title: Cholestyramine--a useful adjunct for the treatment of patients with fecal incontinence.
abstract: OBJECTIVE
  Cholestyramine may improve fecal incontinence, but its use has not been assessed. We report our experience with the use of cholestyramine in the treatment of fecal incontinence.
  
  
  METHODS
  Twenty-one patients (19 female, mean age 65 years) with fecal incontinence (>/=1 episode/week) received cholestyramine along with biofeedback therapy (group A). Stool frequency, stool consistency (Bristol scale), number of incontinent episodes, satisfaction with bowel function (VAS), and anorectal physiology were assessed at 3 months and at 1 year after treatment. Data were compared with a matched group of 21 incontinent subjects (19 female, mean age 64 years) who received biofeedback alone (group B).
  
  
  RESULTS
  At 3 months and at 1 year, group A patients showed decreased stool frequency (p < 0.01), stool consistency (p = 0.001), and number of incontinent episodes (p < 0.04). In contrast, stool frequency (p = 0.8) and stool consistency (0.23) were not different from baseline in group B subjects. In both groups, there was improvement in the satisfaction with bowel function (p < 0.05), anal sphincter pressures (p < 0.05) and ability to retain saline infusion (p < 0.05). Mean dose of cholestyramine used was 3.6 g; 13 subjects (62%) required dose titration, and 7 (33%) subjects reported minor side effects.
  
  
  CONCLUSIONS
  Cholestyramine is safe and useful adjunct for the treatment of diarrhea and fecal incontinence. Most patients require small doses, and dose titration is important. The improvement in stool characteristics favors a drug effect, over and above the benefits of biofeedback therapy.
authors.affiliation: Section of Neurogastroenterology, Division of Gastroenterology-Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Remes-Troche
authors.forename: Ramazan
authors.initials: R
authors.lastname: Ozturk
authors.forename: Carrie
authors.initials: C
authors.lastname: Philips
authors.forename: Mary
authors.initials: M
authors.lastname: Stessman
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000187:drug effects / Q000503:physiopathology; D000930:Antidiarrheals / Q000009:adverse effects / Q000627:therapeutic use*; D001676:Biofeedback, Psychology; D002792:Cholestyramine Resin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003672:Defecation / Q000187:drug effects; D005242:Fecal Incontinence / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011312:Pressure; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; D002792:Cholestyramine Resin