Highlights & Basics
- Fecal incontinence is often multifactorial with local, anatomic, or systemic disorders potentially contributing.
- There is a significant response to conservative therapy and appropriate support.
- For those who do not respond to conservative treatment, specialist investigation is recommended to determine underlying etiology.
- Surgical options include anterior sphincter repair and neosphincter formation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
National Institute for Health and Care Excellence. Faecal incontinence in adults: management. Jun 2007 [internet publication].[Full Text]
Bordeianou LG, Thorsen AJ, Keller DS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Diseases of the Colon & Rectum. 2023 May;66(5):647-61.[Full Text]
Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67(8):1380-99.[Abstract][Full Text]
Thaha MA, Abukar AA, Thin NN, et al. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev. 2015 Aug 24;(8):CD004464.[Abstract][Full Text]
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6. Nelson RL. Epidemiology of fecal incontinence. Gastroenterology. 2004 Jan;126(1 Suppl 1):S3-7.[Abstract]
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8. National Institute for Health and Care Excellence. Faecal incontinence in adults: management. Jun 2007 [internet publication].[Full Text]
9. Norton C, Whitehead WE, Bliss DZ, et al; Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence. Management of fecal incontinence in adults. Neurourol Urodyn. 2010;29(1):199-206.[Abstract][Full Text]
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11. Schiller LR, Santa Ana CA, Schmulen AC, et al. Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. N Engl J Med. 1982 Dec 30;307(27):1666-71.[Abstract]
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15. Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004 Jan;126(1 suppl 1):S14-22.[Abstract][Full Text]
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24. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020 May 6;(5):CD007471.[Abstract][Full Text]
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26. Bordeianou LG, Thorsen AJ, Keller DS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of fecal incontinence. Diseases of the Colon & Rectum. 2023 May;66(5):647-61.[Full Text]
27. American College of Obstetricians and Gynecologists. Practice bulletin no. 210: fecal incontinence. Apr 2019 [internet publication].[Full Text]
28. Baxter NN, Rothenberger DA, Lowry AC. Measuring fecal incontinence. Dis Colon Rectum. 2003 Dec;46(12):1591-605.[Abstract]
29. Vaizey CJ, Carapeti E, Cahill JA, et al. Prospective comparison of faecal incontinence grading systems. Gut. 1999 Jan;44(1):77-80.[Abstract][Full Text]
30. Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018 Aug;67(8):1380-99.[Abstract][Full Text]
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32. Sultan AH, Kamm MA, Talbot IC, et al. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994 Mar;81(3):463-5.[Abstract]
33. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012 Jul;85(1015):865-75.[Abstract][Full Text]
34. Carrington EV, Scott SM, Bharucha A, et al; International Anorectal Physiology Working Group and the International Working Group for Disorders of Gastrointestinal Motility and Function. Expert consensus document: advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol. 2018 May;15(5):309-23.[Abstract][Full Text]
35. Terra MP, Deutekom M, Beets-Tan RG, et al. Relationship between external anal sphincter atrophy at endoanal magnetic resonance imaging and clinical, functional, and anatomic characteristics in patients with fecal incontinence. Dis Colon Rectum. 2006 May;49(5):668-78.[Abstract]
36. Tan E, Anstee A, Koh DM, et al. Diagnostic precision of endoanal MRI in the detection of anal sphincter pathology: a meta-analysis. Int J Colorectal Dis. 2008 Jun;23(6):641-51.[Abstract]
37. Sajid MS, Khatri K, Siddiqui MR, et al. Endo-anal ultrasound versus endo-anal magnetic resonance imaging for the depiction of external anal sphincter pathology in patients with faecal incontinence: a systematic review. Magy Seb. 2010 Feb;63(1):9-15.[Abstract]
38. Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum. 1991 Jan;34(1):22-30.[Abstract]
39. Jacobs PP, Scheuer M, Kuijpers JH. Obstetric fecal incontinence. Role of pelvic floor denervation and results of delayed sphincter repair. Dis Colon Rectum. 1990 Jun;33(6):494-7.[Abstract]
40. Sangwan YP, Coller JA, Barrett RC, et al. Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum. 1996 Jun;39(6):686-9.[Abstract]
41. Frenckner B, Euler C. Influence of pudendal block on the function of the anal sphincters. Gut. 1975 Jun;16(6):482-9.[Abstract][Full Text]
42. Rosier PF, Hosker GL, Szabó L, et al. Executive summary: The International Consultation on Incontinence 2008 Committee on: "Dynamic Testing" for urinary or fecal incontinence. Part 3: Anorectal physiology studies. Neurourol Urodyn. 2010;29(1):153-8.[Abstract][Full Text]
43. Agency for Healthcare Research and Quality. Comparative effectiveness review number 165: treatments for fecal incontinence. Mar 2021 [internet publication].[Full Text]
44. Bliss DZ, Savik K, Jung HJ, et al. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014 Oct;37(5):367-78.[Abstract]
45. Bliss DZ, Jung HJ, Savik K, et al. Supplementation of dietary fiber improves fecal incontinence. Nurs Res. 2001 Jul-Aug;50(4):203-13.[Abstract]
46. Fader M, Cottenden AM, Getliffe K. Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007408.[Abstract][Full Text]
47. Deutekom M, Dobben A. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2015 Jul 20;(7):CD005086.[Abstract][Full Text]
48. Read M, Read NW, Barber DC, et al. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982 Sep;27(9):807-14.[Abstract]
49. Santoro GA, Eitan BZ, Pryde A, et al. Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 2000 Dec;43(12):1676-81.[Abstract]
50. Ehrenpreis ED, Chang D, Eichenwald E. Pharmacotherapy for fecal incontinence: a review. Dis Colon Rectum. 2007 May;50(5):641-9.[Abstract]
51. Tobin GW, Brocklehurst JC. Faecal incontinence in residential homes for the elderly: prevalence, aetiology and management. Age Ageing. 1986 Jan;15(1):41-6.[Abstract]
52. King JC, Currie DM, Wright E. Bowel training in spina bifida: importance of education, patient compliance, age and anal reflexes. Arch Phys Med Rehabil. 1994 Mar;75(3):243-7.[Abstract]
53. Tod AM, Stringer E, Levery C, et al. Rectal irrigation in the management of functional bowel disorders: a review. Br J Nurs. 2007 Jul 26-Aug 8;16(14):858-64.[Abstract]
54. Christensen P, Bazzocchi G, Coggrave M, et al. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology. 2006 Sep;131(3):738-47.[Abstract]
55. Matzel KE. Sacral nerve stimulation for faecal incontinence: its role in the treatment algorithm. Colorectal Dis. 2011 Mar;13(suppl 2):10-4.[Abstract]
56. Hetzer FH. Fifteen years of sacral nerve stimulation: from an open procedure to a minimally invasive technique. Colorectal Dis. 2011 Mar;13(suppl 2):1-4.[Abstract]
57. Dudding TC, Hollingshead JR, Nicholls RJ, et al. Sacral nerve stimulation for faecal incontinence: patient selection, service provision and operative technique. Colorectal Dis. 2011 Aug;13(8):e187-95.[Abstract]
58. Dudding TC, Hollingshead JR, Nicholls RJ, et al. Sacral nerve stimulation for faecal incontinence: optimizing outcome and managing complications. Colorectal Dis. 2011 Aug;13(8):e196-202.[Abstract]
59. Duelund-Jakobsen J, Buntzen S, Lundby L, et al. Sacral nerve stimulation at subsensory threshold does not compromise treatment efficacy: results from a randomized, blinded crossover study. Ann Surg. 2013 Feb;257(2):219-23.[Abstract]
60. Jarrett ME, Mowatt G, Glazener CM, et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg. 2004 Dec;91(12):1559-69.[Abstract]
61. Thaha MA, Abukar AA, Thin NN, et al. Sacral nerve stimulation for faecal incontinence and constipation in adults. Cochrane Database Syst Rev. 2015 Aug 24;(8):CD004464.[Abstract][Full Text]
62. O'Brien PE, Dixon JB, Skinner S, et al. A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence. Dis Colon Rectum. 2004 Nov;47(11):1852-60.[Abstract]
63. Niriella DA, Deen KI. Neosphincters in the management of faecal incontinence. Br J Surg. 2000 Dec;87(12):1617-28.[Abstract]
64. Tillin T, Chambers M, Feldman R. Outcomes of electrically stimulated gracilis neosphincter surgery. Health Technol Assess. 2005 Jul;9(28):1-102.[Abstract][Full Text]
65. Wong WD, Congliosi SM, Spencer MP, et al. The safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study. Dis Colon Rectum. 2002 Sep;45(9):1139-53.[Abstract]
66. Chatoor DR, Taylor SJ, Cohen CR, et al. Faecal incontinence. Br J Surg. 2007 Feb;94(2):134-44.[Abstract]
67. Norton CC, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD002111.[Abstract][Full Text]
68. Davis KJ, Kumar D, Poloniecki J. Adjuvant biofeedback following anal sphincter repair: a randomized study. Aliment Pharmacol Ther. 2004 Sep 1;20(5):539-49.[Abstract]
69. Bravo Gutierrez A, Madoff RD, Lowry AC, et al. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004 May;47(5):727-31.[Abstract]
70. Cook TA, Mortensen NJ. Management of faecal incontinence following obstetric injury. Br J Surg. 1998 Mar;85(3):293-9.[Abstract]
71. Malouf AJ, Norton CS, Engel AF, et al. Long-term results of overlapping anterior anal-sphincter repair for obstetric trauma. Lancet. 2000 Jan 22;355(9200):260-5.[Abstract]
72. Zorcolo L, Covotta L, Bartolo DC. Outcome of anterior sphincter repair for obstetric injury: comparison of early and late results. Dis Colon Rectum. 2005 Mar;48(3):524-31.[Abstract]
73. Draganic B, Eyers AA, Solomon MJ. Island flap perineoplasty decreases the incidence of wound breakdown following overlapping anterior sphincter repair. Colorectal Dis. 2001 Nov;3(6):387-91.[Abstract]
74. Rao SS, Benninga MA, Bharucha AE, et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015 May;27(5):594-609.[Abstract][Full Text]
75. Watson NF, Koshy A, Sagar PM. Anal bulking agents for faecal incontinence. Colorectal Dis. 2012 Dec;14(suppl 3):29-33.[Abstract][Full Text]
76. Graf W, Mellgren A, Matzel KE, et al. Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, sham-controlled trial. Lancet. 2011 Mar 19;377(9770):997-1003.[Abstract]
77. Hoy SM. Dextranomer in stabilized sodium hyaluronate (Solesta): In adults with faecal incontinence. Drugs. 2012 Aug 20;72(12):1671-8.[Abstract]
78. Ratto C, Donisi L, Litta F, et al. Implantation of SphinKeeper(TM): a new artificial anal sphincter. Tech Coloproctol. 2016 Jan;20(1):59-66.[Abstract][Full Text]
79. Malouf AJ, Vaizey CJ, Norton CS, et al. Internal anal sphincter augmentation for fecal incontinence using injectable silicone biomaterial. Dis Colon Rectum. 2001 Apr;44(4):595-600.[Abstract]
80. Vaizey CJ, Kamm MA. Injectable bulking agents for treating faecal incontinence. Br J Surg. 2005 May;92(5):521-7.[Abstract]
81. Maeda Y, Laurberg S, Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD007959.[Abstract][Full Text]
82. National Institute for Health and Care Excellence. Self-expanding implant insertion into the intersphincteric space for faecal incontinence. Jan 2021 [internet publication].[Full Text]
83. Norton C, Burch J, Kamm MA. Patients' views of a colostomy for fecal incontinence. Dis Colon Rectum. 2005 May;48(5):1062-9.[Abstract]
84. US Food and Drug Administration. FDA drug safety communication: FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. Jan 2014 [internet publication].[Full Text]
85. National Institute for Health and Care Excellence (UK). Peristeen transanal irrigation system for managing bowel dysfunction. Jun 2022 [internet publication].[Full Text]
86. De Ganck J, Everaert K, Van Laecke E, et al. A high easy-to-treat complication rate is the price for a continent stoma. BJU Int. 2002 Aug;90(3):240-3.[Abstract]
87. Giordano P, Renzi A, Efron J, et al. Previous sphincter repair does not affect the outcome of repeat repair. Dis Colon Rectum. 2002 May;45(5):635-40.[Abstract]
88. Efron JE, Corman ML, Fleshman J, et al. Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence. Dis Colon Rectum. 2003 Dec;46(12):1606-16.[Abstract]
89. National Institute for Health and Care Excellence. Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence. May 2011 [internet publication].[Full Text]
90. Takahashi-Monroy T, Morales M, Garcia-Osogobio S, et al. SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up. Dis Colon Rectum. 2008 Mar;51(3):355-9.[Abstract]
91. Visscher AP, Lam TJ, Meurs-Szojda MM, et al. Temperature-controlled delivery of radiofrequency energy in fecal incontinence: a randomized sham-controlled clinical trial. Dis Colon Rectum. 2017 Aug;60(8):860-5.[Abstract]
92. George AT, Kalmar K, Sala S, et al. Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg. 2013 Feb;100(3):330-8.[Abstract]
93. Govaert B, Pares D, Delgado-Aros S, et al. A prospective multicentre study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Colorectal Dis. 2010 Dec;12(12):1236-41.[Abstract]
94. Boyle DJ, Prosser K, Allison ME, et al. Percutaneous tibial nerve stimulation for the treatment of urge fecal incontinence. Dis Colon Rectum. 2010 Apr;53(4):432-7.[Abstract]
95. National Institute for Health and Care Excellence. Percutaneous tibial nerve stimulation (PTNS) for faecal incontinence. May 2011 [internet publication].[Full Text]
96. Horrocks EJ, Thin N, Thaha MA, et al. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg. 2014 Apr;101(5):457-68.[Abstract]
97. Knowles CH, Horrocks EJ, Bremner SA, et al. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet. 2015 Oct 24;386(10004):1640-8.[Abstract]
98. van der Wilt AA, Giuliani G, Kubis C, et al. Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg. 2017 Aug;104(9):1167-76.[Abstract]
99. Horrocks EJ, Chadi SA, Stevens NJ, et al. Factors associated with efficacy of percutaneous tibial nerve stimulation for fecal incontinence, based on post-hoc analysis of data from a randomized trial. Clin Gastroenterol Hepatol. 2017 Dec;15(12):1915-21.[Abstract]
100. Sugrue J, Lehur PA, Madoff RD, et al. Long-term experience of magnetic anal sphincter augmentation in patients with fecal incontinence. Dis Colon Rectum. 2017 Jan;60(1):87-95.[Abstract]
101. National Institute for Health and Care Excellence. Insertion of a magnetic-bead band for faecal incontinence. Mar 2014 [internet publication].[Full Text]
102. Frudinger A, Kölle D, Schwaiger W, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut. 2010 Jan;59(1):55-61.[Abstract]
103. Boyer O, Bridoux V, Giverne C, et al. Autologous myoblasts for the treatment of fecal incontinence: results of a phase 2 randomized placebo-controlled study (MIAS). Ann Surg. 2018 Mar;267(3):443-50.[Abstract]
104. Richter HE, Matthews CA, Muir T, et al. A vaginal bowel-control system for the treatment of fecal incontinence. Obstet Gynecol. 2015 Mar;125(3):540-7.[Abstract]
105. Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013 Jun 11;(6):CD002116.[Abstract][Full Text]
106. Rao SS. Current and emerging treatment options for fecal incontinence. J Clin Gastroenterol. 2014 Oct;48(9):752-64.[Abstract][Full Text]
107. Bharucha AE, Rao SSC, Shin AS. Surgical interventions and the use of device-aided therapy for the treatment of fecal incontinence and defecatory disorders. Clin Gastroenterol Hepatol. 2017 Dec;15(12):1844-54.[Abstract][Full Text]
108. Heymen S, Jones KR, Ringel Y, et al. Biofeedback treatment of fecal incontinence: a critical review. Dis Colon Rectum. 2001 May;44(5):728-36.[Abstract]
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