Fecal Incontinence
Publication Date: April 1, 2019
Last Updated: March 14, 2022
Recommendations
Nonsurgical treatments for fecal incontinence are associated with modest short-term efficacy and a low risk of adverse events and are recommended for initial management, except in cases of fistulae or rectal prolapse. (B)
574
Fiber, antimotility agents, and laxatives can be recommended as useful treatments for fecal incontinence. (B)
574
Pelvic floor muscle exercises with or without biofeedback can be recommended for the treatment of fecal incontinence to strengthen the anal sphincter and levator ani muscles, but there are insufficient data on the most effective treatment protocol. (B)
574
Anal sphincter bulking agents may be effective in decreasing fecal incontinence episodes up to 6 months and can be considered as a short-term treatment option for fecal incontinence in women who have failed more conservative treatments. (B)
574
Surgical treatments should not be considered for the initial management of fecal incontinence (except in cases of fistulas or rectal prolapse) because surgical treatments provide only short-term improvement and are associated with more frequent and more severe complications compared with nonsurgical interventions. (B)
574
Sacral nerve stimulation can be considered as a surgical treatment option for women with fecal incontinence with or without anal sphincter disruption who have failed conservative treatments. (B)
574
Sphincteroplasty can be considered in women with anal sphincter disruption and fecal incontinence symptoms who have failed conservative treatments. (B)
574
Women with risk factors should be screened for fecal incontinence. (C)
574
Women who report fecal incontinence symptoms should undergo a complete medical history, symptoms assessment, and physical examination of the rectal, vaginal, and perineal areas. No specific laboratory tests are needed for the initial evaluation of fecal incontinence unless diarrheal infectious processes are suspected. (C)
574
Ancillary diagnostic testing (such as anal sphincter imaging, defecography, anorectal mammography, and pudendal nerve terminal motor latency testing), is not recommended for the routine evaluation of fecal incontinence. (C)
574
Any woman presenting with fecal incontinence and a change in her bowel habits should be considered for a colonoscopy, especially when accompanied by any “red flag” symptoms, including unexplained weight loss, abdominal pain, rectal bleeding, melena, or anemia. (C)
574
It is reasonable for obstetrician–gynecologists to initiate conservative interventions, such as dietary manipulation, bowel scheduling, fiber supplementation, and stool-modifying agents. Patients who are candidates for surgical therapy (such as women with rectovaginal fistulas or rectal prolapse) or who do not respond to conservative treatments should receive further evaluation and treatment by a health care provider with expertise in pelvic surgery. (C)
574
Dietary manipulation (ie, food diaries and dietary changes) and bowel schedules (ie, regular toileting) should be offered to women with fecal incontinence in conjunction with other treatments because these treatments may help improve symptoms and are associated with few adverse events. (C)
574
Recommendation Grading
Overview
Title
Fecal Incontinence
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
April 1, 2019
Last Updated Month/Year
April 1, 2024
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D005242 - Fecal Incontinence
Keywords
fecal incontinence, loose stool, involuntary leakage