Fecal Incontinence in Women: Causes and Treatment

Ashima Makol; Madhusudan Grover; William E Whitehead

Women's Health. 2008;4(5):517-528.

Conclusion & Future Perspective

Fecal incontinence is a common disorder affecting up to 15% of women, and it may have a devastating impact on QOL. Most patients do not seek treatment, apparently because of social stigma and pessimism that symptoms can be improved, and most physicians do not screen for it for similar reasons. However, it is treatable; most patients with FI can be substantially improved or cured through medical management, biofeedback or surgery. We recommend that appropriate professional societies make it a priority to:

Reduce the social stigma associated with FI so that more patients seek treatment
Educate primary-care physicians about treatment options and encourage screening
Develop and test prevention strategies

The major barriers to helping women with incontinence appear to not be the lack of research, but the social and professional barriers to diagnosing and treating this disorder.

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Next Section

Funding information

The authors were supported by grants R24 DK067674 and RO1 DK57048. W Whitehead receives grant support from McNeil Pharmaceuticals, the makers of loperamide. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Cite this: Fecal Incontinence in Women: Causes and Treatment - Medscape - Sep 01, 2008.

Abstract and Introduction
Case Definition
Prevalence
Impact of Fecal Incontinence on Quality of Life
Economic Impact of Fecal Incontinence
Pathophysiology & Diagnostic Tests
Risk Factors
Prevention
Treatment
Conclusion & Future Perspective
References
Sidebar: Executive Summary
Sidebar: Website

Sidebar: Executive Summary

Fecal Incontinence (FI) is a common medical condition affecting up to 15% of women.

It significantly impairs the lifestyle of women and has a tremendous negative impact on social interactions and self-image, resulting in poor quality of life, work absenteeism and self-imposed isolation and depression.

The physiological mechanisms that maintain continence are adequate strength in the pelvic floor muscles to hold back a bowel movement, adequate compliance of the rectum to be able to store stool between bowel movements, ability to sense rectal filling and normal stool consistency. Deficits in any of these may contribute to FI and, in any given patient, the etiology may be multifactorial.

Risk factors that are unique to women include obstetric trauma (instrumental vaginal delivery, prolonged second stage of labor, large neonatal birthweight and occipito-posterior presentation) and hysterectomy. Other risk factors common to both men and women include chronic diarrhea or urgency, obesity and older age. Systemic diseases that increase the risk of FI are irritable bowel syndrome and diabetes, and many neurological disorders increase the risk of FI. Urinary incontinence is a frequently associated condition.

Primary prevention strategies include reducing the incidence of diarrheal diseases through public health measures, discouraging routine use of episiotomies and internal anal sphincter myectomies, encouraging the use of pelvic floor exercises immediately after childbirth and decreasing obesity. Secondary prevention hinges on increasing the willingness of patients to consult their doctors about FI and the willingness of physicians to screen for FI. Conservative treatment measures that are effective are already available.

The role of elective cesarean section to prevent FI is controversial.

Treatments range from education and conservative medical management to biofeedback and surgery. Conservative treatment emphasizes normalization of stool consistency with antidiarrheal drugs or laxatives and encouragement of pelvic floor exercises. Biofeedback aims to strengthen pelvic floor muscles and improve perception of rectal sensations. The most common surgical options are sphincteroplasty, injection of bulking agents to improve resting pressure in the anal canal and colostomy. Sacral nerve stimulation is an experimental approach that appears promising.

It is important to sensitize general practitioners to this under-recognized condition with a high prevalence. Since effective therapies are available, clinicians who care for postpartum and elderly women should routinely screen for FI and offer evaluation and treatment to women with FI.

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