Fecal incontinence in adults

Last reviewed: 26 Aug 2022
Last updated: 27 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • obstetric trauma
  • patulous anus
  • weak squeeze pressure
More key diagnostic factors

Other diagnostic factors

  • constipation
  • urinary incontinence
  • urgency
  • passive leakage
  • fecal seepage
  • perineal scarring
  • perianal fistulae
  • rectal mass
  • rectal prolapse
  • abnormal perianal sensation
Other diagnostic factors

Risk factors

  • 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
  • constipation/impaction
  • rectal prolapse
  • third-degree hemorrhoids
  • congenital abnormalities of the anorectum
  • dementia/learning difficulties
  • pelvic radiation therapy
  • diabetes mellitus
  • episiotomy
  • central neurologic disease
More risk factors

Diagnostic investigations

1st investigations to order

  • examination plus sigmoidoscopy
More 1st investigations to order

Investigations to consider

  • anorectal manometry
  • endoanal ultrasound
  • endoanal MRI
  • pudendal motor nerve latency test
  • electromyography
  • proctography
  • stool culture
  • rectal biopsy
  • CBC
  • CRP
More investigations to consider

Emerging tests

  • transvaginal/transperineal ultrasound

Treatment algorithm

INITIAL

symptomatic but cause undetermined

symptomatic with contributing condition

ACUTE

constipation with overflow

spinal cord damage or neurogenic bowel disorder

external sphincter deficiency

internal sphincter dysfunction

intact sphincter complex

ONGOING

severe incontinence refractory to other treatments

Contributors

Authors

Steven Brown, MBChB, BmedSci, FRCS, MD

Consultant Surgeon

Department of Surgery

Sheffield Teaching Hospitals

Sheffield

UK

Disclosures

SB is an author of a reference cited in this topic.

Peer reviewers

Andrew Miller, MD

Consultant Colorectal/General Surgeon

Leicester Royal Infirmary

Leicester

UK

Disclosures

AM declares that he has no competing interests.

Steven Wexner, MD, FACS, FRCS, FRCS Ed, FASCRS, FAC

Chief of Staff

Chairman

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

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

Pittsburgh

PA

Disclosures

DH declares that he has no competing interests.

  • Differentials

    • Colorectal cancer
    • Cauda equina syndrome
    • Crohn disease
    More Differentials
  • Guidelines

    • Guidelines for the investigation of chronic diarrhoea in adults, 3rd edition
    • Surgical interventions and the use of device-aided therapy for the treatment of fecal incontinence and defecatory disorders
    More Guidelines
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