Fecal incontinence is a common problem affecting women but is underreported because of patients’ reluctance to discuss their symptoms and an inconsistent use of screening tools by physicians. Obstetric injury from vaginal delivery is the principal cause of fecal incontinence among young women. Prevalence rates are highest in the elderly, especially those with declining cognitive function. There are multiple diagnostic tests including anal manometry, endosonography, defecography, and pudendal nerve latency testing to assist physicians in the workup of patients and aid in the selection of appropriate treatment options. After patient identification and workup, most patients can be offered conservative measures including dietary measures and biofeedback. Surgery is indicated for specific abnormalities such as rectal prolapse, fistula, and recent obstetrical sphincter injury repair. Management of refractory cases may include sacral nerve stimulation and percutaneous tibial nerve stimulation. Fecal diversion or an artificial bowel sphincter may be considered when all else has failed.
Primary care physicians, gynecologists, and specialists in female pelvic medicine should screen women for fecal incontinence. Initial conservative therapy may be directed by the primary health provider, and those resistant to this approach should be referred to specialist care.
Fecal incontinence has a significant impact on patient quality of life and is under-reported by patients to healthcare providers. Although obstetric anal sphincter injury is the principle cause of fecal incontinence in young women, other conditions that lead to fecal incontinence should be considered and ruled out. Understanding the pathophysiology, work-up and treatment options is essential not only to colorectal and urogyencology specialties but also to primary care providers who are often the first to see and care for patients with this condition. In an effort to provide the latest on diagnostic studies and treatment options, the team of authors involved in this paper performed a thorough review of the literature and aimed to provide a concise reference for the management of this condition.
From the *Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, and †Division of Colon and Rectal Surgery, Department of General Surgery, Kaiser Permanente, Los Angeles, CA; and ‡Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Harbor UCLA Medical Center, Torrance, CA.
Reprints: Azadeh Rezvan, MD, Harbor UCLA Medical Center, 1000 West Carson Street, Box #489, Torrance, CA 90509. E-mail: firstname.lastname@example.org.
The authors have declared they have no conflicts of interest.