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Functional fecal incontinence — Clinical Guidelines

Overview

Functional fecal incontinence involves the involuntary loss of stool without an identifiable organic cause, significantly impacting quality of life and often associated with psychological distress 6 7.

Diagnosis

Clinical history: Detailed assessment of symptoms, including frequency, amount, and type of incontinence 22.

Physical examination: Including anal sphincter assessment 23.

Anorectal function tests: Such as anorectal manometry and defecography to evaluate sphincter function and pelvic floor dynamics 23.

Grading: Utilize standardized scales like the Wexner score for severity assessment 4.

Management

Behavioral interventions: Pelvic floor exercises, biofeedback, and dietary modifications 18 26.

Pharmacotherapy: Loperamide for moderate symptoms; specific dosing not detailed but used effectively in clinical trials 32.

Surgical options: Stapled ileal reservoir to anal anastomosis for severe refractory cases 33.

Devices: Anal plugs and biofeedback devices for management 18 36.

Special Populations

Pediatrics: Rectal irrigation and conservative treatments for children with fecal incontinence 17.

Elderly: Focus on preventive measures and management of incontinence-associated dermatitis to improve quality of life 1 9.

Comorbidities: Vitamin-D deficiency may be associated with fecal incontinence; consider screening and supplementation 2.

Key Recommendations

Conduct a thorough clinical assessment including detailed history and anorectal function tests for diagnosis (Evidence: Moderate 22 23).

Implement behavioral interventions and dietary modifications as first-line treatments (Evidence: Moderate 18 26).

Consider pharmacological management with loperamide for moderate symptoms, guided by clinical response (Evidence: Weak 32).

Evaluate surgical options like stapled ileal reservoir for severe, refractory cases (Evidence: Expert opinion 33).

Address incontinence-associated dermatitis in elderly patients to improve overall care quality (Evidence: Moderate 1 9).

Screen for vitamin-D deficiency in patients with fecal incontinence, considering supplementation if deficient (Evidence: Moderate 2).

References

1 Deprez J, Ohde N, Eilegård Wallin A, Bååth C, Hommel A, Hultin L et al.. Prognostic factors for the development of incontinence-associated dermatitis (IAD): A systematic review. International wound journal 2024. link 2 Neshatian L, Grant G, Fernandez-Becker N, Yuan Y, Garcia P, Becker L et al.. The association between vitamin-D deficiency and fecal incontinence. Neurogastroenterology and motility 2024. link 3 Chen H, Liu Y, Wu J, Liang F, Liu Z. Acupuncture for postprostatectomy incontinence: a systematic review. BMJ supportive & palliative care 2023. link 4 Assmann SL, Keszthelyi D, Kleijnen J, Anastasiou F, Bradshaw E, Brannigan AE et al.. Guideline for the diagnosis and treatment of Faecal Incontinence-A UEG/ESCP/ESNM/ESPCG collaboration. United European gastroenterology journal 2022. link 5 Redón-Gálvez L, Alarcón Parra RO, Páez Borda Á. Post void incontinence secondary to female urethral diverticulum. Archivos espanoles de urologia 2019. link 6 . ACOG Practice Bulletin No. 210: Fecal Incontinence. Obstetrics and gynecology 2019. link 7 . ACOG Practice Bulletin No. 210 Summary: Fecal Incontinence. Obstetrics and gynecology 2019. link 8 Goddard GR, Rymeski B, Jenkins T, Mullapudi B, Dickie BH, Bischoff A et al.. A comparison of surgical complications after appendicostomy and neoappendicostomy in pediatric patients. Journal of pediatric surgery 2019. link 9 Voegeli D. Prevention and management of incontinence-associated dermatitis. British journal of nursing (Mark Allen Publishing) 2017. link 10 Demir N, Yuruyen M, Atay K, Yavuzer H, Hatemi I, Doventas A et al.. Prevalence of fecal incontinence and associated risk factors in elderly outpatients: a cross-sectional study. Aging clinical and experimental research 2017. link 11 Tamanini JT, de Jesus FA, Castro RA, Ferreira Sartori MG, Castello Girão MJ, Dos Santos JL et al.. The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study. Neurourology and urodynamics 2016. link 12 Unger CA, Goldman HB, Jelovsek JE. Fecal incontinence: the role of the urologist. Current urology reports 2014. link 13 van Tilburg MA, Squires M, Blois-Martin N, Williams C, Benninga MA, Peeters B et al.. Parental knowledge of fecal incontinence in children. Journal of pediatric gastroenterology and nutrition 2012. link 14 Nyrop KA, Grover M, Palsson OS, Heymen S, Palmer MH, Goode PS et al.. Likelihood of nursing home referral for fecally incontinent elderly patients is influenced by physician views on nursing home care and outpatient management of fecal incontinence. Journal of the American Medical Directors Association 2012. link 15 Langemo D, Hanson D, Hunter S, Thompson P, Oh IE. Incontinence and incontinence-associated dermatitis. Advances in skin & wound care 2011. link 16 Rosier PF, Hosker GL, Szabó L, Capewell A, Gajewski JB, Sand PK. Executive Summary: The International Consultation on Incontinence 2008--Committee on: "Dynamic Testing"; for urinary or fecal incontinence. Part 3: Anorectal physiology studies. Neurourology and urodynamics 2010. link 17 Bohr C. Using rectal irrigation for faecal incontinence in children. Nursing times 2009. link 18 Herbert J. Use of anal plugs in faecal incontinence management. Nursing times 2008. link 19 Rogers J. The impact paediatric bowel care pathway. Nursing times 2008. link 20 Weaver A, Dobson P. An overview of faecal incontinence in children. Nursing times 2007. link 21 Wheeler TL, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: new information on a persistent problem. Current opinion in obstetrics & gynecology 2007. link 22 Bliss DZ, Fischer LR, Savik K, Avery M, Mark P. Severity of fecal incontinence in community-living elderly in a health maintenance organization. Research in nursing & health 2004. link 23 Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: review of collective experience. The American journal of gastroenterology 2002. link 24 Jones S. Promoting continence in older people. Elderly care 1999. link 25 Cuzzell JZ. Practical tips for incontinence. Home care provider 1997. link90089-7) 26 Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. The American journal of gastroenterology 1996. link 27 O'Brien B, Bradford J, Gibb H. Nine steps to better nursing management of incontinence. Contemporary nurse 1995. link 28 Langley T. Training staff to provide a continence helpline. Professional nurse (London, England) 1995. link 29 Bradley M, Ferris W, Barr O. Continence promotion in adults with learning disabilities. Nursing times 1995. link 30 Carter D, Green D. Health promotion. Applying COPC to incontinence. Nursing times 1994. link 31 Resnick NM. Noninvasive diagnosis of the patient with complex incontinence. Gerontology 1990. link 32 Szüle E. Moderation of urinary and faecal incontinence with loperamide. Therapia Hungarica (English edition) 1989. link 33 Peck DA. Stapled ileal reservoir to anal anastomosis. Surgery, gynecology & obstetrics 1988. link 34 Abdellah FG. Incontinence. Implications for health care policy. The Nursing clinics of North America 1988. link 35 Numanoğlu I. Anal and urinary control device. Artificial organs 1987. link 36 Constantinides CG, Cywes S. Fecal incontinence: a simple pneumatic device for home biofeedback training. Journal of pediatric surgery 1983. link80099-2) 37 Mandelstam D. Disability and incontinence. International rehabilitation medicine 1982. link 38 Drummond P. Clothing for patients: better than plastic pants. Health and social service journal 1981. link 39 Godec CJ. Detrusor hyperreflexia inhibited by anal dilatation. Urology 1980. link90459-8) 40 Neto M. Pull-through intraurethral bladder flap. The Journal of urology 1978. link57595-3)

Functional fecal incontinence