Management of Fecal Incontinence

Publication Date: May 1, 2023
Last Updated: June 1, 2023

Summary of Recommendations

620
Measures that assess the nature and severity of incontinence and the impact of incontinence on quality of life should be used as a part of the assessment of FI. (C, L)
620
A physical examination is an essential component of the evaluation of patients with FI. (S, U)
620
Anorectal physiology testing (manometry, anorectal sensation, volume tolerance, and compliance) can be considered to help define the elements of dysfunction and guide management. (C, VL)
620
Endoanal ultrasound may be useful to evaluate sphincter anatomy when planning a sphincter repair. (C, VL)
620
Pudendal nerve terminal motor latency testing is not routinely recommended. (S, VL)
620
Endoscopy should be performed according to established screening guidelines and in patients presenting with symptoms that warrant further evaluation (ie, changes in bowel habits, bleeding). (S, M)
620
Dietary and medical management are recommended as first-line therapy for patients with FI. (S, L)
620
Bowel training programs can improve rectal evacuation in selected patients. (C, VL)
620
Biofeedback may be considered for patients with FI. (C, L)
620
Vaginal mechanical inserts are not routinely recommended for FI. (C, VL)
620
Anal mechanical insert devices are not routinely recommended for FI. (C, VL)
620
Anal sphincteroplasty may be considered in patients with a defect in the external anal sphincter, but clinical results often deteriorate over time. (C, L)
620
Repeat anal sphincter reconstruction after a failed overlapping sphincteroplasty should generally be avoided. (C, VL)
620
Sacral neuromodulation may be considered as a first-line surgical option for incontinent patients with or without sphincter defects. (C, L)
620
Injection of biocompatible bulking agents into the anal canal is not routinely recommended for the treatment of FI. (C, L)
620
Application of temperature-controlled radiofrequency energy to the sphincter complex is not recommended to treat FI. (C, VL)
620
Antegrade colonic enemas can be considered in highly motivated patients who are seeking an alternative to a stoma. (C, VL)
620
Colostomy is an option for patients who have failed or do not wish to pursue other therapies for FI. (C, VL)
620

Recommendation Grading

Abbreviations

  • FI: Fecal Incontinence

Overview

Title

Management of Fecal Incontinence

Authoring Organization

Publication Month/Year

May 1, 2023

Last Updated Month/Year

January 3, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Fecal incontinence (FI) is generally defined as the uncontrolled passage of feces for a duration of at least 3 months in an individual who previously had control. The prevalence of FI varies widely depending on the specific definition used and the population surveyed, ranging between 1.4% and 18% in women. A study of bowel function in a primary care network found the incidence of FI to be 12.5%, with many patients reporting moderate to severe FI (Vaizey score more than 8). The Mature Women’s Health Study administered an online survey to 5817 women aged >45 years with an 86% response rate and found that nearly 20% of women reported FI. Although many women with FI have coexisting pelvic floor disorders, the most bothersome symptoms are most often related to their FI. FI in men is not as common and is most commonly because of evacuatory dysfunction and rectal hyposensitivity. The highest incidence of incontinence is reported in nursing home populations, in which rates of FI can reach as high as 50%; FI is the second leading cause of nursing home placement in the United States. The management of FI is challenging and needs to be individualized according to the severity of symptoms, cause, and coexisting pathology. Aside from conservative and supportive measures, several surgical interventions are available to treat FI with variable efficacy. This practice guideline reviews the medical and surgical options currently available for the management of patients with FI. Treatments for FI that are not currently approved for use in the United States by the Food and Drug Administration (FDA), have become unavailable in the United States, or lack clinical data to support their use are beyond the scope of this guideline.

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Long term care, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physical therapist, physician, physician assistant

Scope

Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D005242 - Fecal Incontinence, D000074432 - Sphincterotomy

Keywords

fecal incontinence, sphincteroplasty, bowel sphincter, sacral nerve stimulation

Source Citation

Bordeianou, Liliana G. M.D., M.P.H.1; Thorsen, Amy J. M.D.2; Keller, Deborah S. M.S., M.D.3; Hawkins, Alexander T. M.D., M.P.H.4; Messick, Craig M.D.5; Oliveira, Lucia M.D., Ph.D.6; Feingold, Daniel L. M.D.7; Lightner, Amy L. M.D.8; Paquette, Ian M. M.D.9. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Fecal Incontinence. Diseases of the Colon & Rectum 66(5):p 647-661, May 2023. | DOI: 10.1097/DCR.0000000000002776 

Methodology

Number of Source Documents
182
Literature Search Start Date
January 1, 2014
Literature Search End Date
September 22, 2022