Three types of treatment are commonly used for fecal incontinence: medical therapy, biofeedback, and surgery. The specific treatment(s) recommended will depend upon the underlying cause of fecal incontinence.
Medical therapy – Medical therapy includes medication and certain measures that can reduce the frequency of incontinence and alter stool consistency, leading to improved bowel control. Often, basic measures will improve minor incontinence, but more aggressive measures may be needed to control major incontinence. If diarrhea is contributing to fecal incontinence, specific medications and treatments can target the actual source of the diarrhea.
Bulking substances – Oral substances that promote bulkier stools may help control bowel function in people who have liquid stools by absorbing stool water, thereby thickening the consistency of stool. Methylcellulose (a form of fiber) is one type of bulking substance that is commonly used. Increasing dietary fiber may also help to bulk stools.
Medications that reduce stool frequency – The frequency of stools can be reduced with medications that are usually prescribed for diarrhea, such as loperamide and diphenoxylate. Loperamide can also increase internal anal sphincter tone.
Anticholinergic medications – When taken before meals, anticholinergic medications (such as the prescription drug hyoscyamine) can decrease the incontinence that occurs after meals in some people. The medications work by reducing contractions in the colon.
Treatment of impaction – Impacted feces may be removed by a healthcare provider. This involves inserting a gloved, well-lubricated finger into the rectum to remove pieces of stool and stimulate a bowel movement. After disimpaction, the patient may be given recommendations for treating constipation to prevent impaction from recurring.
Defecation programs – When incontinence is related to the presence of certain disabilities or mental health conditions, clinician often recommend a scheduled defecation program to promote normal bowel function.
Biofeedback – Biofeedback is a safe and noninvasive way of retraining muscles in the pelvis and abdominal wall. During biofeedback training, sensors are placed on an anal plug and on the wall of the abdomen; visual and/or auditory feedback helps people identify and contract the muscles that help maintain continence. Biofeedback can be successful, although not all studies have confirmed a benefit. The people most likely to benefit from this type of therapy are people who can contract the external anal sphincter and people who have at least some rectal sensation. The effects of biofeedback may begin to decline six months after the initial training, and retraining may be helpful.
Sacral nerve stimulation – Electrical stimulation of the sacral nerve roots can restore complete continence in 40 to 75 percent of patients whose anal sphincter muscles are intact . An electrode is surgically inserted near a nerve in the sacral (low back) area while the stimulator is implanted under the abdominal wall. It is not entirely clear how sacral nerve stimulation works and experience with this approach is limited. Side effects include pain, malfunction and infections, which may require the device to be removed. At present, it is generally reserved for patients with an intact or repaired anal sphincter who have tried conventional treatment but had unsatisfactory improvement in symptoms.
Anal stimulation – Anal electrical stimulation involves daily home stimulation using an anal probe electrode. A controlled trial suggested that it has only a modest benefit, possibly from increasing sensitization of the anal area.
Surgery – Several different surgical procedures can help alleviate fecal incontinence. These procedures include direct repair of damaged sphincters, reinforcement of anorectal structures, implantation of artificial sphincters, and muscle transfer procedures. Surgical repair can reduce or resolve incontinence, particularly for women who develop a tear in the external anal sphincter during childbirth and people with injury of the sphincter due to surgery or other causes. Surgery cures incontinence in 80 percent of women with childbirth-related sphincter tears. In people who have irreparable damage of the sphincters, muscles can be transferred from other areas of the body, usually the leg or buttock, and surgically placed around the anal canal. These muscles mimic the action of the damaged sphincters. Some transferred muscles may require constant electrical stimulation to maintain a contracted state. Muscle transfer surgery can restore continence in up to 73 percent of people. An alternative to a transferred muscle is a synthetic anal cuff that can be inflated to hold back feces and deflated to allow bowel movements. However, this type of procedure is only performed in specialized centers. Complications can occur even in when they are performed by experts.
Colostomy – Colostomy is a surgical procedure that diverts stool away from the rectum toward the abdominal wall. The stool is collected in a bag that fits tightly against the skin. This eliminates leakage of stool from the rectum. Variations on the procedure may allow for control of bowel emptying. Colostomy may be considered in patients with intolerable symptoms who are not candidates for any other therapy, or in whom other treatments have failed.
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