Japanese Practice Guidelines for Fecal Incontinence Part 2-Examination and Conservative Treatment for Fecal Incontinence- English Version

Abstract

Examination for fecal incontinence is performed in order to evaluate the condition of each patient. As there is no single method that perfectly assesses this condition, there are several tests that need to be conducted. These are as follows: anal manometry, recto anal sensitivity test, pudendal nerve terminal motor latency, electromyogram, anal endosonography, pelvic magnetic resonance imaging (MRI) scan, and defecography. In addition, the mental and physical stress most patients experience during all these examinations needs to be taken into consideration. Although some of these examinations mostly apply for patients with constipation, we hereby describe these tests as tools for the assessment of fecal incontinence. Conservative therapies for fecal incontinence include diet, lifestyle, and bowel habit modification, pharmacotherapy, pelvic floor muscle training, biofeedback therapy, anal insert device, trans anal irrigation, and so on. These interventions have been identified to improve the symptoms of fecal incontinence by determining the mechanisms resulting in firmer stool consistency; strengthening the pelvic floor muscles, including the external anal sphincter; normalizing the rectal sensation; or periodic emptying of the colon and rectum. Among these interventions, diet, lifestyle, and bowel habit modifications and pharmacotherapy can be performed with some degree of knowledge and experience. These two therapies, therefore, can be conducted by all physicians, including general practitioners and other physicians not specializing in fecal incontinence. However, patients with fecal incontinence who did not improve following these initial therapies should be referred to specialized institutions. Contrary to the initial therapies, specialized therapies, including pelvic floor muscle training, biofeedback therapy, anal insert device, and trans anal irrigation, should be conducted in specialized institutions as these require patient education and instructions based on expert knowledge and experience. In general, conservative therapies should be performed for fecal incontinence before surgery because its pathophysiologies are mostly attributed to benign conditions. All Japanese healthcare professionals who take care of patients with fecal incontinence are expected to understand the characteristics of each conservative therapy, so that appropriate therapies will be selected and performed. Therefore, in this chapter, the characteristics of each conservative therapy for fecal incontinence are described.

Fecal Incontinence: The Importance of a Structured Pathophysiological Model

“…Dietary measures, medical treatment to thicken the stool, and pelvic floor physiotherapy are often effective in mild cases of urge incontinence [6,15]. If these treatment options are not effective, sacral neuromodulation (SNM) or retrograde colonic irrigation can follow.…”

“…In their excellent and comprehensive review recently published by this journal, Maeda et al [5][6][7] indicated how many aspects should be considered in the analysis and management of fecal incontinence. Fecal incontinence can have many causes, including disorders that cause fecal incontinence in an intact continence mechanism, such as inflamma-tory bowel disease and overflow diarrhea.…”

Stuhlinkontinenz – vom Symptom zur Therapie

“…Bisacodyl-Suppositorien wirken sekretagog und entfalten im Rektum eine prokinetische Wirkung. Glycerin-Suppositorien als reines Gleitmittel sind weniger wirksam [5,7].…”

“…Die Darmpassage wird verlangsamt und damit die Rückresorption von Wasser und Elektrolyten gesteigert: Resultat ist eine Modulation der Stuhlkonsistenz. Die Dosierung sollte graduell und symptom-orientiert erfolgen, um Obstipationsphasen durch eine Überdosierung zu vermeiden 7 8 .…”

Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study

“…Although the use of perianal injections for treating FI is increasing in Europe and North America, no bulking agent has been approved in Japan thus far [14]. Injection sclerotherapy is an effective office procedure for treating hemorrhoids.…”