Evolving therapy for fecal incontinence.
BACKGROUND
Fecal incontinence is common and can be socially debilitating. Nonoperative management of fecal incontinence includes dietary modification, antidiarrheal medication, and biofeedback. The traditional surgical approach is sphincteroplasty if there is a defect of the external sphincter. Innovative treatment modalities have included sacral nerve stimulation, injectable implants, dynamic graciloplasty, and artificial bowel sphincter.


CONCLUSIONS
This review was designed to assess the various surgical options available for fecal incontinence and critically evaluate the evidence behind these procedures. The algorithm in the surgical treatment of fecal incontinence is shifting. Injectable therapy and sacral nerve stimulation are likely to be the mainstay in future treatment of moderate and severe fecal incontinence, respectively. Sphincteroplasty is limited to a small group of patients with isolated defect of the external sphincter. A stoma, although effective, can be avoided in most cases.
Tan
Jane J Y
JJ
Department of Colorectal Surgery, Royal Melbourne Hospital, Melbourne, Australia. janetanjy@yahoo.com.sg
Chan
Miranda
M
Tjandra
Joe J
JJ
D000465:Algorithms; D001003:Anal Canal / Q000601:surgery; D000930:Antidiarrheals / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D013505:Digestive System Surgical Procedures; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D019736:Prostheses and Implants; D020127:Recovery of Function; D016896:Treatment Outcome
D000930:Antidiarrheals