=18268289 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18268289  }} </ref> <ref name="pmid23076935">{{cite journal| author=Boyle R, Hay-Smith EJ, Cody JD, Mørkved S| title=Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 10 | issue=  | pages= CD007471 | pmid=23076935 | doi=10.1002/14651858.CD007471.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23076935  }} </ref>
**Elimination of interventions such as episiotomy, lateral sphincterotomy, and anal sphincter stretch in women may be helpful in preventing fecal incontinence. <ref name="pmid20025031">{{cite journal| author=Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J, Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence| title=Management of fecal incontinence in adults. | journal=Neurourol Urodyn | year= 2010 | volume= 29 | issue= 1 | pages= 199-206 | pmid=20025031 | doi=10.1002/nau.20803 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20025031  }} </ref>
==Case Studies==

[[Fecal incontinence case study one|Case #1]]

==Related Chapters==
* [[Steatorrhea]]
* [[Encopresis]]
* [[Soiling]]

==External Links==
*[http://www.colorep.it/Rivista%20CEC/consensus_conference.htm Consensus Conference: Treatment Options for Fecal Incontinence. Saint Vincent Oct 2002]
*http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/
*http://www.spinalcord.ar.gov/Publications/FactSheets/sheets6-10/fact10.html
*[[National Institute for Health and Clinical Excellence|NICE]] guidance IPG159:  [http://www.nice.org.uk/page.redirect?o=IP_19 Stimulated graciloplasty for faecal incontinence]
*[[National Institute for Health and Clinical Excellence|NICE]] guidance IPG099: [http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11079 Sacral nerve stimulation for faecal incontinence]

{{Digestive system and abdomen symptoms and signs}}
{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}

[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Symptoms]]
[[Category:Primary care]]

{{WH}}
{{WS}}

[[cs:Fekální inkontinence]]
[[de:Stuhlinkontinenz]]
[[fr:Incontinence fécale]]
[[it:Incontinenza fecale]]
[[nl:Ontlastingincontinentie]]
[[pt:Incontinência fecal]]
[[sk:Fekálna inkontinencia]]
[[fi:Ulosteinkontinenssi]]
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