Fecal incontinence

Fecal incontinence (FI) is commonly defi ned as the involuntary loss of feces, and has signifi cant psychosocial consequences. Several factors, and in particular anal sphincter trauma secondary to obstetric injury, have been implicated as a cause of 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 fl oor retraining may be useful for patients who do not respond to these measures. Although anal sphincteroplasty improves fecal continence in the short term, the benefi cial effects wane over time.