An Evidence-Based Approach to the Evaluation, Diagnostic Assessment, and Treatment of Fecal Incontinence in Women

Abstract

Fecal incontinence (FI) is a debilitating disorder which negatively impacts quality of life. The etiology is often multifactorial and although most women with FI are able to be treated, many remain untreated because a significant proportion of women do not report their symptoms and seek care. The evaluation and treatment of FI can be also hindered by a lack of understanding of the mechanisms and current options. This article provides a review on the evidence-based evaluation and management for FI.

Pudendal nerve testing does not contribute to surgical decision making following anorectal testing in patients with faecal incontinence

“…Although EAUS is operator dependent and findings can be confounded by anatomical variations [8], identification of an external sphincter defect using EAUS was shown in our study to be associated with surgical decision making and supports the continued use of EAUS in the assessment of patients with FI.…”

The relationship between fecal incontinence, constipation and defecatory symptoms in women with pelvic floor disorders

“…The presence of a defecation disorder in women with FI has significant clinical implications and may modify the patient's response to treatment. First line management for FI often includes use of constipating anti‐diarrheal medication . In patients who already have difficulty defecating, this may worsen their symptoms.…”

Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury

“…Sexually active women reported less pain and fear of incontinence during intercourse and increased quality of life. OASIS is a well-known risk factor for faecal incontinence [2,4], but an association between OASIS and faecal incontinence combined with urinary incontinence is less clear. Development of concomitant urinary incontinence in the long term seems to be multifactorial since pregnancy and childbirth contribute due to stretching of the pelvic floor muscles, endopelvic fascia and nerves [24].…”

“…Although pelvic floor dysfunction after vaginal delivery is commonly reported within 12 months of delivery, long-term effects usually present two to three decades after childbirth. It appears that urinary and faecal incontinence share common risk factors in addition to OASIS, such as ageing, progressive neuropathy, lack of fascial support and hormonal changes [4,6,24].…”

“…Pelvic floor disorders consist of a wide range of clinical problems with a major impact on quality of life, including faecal incontinence, urinary incontinence, sexual dysfunction, pelvic organ prolapse and chronic pelvic pain [1][2][3]. The aetiology of pelvic floor disorders is multifactorial and associated with obstetric anal sphincter injuries (OASIS), ageing, hormonal status and lifestyle [4], with vaginal birth being the main risk factor [5].…”