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Fecal incontinence

What's new

Updated 2023 ASCRS guidelines for the diagnosis and management of fecal incontinence.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of fecal incontinence are prepared by our editorial team based on guidelines from the American Society of Colon and Rectal Surgeons (ASCRS 2023), the American College of Gastroenterology (ACG 2021), the American College of Obstetricians and Gynecologists (ACOG 2019), and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK...
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Screening and diagnosis

Indications for screening: as per ACOG 2019 guidelines, Obtain screen for fecal incontinence in female patients with risk factors, such as:
age > 50 years
residence in long-term care facilities
pelvic floor disorders
history of obstetric anal sphincter injuries
history of pelvic irradiation
engagement in anal intercourse
urinary incontinence
chronic diarrhea
rectal urgency
diabetes
obesity.
B
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Diagnostic investigations

History and physical examination: as per ASCRS 2023 guidelines, Elicit a history to help determine the etiology of incontinence, including specific risk factors for incontinence, and characterize the duration and severity of symptoms.
E
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  • Anorectal physiology testing

  • Pudendal nerve conduction studies

  • Diagnostic imaging

  • Laboratory tests

Diagnostic procedures

Lower gastrointestinal endoscopy: as per ASCRS 2023 guidelines, Perform endoscopy according to established screening guidelines and in patients presenting with symptoms warranting further evaluation (changes in bowel habits, bleeding).
B

Medical management

Conservative management: as per ASCRS 2023 guidelines, Offer dietary and medical management as first-line therapy in patients with fecal incontinence.
B

Nonpharmacologic interventions

Dietary modifications
As per ACOG 2019 guidelines:
Consider advising fiber supplementation in female patients with fecal incontinence.
C
Offer dietary manipulation (food diaries and dietary changes) and bowel schedules (regular toileting) in conjunction with other treatment in female patients with fecal incontinence.
B

More topics in this section

  • Pelvic floor exercises

  • Bowel training

  • Anal and vaginal mechanical inserts

Therapeutic procedures

Biofeedback therapy: as per ASCRS 2023 guidelines, Consider offering biofeedback therapy in patients with fecal incontinence.
C

More topics in this section

  • Perianal injection of bulking agents

  • Sacral nerve stimulation

  • Transanal radiofrequency

Surgical interventions

Indications for surgery: as per ASCRS 2023 guidelines, Consider performing anal sphincteroplasty in patients with a defect in the external anal sphincter, recognizing that clinical results often deteriorate over time.
C
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