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
Famous quotes containing the word treatment:
“[17th-century] Puritans were the first modern parents. Like many of us, they looked on their treatment of children as a test of their own self-control. Their goal was not to simply to ensure the child’s duty to the family, but to help him or her make personal, individual commitments. They were the first authors to state that children must obey God rather than parents, in case of a clear conflict.”
—C. John Sommerville (20th century)
“I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a pessary to cause abortion. I will keep pure and holy both my life and my art.”
—Hippocrates (c. 460–c. 370 B.C.)
“James’s great gift, of course, was his ability to tell a plot in shimmering detail with such delicacy of treatment and such fine aloofness—that is, reluctance to engage in any direct grappling with what, in the play or story, had actually “taken place”Mthat his listeners often did not, in the end, know what had, to put it in another way, “gone on.””
—James Thurber (1894–1961)