title: Review of the diagnosis, management and treatment of fecal incontinence.
abstract: Fecal incontinence is a common problem affecting women but is underreported because of patients' reluctance to discuss their symptoms and an inconsistent use of screening tools by physicians. Obstetric injury from vaginal delivery is the principal cause of fecal incontinence among young women. Prevalence rates are highest in the elderly, especially those with declining cognitive function. There are multiple diagnostic tests including anal manometry, endosonography, defecography, and pudendal nerve latency testing to assist physicians in the workup of patients and aid in the selection of appropriate treatment options. After patient identification and workup, most patients can be offered conservative measures including dietary measures and biofeedback. Surgery is indicated for specific abnormalities such as rectal prolapse, fistula, and recent obstetrical sphincter injury repair. Management of refractory cases may include sacral nerve stimulation and percutaneous tibial nerve stimulation. Fecal diversion or an artificial bowel sphincter may be considered when all else has failed. Primary care physicians, gynecologists, and specialists in female pelvic medicine should screen women for fecal incontinence. Initial conservative therapy may be directed by the primary health provider, and those resistant to this approach should be referred to specialist care.
authors.affiliation: From the *Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, and †Division of Colon and Rectal Surgery, Department of General Surgery, Kaiser Permanente, Los Angeles, CA; and ‡Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Harbor UCLA Medical Center, Torrance, CA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Rezvan
authors.forename: Sharon
authors.initials: S
authors.lastname: Jakus-Waldman
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
authors.forename: Tajnoos
authors.initials: T
authors.lastname: Yazdany
authors.forename: John
authors.initials: J
authors.lastname: Nguyen
mesh_terms: D001003:Anal Canal / Q000033:anatomy & histology / Q000293:injuries* / Q000502:physiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D012007:Rectum / Q000502:physiology