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Fecal incontinence: mechanisms and management

Halland, Magnusa; Talley, Nicholas J.a,b

Current Opinion in Gastroenterology: January 2012 - Volume 28 - Issue 1 - p 57–62
doi: 10.1097/MOG.0b013e32834d2e8b
LARGE INTESTINE: Edited by Ciarán Kelly
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Purpose of review Fecal incontinence is a common condition, which leads to impaired quality of life and huge financial cost at an individual and societal level. Recent studies have identified novel and potentially modifiable risk factors. Newer diagnostic modalities are giving more detailed information about underlying disorders, helping to implement targeted treatment. Many therapeutic options exist, and newer treatments are changing outcomes. This article will review recent developments in mechanisms, diagnosis, and treatment of fecal incontinence.

Recent findings Potentially modifiable risk factors have recently been identified, and should translate to changes in clinical practice and hopefully patient outcomes. These include diarrhea, smoking, and dietary fiber. Advances have been made in anatomical and physiological testing of the anorectum and this may assist in clarifying the diagnosis and guiding management. The long-term benefit of biofeedback has been questioned but patient selection may be key. Novel pharmacological therapies (e.g., clonidine) and minimally invasive surgical procedures are changing outcomes in well selected patients. The development of a magnetic anal sphincter may add a new management alternative in patients who are refractory to conservative management.

Summary Fecal incontinence remains a clinical challenge. Only a minority of persons with fecal incontinence seek treatment, but for those who do, improved understanding of risk factors coupled with diagnostic techniques and treatments are improving outcomes.

aDepartment of Gastroenterology, John Hunter Hospital

bFaculty of Health, University of Newcastle, Newcastle, New South Wales, Australia

Correspondence to Professor Nicholas J. Talley, Faculty of Health, University of Newcastle, Callaghan, Newcastle, New South Wales 2303, Australia. Tel: +61 2 49216378; fax: +61 2 4921 5669; e-mail: Nicholas.talley@newcastle.edu

© 2012 Lippincott Williams & Wilkins, Inc.