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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2017; 23(1): 11-24
Published online Jan 7, 2017. doi: 10.3748/wjg.v23.i1.11
Fecal incontinence - Challenges and solutions
Nallely Saldana Ruiz, Andreas M Kaiser
Nallely Saldana Ruiz, Andreas M Kaiser, Department of Surgery, Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: Kaiser AM developed concept; Saldana Ruiz N did literature search; Saldana Ruiz N and Kaiser AM analyzed published data, wrote/edited the paper.
Conflict-of-interest statement: There are not conflicting interests to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreas M Kaiser, MD, FACS, FASCRS, Professor of Clinical Surgery, Department of Surgery, Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 7418, Los Angeles, CA 90033, United States. akaiser@usc.edu
Telephone: +1-323-8653690 Fax: +1-323-8653671
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: September 20, 2016
Revised: October 14, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: January 7, 2017
Processing time: 129 Days and 17.7 Hours
Abstract

Fecal incontinence is not a diagnosis but a frequent and debilitating common final pathway symptom resulting from numerous different causes. Incontinence not only impacts the patient’s self-esteem and quality of life but may result in significant secondary morbidity, disability, and cost. Treatment is difficult without any panacea and an individualized approach should be chosen that frequently combines different modalities. Several new technologies have been developed and their specific roles will have to be defined. The scope of this review is outline the evaluation and treatment of patients with fecal incontinence.

Keywords: Fecal incontinence; Sphincteroplasty; Sacral nerve stimulation; Endorectal ultrasound; New technologies; Quality of life

Core tip: Fecal incontinence is frequent, under-reported, and lacks a perfect treatment solution. Fecal control is not equivalent to normal sphincter muscles. Other factors such (e.g., stool consistency, rectal reservoir function and elasticity are equally important. Incontinence is rather a symptom than a diagnosis, representing the common final pathway of various etiologies. Measurement of fecal incontinence remains subjective and based on patient reporting. Successful incontinence management combines a thorough understanding of contributing factors, workup and interpretation of individual results, tailoring of individual treatment plan. New technologies are abundant but not indicated for all patients, and objective results often less strong than advertised.