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 feel that any form of so called psychotherapy is strongly contraindicated for addicts.... The question “Why did you start using narcotics in the first place?” should never be asked. It is quite as irrelevant to treatment as it would be to ask a malarial patient why he went to a malarial area.”
—William Burroughs (b. 1914)
“Ambivalence reaches the level of schizophrenia in our treatment of violence among the young. Parents do not encourage violence, but neither do they take up arms against the industries which encourage it. Parents hide their eyes from the books and comics, slasher films, videos and lyrics which form the texture of an adolescent culture. While all successful societies have inhibited instinct, ours encourages it. Or at least we profess ourselves powerless to interfere with it.”
—C. John Sommerville (20th century)