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Am J Gastroenterol. 2015 Jan;110(1):138-46; quiz 147. doi: 10.1038/ajg.2014.303. Epub 2014 Oct 21.

Treatment of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases workshop.

Author information

1
1] Division of Gastroenterology and Hepatology, Department of Medicine, Chapel Hill, North Carolina, USA [2] Division of Urogynecology and Reconstructive Pelvic Floor Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA.
2
Department of Gastroenterology, Georgia Regents University, Augusta, Georgia, USA.
3
Colon and Rectal Surgery Associates, Ltd., St. Paul, Minnesota, USA.
4
Department of Colon and Rectal Surgery, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
5
Section of Colorectal Surgery, University of California, San Francisco, California, USA.
6
Department of Regenerative Medicine, Wake Forest Institute for Regenerative Medicine, Winston Salem, North Carolina, USA.
7
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
8
National Institutes of Diabetes, Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland, USA.

Abstract

This is the second of a two-part summary of a National Institutes of Health conference on fecal incontinence (FI) that summarizes current treatments and identifies research priorities. Conservative medical management consisting of patient education, fiber supplements or antidiarrheals, behavioral techniques such as scheduled toileting, and pelvic floor exercises restores continence in up to 25% of patients. Biofeedback, often recommended as first-line treatment after conservative management fails, produces satisfaction with treatment in up to 76% and continence in 55%; however, outcomes depend on the skill of the therapist, and some trials are less favorable. Electrical stimulation of the anal mucosa is ineffective, but continuous electrical pulsing of sacral nerves produces a ≥50% reduction in FI frequency in a median 73% of patients. Tibial nerve electrical stimulation with needle electrodes is promising but remains unproven. Sphincteroplasty produces short-term clinical improvement in a median 67%, but 5-year outcomes are poor. Injecting an inert bulking agent around the anal canal led to ≥50% reductions of FI in up to 53% of patients. Colostomy is used as a last resort because of adverse effects on quality of life. Several new devices are under investigation but not yet approved. FI researchers identify the following priorities for future research: (1) trials comparing the effectiveness, safety, and cost of current therapies; (2) studies addressing barriers to consulting for care; and (3) translational research on regenerative medicine. Unmet patient needs include FI in special populations (e.g., neurological disorders and nursing home residents) and improvements in behavioral treatments.

PMID:
25331348
DOI:
10.1038/ajg.2014.303
[Indexed for MEDLINE]

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