Treatment

Treatment for fecal incontinence varies from noninvasive to invasive procedures.

1. Dietary and lifestyle modification

Dietary and lifestyle modification are the initial treatment for patients with fecal
incontinence. It is necessary to decrease modifiable risk factors such as obesity,
inactivity and smoking. Significant improvements are shown on obese women who lost
weight.(Freeman & Menees 2016; Margolin 2008) Patients are advised to consume food
that act as a bulking agents, like food with high fibers, and avoid food that precipitate
incontinency, like the ones that cause loose stool and urgency, such as caffeine, dairy and
food with high in fats.(Freeman & Menees 2016; Margolin 2008)

2. Biofeedback
Biofeedback is a form of physical therapy and muscle re-training. Biofeedback as the first
line treatment for patients with idiopathic fecal incontinence in mild to moderate cases,
with or without pelvic floor strengthening exercises.(Margolin 2008; Bharucha 2008)
This option is preferable since it is much less invasive, painless, safe, inexpensive and
effective long-term.(Freeman & Menees 2016; Margolin 2008) There are a few forms of
biofeedback which includes monitored or home sessions, pelvic floor exercises, digital
feedback, electrical stimulation, balloons and manometric or ultrasound monitoring of
response.(Margolin 2008) Pelvic floor exercises or the Kegel technique requires patient
to squeeze the muscles around the anal canal for 10 seconds without having the
abdominal wall contracted, and then relax the muscles. This exercise can be done either
in sitting or standing position.(Freeman & Menees 2016; Bharucha 2008) Using rectal
balloon and anal manometric or surface EMG sensors, patients can have visual feedback
and from this they can learn to coordinate sphincter contraction during rectal distention,
also to recognize rectal distention with progressively smaller volumes.(Bharucha 2008)

3. Medication
Medication is the mainstay management for fecal incontinence for patients that do not
improve with noninvasive treatment. Adding daily fiber supplement acts as a bulking
agent to help produce more solid stool. This medication has several mechanisms of
actions, even though they all serve the same purpose. The most common ones to use are
stool bulking agents (psyllium, methylcellulose, gum Arabic) and antidiarrheal
(loperamide, diphenoxylate/ atropine, codein).(Freeman & Menees 2016; Van Koughnett
& Wexner 2013) Amongst all of these, the most common medication used for treating
patients with fecal incontinence is loperamide, it may also have beneficial effect to the
sphincter resting tone. (Van Koughnett & Wexner 2013)The effective dose for loperamide
is 2-4 mg, taken 30 minutes before meals, up to 16 mg daily.(Bharucha 2008) Patients
can take loperamide before special occasions to reduce the risk of having an incident.
 4. Anal sphincternoplasty
This is the main surgical procedures for patients with fecal incontinence due to sphincter
defect, especially due to traumatic childbirth or prior anal surgery.(Van Koughnett &
Wexner 2013; Chin 2014; Wang & Abbas 2013) The defect can be repaired by an end-to
end or over-lapping approach.(Chin 2014) Most of the patients condition improves
shortly after recovery from the procedure, but there is evidence that it has no long-term
benefit and there is a chance of getting long-term worsening of symptoms that occurs
after the sphincter being repaired.(Chin 2014; Wang & Abbas 2013)

5. Sacral nerve stimulation

It has 2 procedures for this treatment option: initial implantation of a percutaneous lead in
the third sacral foramen with a brief trial (usually 1to 2 weeks), and then followed by
implanting a permanent device.(Margolin 2008; Wang & Abbas 2013; Van Koughnett &
Wexner 2013) During the trial period, patient maintains a diary to record the frequency of
incontinence, if there is an improvement of 50% or more then it indicates for a permanent
device implantation, and the battery life for the device has 3 to 5 years of life depending
on the degree of stimulation.(Wang & Abbas 2013) A trial for this management reports a
good long-term outcome. Improvement of the quality of life is seen with patients have
fewer episodes of incontinence and decreased urgency, even though the mechanism of
sacral stimulation is not completely clear.(Van Koughnett & Wexner 2013; Wang &
Abbas 2013) There are a few complications related to the procedures such as pain,
infection, seroma formation, bleeding and scarring. (Wang & Abbas 2013)

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Chin, K., 2014. Obstetrics and fecal incontinence. Clinics in Colon and Rectal Surgery, 27(3),
pp.110112.
Freeman, A. & Menees, S., 2016. Fecal Incontinence and Pelvic Floor Dysfunction in Women: A
Review. Gastroenterology Clinics of North America, 45(2), pp.217237. Available at:
http://dx.doi.org/10.1016/j.gtc.2016.02.002.
Van Koughnett, J.A.M. & Wexner, S.D., 2013. Current management of fecal incontinence:
choosing amongst treatment options to optimize outcomes. World journal of
gastroenterology, 19(48), pp.921630. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/24409050 [Accessed July 5, 2017].
Margolin, D.A., 2008. New options for the treatment of fecal incontinence. The Ochsner journal,
8(1), pp.1824. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21603552 [Accessed
July 5, 2017].
Wang, J.Y. & Abbas, M.A., 2013. Current management of fecal incontinence. The Permanente
journal, 17(3), pp.6573. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24355892
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