Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-13T03:55:52.913Z Has data issue: false hasContentIssue false

Chapter 29 - Fecal Incontinence

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Alayne D. Markland ,
Jan Busby-Whitehead  and
William E. Whitehead
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Fecal incontinence (FI) is defined as the involuntary loss of solid or liquid stool and has an enormous impact on quality of life. Continence depends on a number of factors including cognitive function, stool volume and stool consistency, colonic transit, rectal compliance, anal sphincter function, anorectal sensation, and anorectal reflexes. Loss of continence often results from impairment in any of these factors. Initial evaluation consists of a focused history and a physical examination looking for potential reversible and/or treatable factors. First-line treatment include dietary, behavioral, and pharmacologic management approaches in community-dwelling and long-term care settings. If first-line treatments are not effective, additional evaluation with anorectal manometry and other tests may be warranted. Surgical treatments for FI may improve symptoms and more efficacy data is needed, especially among older adults. Therapeutic options using behavioral, pharmacological, and surgical approaches can lead to symptomatic improvements or cure for FI and increased quality of life for the older patient.

Keywords

fecal incontinencestool consistencypelvic floor muscle exercisesbehavioral therapyaccidental bowel leakageneuromodulationsurgery
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 364 - 372
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ng, KS, Sivakumaran, Y, Nassar, N, Gladman, MA. Fecal incontinence: Community prevalence and associated factors – A systematic review. Dis Colon Rectum. 2015; 58(12):1194–1209.CrossRefGoogle ScholarPubMed
Grover, M, Busby-Whitehead, J, Palmer, MH, Heymen, S, Palsson, OS, Goode, PS, Turner, M, Whitehead, WE. Survey of geriatricians on the effect of fecal incontinence on nursing home referral. J Am Geriatr Soc. 2010; 58(6):1058–1062.CrossRefGoogle ScholarPubMed
Halland, M, Koloski, NA, Jones, M, Byles, J, Chiarelli, P, Forder, P, Talley, NJ. Prevalence correlates and impact of fecal incontinence among older women. Dis Colon Rectum. 2013; 56(9):1080–1086.CrossRefGoogle ScholarPubMed
Rey, E, Choung, RS, Schleck, CD, Zinsmeister, AR. Onset and risk factors for fecal incontinence in a US community. Am J Gastroenterol. 2010; 105(2):412–419.CrossRefGoogle Scholar
Matthews, CA, Whitehead, WE, Townsend, MK, Grodstein, F, Locke, GR III, Talley, NJ. Risk factors for urinary, fecal, or dual incontinence in the Nurses’ Health Study. Obstet Gynecol. 2013; 122(3):539–545.Google Scholar
Wu, JM, Matthews, CA, Vaughan, CP, Markland, AD. Urinary, fecal, and dual incontinence in older U.S. adults. J Am Geriatr Soc. 2015; 63(5):947–953.CrossRefGoogle ScholarPubMed
Christoforidis, D, Bordeianou, L, Rockwood, TH, Lowry, AC, Parker, S, Mellgren, AF. Faecal incontinence in men. Colorectal Dis. 2011; 13(8):906–913.Google Scholar
Brown, HW, Wexner, SD, Lukacz, ES. Factors associated with care seeking among women with accidental bowel leakage. Female Pelvic Med Reconstr Surg. 2013; 19(2):66–71.CrossRefGoogle ScholarPubMed
Brown, HW, Wexner, SD, Segall, MM, Brezoczky, KL, Lukacz, ES. Accidental bowel leakage in the mature women’s health study: Prevalence and predictors. Int J Clin Prac. 2012; 66(11):1101–1108.CrossRefGoogle ScholarPubMed
Leung, FW, Schnelle, JF. Urinary and fecal incontinence in nursing home residents. Gastroenterol Clin North Am. 2008; 37(3):697–707, x.Google Scholar
Zyczynski, HM, Richter, HE, Sung, VW, Arya, LA, Lukacz, ES, Visco, AG, et al. Performance, acceptability, and validation of a phone application bowel diary. Neurourol Urodyn. 2020; 39(8):2480–2489.Google Scholar
Hawkins, AT, Rothman, RL, Geiger, TM, Canedo, JR, Edwards-Hollingsworth, K, LaNeve, DC, Penson, DF. Patient-reported outcome measures in colon and rectal surgery: A systematic review and quality assessment. DisColon Rectum. 2020; 63(8):1156–1167.Google Scholar
Carrington, EV, and all members of the International Anorectal Physiology Working Group. The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020; 32(1):e13679.Google Scholar
Meyer, I, Richter, HE. An evidence-based approach to the evaluation, diagnostic assessment, and treatment of fecal incontinence in women. Curr Obstet Gynecol Rep. 2014; 3(3):155–164.CrossRefGoogle Scholar
Lee, YY, Erdogan, A, Rao, SSC. High resolution and high definition anorectal manometry and pressure topography: Diagnostic advance or a new kid on the block? Curr Gastroenterol Rep. 2013; 15(12):360.Google Scholar
Carrington, EV, Scott, SM, Bharucha, A, Mion, F, Remes-Troche, JM, Malcolm, A, Heinrich, H, Fox, M, Rao, SS. Expert consensus document: Advances in the evaluation of anorectal function. Nat R. Gastroenterol hepatol. 2018; 15(5):309–323.CrossRefGoogle ScholarPubMed
Khatri, G, de Leon, AD, Lockhart, ME. MR imaging of the pelvic floor. Magn Reson Imaging Clin N Am. 2017; 25(3):457–480.Google Scholar
Forte, ML. AHRQ comparative effectiveness reviews, in Treatments for Fecal Incontinence. Rockville, MD: Agency for Healthcare Research and Quality (US), 2016.Google Scholar
Whitehead, WE, Rao, SSC, Lowry, A, Nagle, D, Varma, M, Bitar, KN, Bharucha, AE, Hamilton, FA. Treatment of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases workshop. Am J Gastroenterol. 2015; 110(1):138–146.Google Scholar
Paquette, I.M, Varma, M, Kaiser, AM, Steele, SR, Rafferty, JF. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015; 58(7):623–636.Google Scholar
Forte, ML, Andrade, KE, Lowry, AC, Butler, M, Bliss, DZ, Kane, RL. Systematic review of surgical treatments for fecal incontinence. Dis Colon Rectum. 2016; 59(5):443–469.Google Scholar
Markland, AD, Burgio, KL, Whitehead, WE, Richter, HE, Wilcox, CM, Redden, DT, Beasley, TM, Goode, PS. Loperamide versus psyllium fiber for treatment of fecal incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) randomized clinical trial. Dis Colon Rectum. 2015; 58(10):983–993.Google Scholar
Omar, MI, Alexander, CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013; 6:CD002116.Google Scholar
Remes-Troche, J, Ozturk, R, Phillips, C, Stessman, M, Roa, SSC. Cholestyramine: A useful adjunct for the treatment of patients with fecal incontinence. Int J Colorect Dis. 2008; 23(2):189.CrossRefGoogle ScholarPubMed
Krassioukov, A, Eng, JJ, Claxton, G, Sakakibara, BM, Shum, S. Neurogenic bowel management after spinal cord injury: A systematic review of the evidence. Spinal Cord. 2010; 48(10):718–733.Google Scholar
Norton, C, Cody, JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2012; 7:CD002111.Google Scholar
Markland, AD, Jelovsek, JE, Whitehead, WE, Newman, DK, Andy, UU, Dyer, K, et al. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol. Neurogastroenterol Motil. 2017; 29(1):10.1111/nmo.12906. doi: 10.1111/nmo.12906.CrossRefGoogle ScholarPubMed
Jelovsek, JE, Markland, AD, Whitehead, WE, Barber, MD, Newman, DK, Rogers, RG, et al. Controlling faecal incontinence in women by performing anal exercises with biofeedback or loperamide: A randomised clinical trial. Lancet Gastroenterol Hepatol. 2019; 4(9):698–710.Google Scholar
Richter, HE, Jelovsek, JE, Iyer, P, Rogers, RG, Meyer, I, Newman, DK, et al. Characteristics associated with clinically important treatment responses in women undergoing nonsurgical therapy for fecal incontinence. Am J Gastroenterol. 2020; 115(1):115–127.Google Scholar
Dehli, T, Stordahl, A, Vatten, LJ, Romundstad, PR, Mevick, K, Sahlin, Y, Lindsetmo, RO, Vonen, B. Sphincter training or anal injections of dextranomer for treatment of anal incontinence: A randomized trial. Scand J Gastroenterol. 2013; 48(3):302–310.Google Scholar
Sarveazad, A, Newstead, GL, Mirzaei, R, Joghataei, MT, Bakhtiari, M, Babahajian, A, Mahjoubi, B. A new method for treating fecal incontinence by implanting stem cells derived from human adipose tissue: Preliminary findings of a randomized double-blind clinical trial. Stem Cell Res Ther. 2017; 8(1):40.Google Scholar
Tan, J, Chan, M, Tjandra, J. Evolving therapy for fecal incontinence. Dis Colon Rectum. 2007; 50(11):1950–1967.CrossRefGoogle ScholarPubMed
Knowles, CH, Horrocks, EJ, Bremner, SA, Stevens, N, Norton, C, O’Connell, PR, Eldridge, S, CONFIDeNT Study Group. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): A double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet. 2015; 386(10004):1640–1648.Google Scholar
Richter, HE, Matthews, CA, Muir, T, Takase-Sanchez, MM, Hale, DSs, Van Drie, D, Varma, MD. A vaginal bowel-control system for the treatment of fecal incontinence. Obstet Gynecol. 2015; 125(3):540–547.Google Scholar
Lukacz, ES, Segall, MM, Wexner, SD. Evaluation of an anal insert device for the conservative management of fecal incontinence. Dis Colon Rectum. 2015; 58(9):892–898.CrossRefGoogle ScholarPubMed
Schnelle, JF, Leung, FW, Rao, SSC, Beuscher, L, Keeler, E, Clift, JW, Simmons, S. A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc. 2010; 58(8):1504–1511.Google Scholar
Schnelle, JF, Kapur, K, Alessi, C, Osterweil, D, Beck, JG, Al-Samarrai, N, Ouslander, JG. Does an exercise and incontinence intervention save healthcare costs in a nursing home population? J Am Geriatr Soc. 2003; 51(2):161–168.Google Scholar
Heymen, S, Scarlett, Y, Jones, K, Ringel, Y, Drossman, D, Whitehead, WE. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum. 2009; 52:1730–1737. doi: 10.1007/DCR0b013e3181b55455.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×