Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9216
Revised: October 7, 2013
Accepted: November 2, 2013
Published online: December 28, 2013
The severity of fecal incontinence widely varies and can have dramatic devastating impacts on a person’s life. Fecal incontinence is common, though it is often under-reported by patients. In addition to standard treatment options, new treatments have been developed during the past decade to attempt to effectively treat fecal incontinence with minimal morbidity. Non-operative treatments include dietary modifications, medications, and biofeedback therapy. Currently used surgical treatments include repair (sphincteroplasty), stimulation (sacral nerve stimulation or posterior tibial nerve stimulation), replacement (artificial bowel sphincter or muscle transposition) and diversion (stoma formation). Newer augmentation treatments such as radiofrequency energy delivery and injectable materials, are minimally invasive tools that may be good options before proceeding to surgery in some patients with mild fecal incontinence. In general, more invasive surgical treatments are now reserved for moderate to severe fecal incontinence. Functional and quality of life related outcomes, as well as potential complications of the treatment must be considered and the treatment of fecal incontinence must be individualized to the patient. General indications, techniques, and outcomes profiles for the various treatments of fecal incontinence are discussed in detail. Choosing the most effective treatment for the individual patient is essential to achieve optimal outcomes in the treatment of fecal incontinence.
Core tip: An increasing number of treatment options for the management of fecal incontinence have been developed. In addition to traditional options such as sphincteroplasty and colostomy, non-surgical options such as biofeedback and dietary modification may be considered for mild incontinence. Injectable materials and radiofrequency energy delivery are two newer treatments for mild incontinence. Surgical options for moderate to severe incontinence include sacral nerve stimulation, artificial bowel sphincter implantation, muscle transposition, antegrade continence enemas, sphincteroplasty, and colostomy formation. Treatment for fecal incontinence (repair, stimulation, replacement, augmentation, or diversion) must be individualized to the patient, considering the underlying cause and impact on quality of life of the fecal incontinence.