Office-based management of fecal incontinence.
Fecal incontinence (FI) is a devastating disorder that is more prevalent than previously realized. FI is the involuntary loss of stool. Many factors contribute to the pathophysiology of FI, including advanced age, bowel irregularity, parity, and obesity. A detailed history and focused rectal examination are important to making the diagnosis and determining contributing causes. Although multiple diagnostic studies are available to assess the cause of FI, specific guidelines that delineate when testing should be done do not exist. Clinicians must weigh the risk, benefit, and burden of testing against the need for empiric treatment. All types of FI are initially managed in the same way, which includes lifestyle modification to reduce bowel derangements, improved access to toileting, and initiation of a bulking regimen to improve stool consistency. If initial conservative management fails, pharmaco-logic agents, biofeedback, or surgery may be indicated.
The authors are affiliated with the Mayo Clinic in Scottsdale, Arizona. Dr. Costilla is a Resident in the Department of Internal Medicine. Dr. Mayer is an Assistant Professor in the Division of Women's Health Internal Medicine. Dr. Crowell is a Professor and Dr. Foxx-Orenstein is an Associate Professor in the Division of Gastroenterology.
Vanessa C
VC
Costilla
Amy E
AE
Foxx-Orenstein
Anita P
AP
Mayer
Michael D
MD
Crowell
Fecal incontinence; anal incontinence; bariatric surgery incontinence; fecal seepage; flatal incontinence; obesity incontinence