This is the second of a two-part summary of a National Institutes of Health conference on fecal incontinence (FI) that summarizes current treatments and identifies research priorities. Conservative medical management consisting of patient education, fiber supplements or antidiarrheals, behavioral techniques such as scheduled toileting, and pelvic floor exercises restores continence in up to 25% of patients. Biofeedback, often recommended as first-line treatment after conservative management fails, produces satisfaction with treatment in up to 76% and continence in 55%; however, outcomes depend on the skill of the therapist, and some trials are less favorable. Electrical stimulation of the anal mucosa is ineffective, but continuous electrical pulsing of sacral nerves produces a ≥50% reduction in FI frequency in a median 73% of patients. Tibial nerve electrical stimulation with needle electrodes is promising but remains unproven. Sphincteroplasty produces short-term clinical improvement in a median 67%, but 5-year outcomes are poor. Injecting an inert bulking agent around the anal canal led to ≥50% reductions of FI in up to 53% of patients. Colostomy is used as a last resort because of adverse effects on quality of life. Several new devices are under investigation but not yet approved. FI researchers identify the following priorities for future research: (1) trials comparing the effectiveness, safety, and cost of current therapies; (2) studies addressing barriers to consulting for care; and (3) translational research on regenerative medicine. Unmet patient needs include FI in special populations (e.g., neurological disorders and nursing home residents) and improvements in behavioral treatments.
1Division of Gastroenterology and Hepatology, Department of Medicine, Chapel Hill, North Carolina, USA
2Division of Urogynecology and Reconstructive Pelvic Floor Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
3Department of Gastroenterology, Georgia Regents University, Augusta, Georgia, USA
4Colon and Rectal Surgery Associates, Ltd., St. Paul, Minnesota, USA
5Department of Colon and Rectal Surgery, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
6Section of Colorectal Surgery, University of California, San Francisco, California, USA
7Department of Regenerative Medicine, Wake Forest Institute for Regenerative Medicine, Winston Salem, North Carolina, USA
8Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
9National Institutes of Diabetes, Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA
Correspondence: William E. Whitehead, PhD, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Campus Box 7080, Chapel Hill, North Carolina 27516-7080, USA. E-mail: William_Whitehead@med.unc.edu
Received 01 June 2014; accepted 05 August 2014
Guarantor of the article: William E. Whitehead, PhD.
Specific author contributions: Planning committee, conference presenter, and manuscript author: William E. Whitehead; planning committee, conference presenter, and manuscript revised and accepted: Satish S.C. Rao and Adil E. Bharucha; conference presenter and manuscript revised and accepted: Ann Lowry, Deborah Nagle, Madhulika Varma, and Khalil N. Bitar.
Financial support: National Institute of Diabetes and Digestive and Kidney Diseases provided financial assistance for the conference.
Potential competing interests: William Whitehead received grant support from Salix Pharmaceuticals.