Fecal Incontinence: Etiology, Diagnosis, and Management.
BACKGROUND
Fecal incontinence is a debilitating condition affecting primarily the elderly. Many patients suffer in silence resulting in both underdiagnosis and undertreatment often culminating in an overall poor quality of life.


METHODS
We sought to review the etiology, diagnosis, and treatment of fecal incontinence based on current literature. Additionally, newer treatment methods such as Solesta will be evaluated.


RESULTS
There are many diagnostic modalities available to assess the degree and severity of the patient's incontinence; however, a thorough history and physical exam is critical. Initial attempts at treatment focus on medical management primarily through stool texture modification with the aid of bulking agents. Failure of medical therapy is often followed by a graded increase in the complexity and invasiveness of the available treatment options. The selection of the most appropriate surgical option, such as overlapping sphincteroplasty and neuromodulation, is multifactorial involving both surgeon and patient-related factors. Neuromodulation has received increased attention in the last decade due to its documented therapeutic success, and newer office-based procedures, such as the Solesta injection, are showing promising results in properly selected patients. Finally, diversion remains an option for select patients who have failed all other therapies.


CONCLUSIONS
The etiology of fecal incontinence is multifactorial, involving a complex interplay between stool consistency and anatomic integrity. The diagnosis and treatment of fecal incontinence continue to evolve and are showing promising results.
Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA. karim.alavi@umassmemorial.org.
Karim
K
Alavi
Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA.
Sook
S
Chan
Division of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, MO, USA.
Paul
P
Wise
Division of Colon and Rectal Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Andreas M
AM
Kaiser
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Ranjan
R
Sudan
Division of Colon and Rectal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Liliana
L
Bordeianou
D003911:Dextrans / Q000627:therapeutic use; D004032:Diet; D013505:Digestive System Surgical Procedures; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D010808:Physical Examination; D019736:Prostheses and Implants; D011788:Quality of Life; D012720:Severity of Illness Index
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
Artificial sphincter; Fecal incontinence; Graciloplasty; Sacral nerve stimulation; Sphincteroplasty