Fecal incontinence

Fecal incontinence is a socially debilitating problem that affects an unknown number of people. Many factors have contributed to the problematic nature of estimating the gravity of this condition. They include a lack of standard definitions for the severity and frequency of incontinence, the variable patient populations sampled, the unwillingness of patients to report symptoms due to embarrassment, and the lack of awareness and understanding of the problem among medical providers. The etiology of fecal incontinence is frequently multifactorial. The history and physical exam are often adequate to determine the etiology of fecal incontinence. However, objective testing in an anorectal physiology laboratory can be beneficial in delineating the degree of impairment based on sphincter pressures, size of anatomic sphincter defects, and presence of pudendal neuropathy. Surgical therapy for sphincter defects can be quite successful. However, new therapies such as stimulated graciloplasty, artificial anal sphincters, and sacral nerve stimulation show promise for those without anatomic defects. The socioeconomic and psychosocial impact of fecal incontinence is enormous in both the community and nursing home population and is, therefore, an important concern for the colorectal surgeon.