Fecal incontinence

Fecal incontinence is a relatively prevalent, multifactorial and multifaceted disorder with significant psychosocial consequences. In patients who do not have an underlying disorder associated with incontinence, anal sphincter trauma caused by obstetric or surgical injury, chronic straining, diarrhea, and aging have been implicated. The relative contributions of obstetric and nonobstetric risk factors and the specific obstetric risk factors for pelvic floor injury must be clarified. The clinical assessment and diagnostic testing are directed toward assessing the cause of the symptom, likely anatomical and physiological disturbances, and impact on quality of life. Treatment should be tailored to patient's symptoms; it is unclear which components of biofeedback therapy contribute to its favorable effects. Surgical therapies should be restricted to carefully selected patients; artificial sphincter procedures and dynamic graciloplasty are associated with significant morbidity. Newer, less invasive therapeutic approaches are being evaluated. It is conceivable that an improved understanding of risk factors will lead to measures to prevent pelvic floor injury in future.