Treatment
Treatment choice depends on the cause and severity of FI, and also the motivation of the patient. Commonly, conservative measures may be combined, and if appropriate surgery carried out. This is a reflection of the multifactorial etiology that is a regular feature of FI. Successive treatments may be attempted until symptoms are satisfactorily controlled. "Social continence" has been given various precise definitions for the purposes of research, but it generally refers to a state where FI symptoms are controlled to an extent that is acceptable to the patient, and does not impact significantly on their life. The concept by no means equates to normal, full continence.
A treatment algorithm for FI based upon its cause has been proposed, including conservative, non-operative and surgical measures.
| Consistency of FI | Cause | first line | second line | third line |
|---|---|---|---|---|
| Diarrhea | Inflammatory | Anti-inflammatory drugs | Constipating drugs | Colostomy |
| Pseudodiarrhea | Encopresis | Laxatives | Lavage | Colostomy |
| Solid | Pelvic floor | Biofeedback | Sacral nerve stimulation | Colostomy |
| Sphincter intact | Sacral nerve stimulation | Lavage | Colostomy | |
| Sphincter rupture | Anal repair | Sacral nerve stimulation/Neosphincter | Colostomy | |
| Anal atresia | Lavage | Neosphincter | Colostomy | |
| Rectal prolapse | Rectopexy | Perineal resection | Colostomy | |
| Soiling | Keyhole defect | Lavage | PTQ implant |
Neosphincter refers to either dynamic graciloplasty or artificial bowel sphincter. Lavage refers to retrograde rectal irrigation.
Read more about this topic: Fecal Incontinence
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