Fecal incontinence is a condition characterized by the involuntary loss of solid or liquid feces. Causes and presentations are variable. Fecal incontinence remains a grossly underreported condition in the US and affects approximately 8% of adults older than 65 years of age. Prevalence is similar in women and men. Diagnosis involves a detailed medical history, physical examination, and diagnostic testing such as the evaluation of the neuromuscular function of the anorectum (anorectal manometry). Treatment is determined based on the etiology, and usually involves supportive measures such as dietary changes, pelvic floor physiotherapy, and medical therapy aimed at reducing stool frequency and improving stool consistency. Complications include perianal dermatitis and psychological distress.
- Fecal incontinence (FI): the involuntary loss of feces
- Fecal urge incontinence: lack of ability to retain stool despite efforts to do so
- Passive fecal incontinence: the involuntary loss of stool without awareness of the need to defecate preceding the event
- Bowel disorders
- Urinary incontinence
- Fecal retention and/or impaction
- Pregnancy: related to childbirth (e.g., instrumental delivery, prolonged second stage of labor)
- Surgery: e.g., fistulotomy
- Neuropathic disorders
- Rectal and anal disorders
- Other: hormone replacement therapy, pelvic radiation
- Chronic or recurring fecal leakage
- May be associated with flatus, abdominal discomfort, and/or bloating
- Physical examination
- Anorectal manometry: first diagnostic test
Balloon expulsion test: a test performed to diagnose defecatory disorders by assessing an individual's ability to evacuate a simulated stool.
- A latex balloon attached to a catheter is inserted into the patient's rectum and filled with 50 mL of fluid. Afterward, the patient is given privacy and asked to expel the balloon into a toilet.
- Positive test: inability to expel the balloon within 60 seconds is suggestive of a defecatory disorder
- Performed when there is suspicion of underlying dyssynergic defecation
- Pelvic floor and anal MRI or anorectal ultrasound: detect structural abnormalities
- Colonoscopy: in individuals with risk factors for colorectal cancer
- Barium defecography: performed in individuals with refractory fecal incontinence
- Anal sphincter electromyography
- Dietary changes
- Keeping a food diary
- Bowel control exercises
- Medical therapy
- Biofeedback therapy: cases of external anal sphincter weakness or nerve injury
- Surgical therapy: reserved for patients with refractory fecal incontinence or significant structural abnormalities (e.g., rectal prolapse, rectocele)
- Psychological distress
- Perianal dermatitis
We list the most important complications. The selection is not exhaustive.