Fecal Incontinence (2023)
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Management of Fecal Incontinence (2023)- Author Information
- STATEMENT OF THE PROBLEM
- METHODOLOGY
- Certainty of Evidence
- EVALUATION
- A History Should Be Obtained to Help Determine the Cause of Incontinence and Should Include Specific Risk Factors for Incontinence and Characterize the Duration and Severity of Symptoms
- Measures That Assess the Nature and Severity of Incontinence and the Impact of Incontinence on Quality of Life Should Be Used as a Part of the Assessment of FI
- A Physical Examination Is an Essential Component of the Evaluation of Patients With FI
- Anorectal Physiology Testing (Manometry, Anorectal Sensation, Volume Tolerance, and Compliance) Can Be Considered to Help Define the Elements of Dysfunction and Guide Management
- Endoanal Ultrasound May Be Useful to Evaluate Sphincter Anatomy When Planning a Sphincter Repair
- Pudendal Nerve Terminal Motor Latency Testing Is Not Routinely Recommended
- Endoscopy Should Be Performed According to Established Screening Guidelines and in Patients Presenting With Symptoms That Warrant Further Evaluation (ie, Changes in Bowel Habits, Bleeding)
- NONOPERATIVE MANAGEMENT
- Dietary and Medical Management Are Recommended as First-Line Therapy for Patients With FI
- Bowel Training Programs Can Improve Rectal Evacuation in Selected Patients
- Biofeedback May Be Considered for Patients With FI
- Vaginal Mechanical Inserts Are Not Routinely Recommended for FI
- Anal Mechanical Insert Devices Are Not Routinely Recommended for FI
- SURGICAL MANAGEMENT
- Anal Sphincteroplasty May Be Considered in Patients With a Defect in the External Anal Sphincter, but Clinical Results Often Deteriorate Over Time
- Repeat Anal Sphincter Reconstruction After a Failed Overlapping Sphincteroplasty Should Generally Be Avoided
- Sacral Neuromodulation May Be Considered as a First-Line Surgical Option for Incontinent Patients With or Without Sphincter Defects
- Injection of Biocompatible Bulking Agents Into the Anal Canal Is Not Routinely Recommended for the Treatment of FI
- Application of Temperature-Controlled Radiofrequency Energy to the Sphincter Complex Is Not Recommended to Treat FI
- Antegrade Colonic Enemas Can Be Considered in Highly Motivated Patients Who Are Seeking an Alternative to a Stoma
- Colostomy Is an Option for Patients Who Have Failed or Do Not Wish to Pursue Other Therapies for FI
- References
- Management of Anal Fissures (2023)