Fecal Incontinence

Fecal incontinence (FI) is commonly defined as the involuntary loss of feces, and has significant psychosocial consequences. Several factors, and in particular anal sphincter trauma secondary to obstetric injury, have been implicated to cause FI. The clinical evaluation is very useful for assessing symptom severity and for guiding management. Testing is guided by clinical features and the response to therapy and generally begins with anorectal manometry. Additional tests (e.g., endoanal ultrasound, defecography, pelvic MRI, and anal electromyography) are useful in selected cases. In many patients, patient education and management of disordered bowel habits are very useful for improving fecal continence; pelvic floor retraining may be useful for patients who do not respond to these measures. Although anal sphincteroplasty improves fecal continence in the short term, the beneficial effects wane over time.