Fecal incontinence

Fecal incontinence – also called anal incontinence – is the inability to control bowel movements, resulting in the involuntary loss of solid or liquid stool. It can extend to complete loss of bowel control.

The actual prevalence of fecal incontinence is unknown. About 2% of the general population suffer from an inability to control bowel movements. The problem increases with age: up to 11% of men and 26% of women report incontinence after the age of 50 and reach a proportion of up to 40% in nursing homes.

Since it is usually an acquired fecal incontinence, the determination of the underlying cause is often used to classify the fecal incontinence and to decide on the further diagnostic examination and the therapeutic course:

  • Anal sphincter lesions
  • Neurogenic fecal incontinence
  • Idiopathic fecal incontinence

The diagnosis of fecal incontinence is based on a standard anorectal examination, clinical history, endoanal ultrasound examination, magnetic resonance imaging and anorectal physiology (pressure and sensitivity measurements).

Treatment should generally range from conservative to invasive, surgical, and from less to more invasive.

Conservative therapy aims to influence the consistency of the stool, the duration of the passage of the large intestine, emptying of the bowel, the function of the sphincter muscles and their perception, as well as the filling of the rectum. There are several treatment options available:

  • Low fiber diet
  • Loperamide
  • Retrograde enemas
  • Exercise for the pelvic floor muscles / biofeedback
  • Anal electrical stimulation
  • Analtamps

The choice of surgical treatment depends mainly on the severity of symptoms and the structural integrity of the sphincter muscles:

  • Anal sphincteroplasty (sphincter suture)
  • Repair of the pelvic floor
  • Sphincter replacement (dynamic gracilis plastic)
  • Sacral nerve stimulation
  • Stimulation of the posterior tibial nerve
  • Injectables
  • Anterograde colonic irrigation
  • Stoma

It is increasingly recognized that a single treatment mode is not sufficient for some patients and that a combination – both conservative and surgical – may be necessary for an optimal result.