The pathogenesis of fecal incontinence is often multifactorial with local, anatomic, or systemic disorders potentially contributing.
There is a significant response to conservative therapy and appropriate support.
For those who do not respond to conservative treatment, specialist investigation is recommended to determine underlying etiology.
Surgical options include anterior sphincter repair and neosphincter formation.
Fecal incontinence is the involuntary passage of flatus or feces. The underlying etiology is often complex with multiple possible contributing factors including anorectal structural abnormalities, neurologic disorders, cognitive or behavioral dysfunction, stool consistency, or general disability (particularly age). Sometimes no cause can be found. It is extremely common, affecting up to 10% of adults, but the true prevalence remains hidden due to the associated stigma.
History and exam
- female sex
- older age
- nursing home resident
- forceps delivery
- baby >4 kg or delayed second stage of labor
- occipitoposterior presentation
- iatrogenic sphincter injury
- multiple sclerosis/stroke/pudendal neuropathy/spinal injury
- infectious diarrhea or inflammatory bowel disease
- rectal prolapse
- 3rd degree hemorrhoids
- congenital abnormalities of the anorectum
- dementia/learning difficulties
- pelvic radiation therapy
- diabetes mellitus
- central neurological disease
Steven Brown, MBChB, BmedSci, FRCS, MD
Department of Surgery
Sheffield Teaching Hospitals
SB is an author of a reference cited in this topic.
Andrew Miller, MD
Consultant Colorectal/General Surgeon
Leicester Royal Infirmary
AM declares that he has no competing interests.
Steven Wexner, MD, FACS, FRCS, FRCS Ed, FASCRS, FAC
Chief of Staff
Department of Colorectal Surgery
SW was a member of the Scientific advisory board, has received honoraria, and is a consultant for GlaxoSmithKline.
David Hackam, MD, PhD
Assistant Professor of Surgery
Children's Hospital of Pittsburgh
DH declares that he has no competing interests.
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