Materiały źródłowe

• #1 Fecal incontinence – Wikipedia

  https://en.wikipedia.org/wiki/Fecal_incontinence

  Fecal incontinence (FI), or in some forms, encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents including flatus (gas), liquid stool elements and mucus, or solid feces. […] Incontinence can result from different causes and might occur with either constipation or diarrhea. […] Continence is maintained by several interrelated factors, including the anal sampling mechanism, and incontinence usually results from a deficiency of multiple mechanisms. […] The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions), altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn’s disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence).

• #2 Fecal Incontinence : Pathogenesis, Diagnosis, and Updated Treatment Strategies – EM consulte

  https://www.em-consulte.com/es/article/1500539/fecal-incontinence-pathogenesis-diagnosis-and-upda

  Fecal incontinence (FI) is defined as the involuntary loss or passage of solid or liquid stool in patients. FI is a common and debilitating condition in men and women. The incidence increases with age and also often goes unreported to health care providers. It is crucial that providers ask at-risk patients about possible symptoms. Evaluation and management is tailored to specific symptoms and characteristics of the incontinence. If conservative methods fail to improve symptoms, then other surgical options are considered, such as sacral nerve stimulation and anal sphincter augmentation. This review provides an update on current and future therapies. […] Keywords : Fecal incontinence, Accidental bowel leakage, Anal sphincter, Sphincter injury.

• #3 The Mexican consensus on fecal incontinence | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-the-mexican-consensus-on-fecal-articulo-S2255534X23001160

  The pathophysiology of fecal incontinence is complex and multifactorial. Over 80% of patients have more than one alteration; thus, every effort should be made to determine the pathophysiology so that personalized treatment can be provided […] The pathophysiology of FI is heterogeneous and there is more than one related mechanism in over 80% of cases. Each individual can present with several of the pathophysiologic mechanisms, and expectedly, frequency and severity of episodes of FI would be greater, the higher the number of said mechanisms. In general terms, the pathophysiologic mechanisms that lead to FI can be grouped as follows: Anatomic/structural factors; they involve anal sphincter muscle lesions, rectal disorders (inflammation, laxity), puborectal muscle alterations (direct lesion), and neurologic alterations (damage to both the peripheral nerves [neuropathy] and the central nervous system [spinal cord injury]). Functional factors; they include changes in rectal sensation due to different causes and problems in defecation dynamics (dyssynergic defecation), the latter impeding adequate stool expulsion. Reduced stool consistency associated or not with rectal urgency and accelerated intestinal transit due to different etiologies (infectious causes, bacterial overgrowth, excess bile salts) can lead to more frequent FI episodes. Miscellaneous causes, such as impaired cognitive function (dementia), psychiatric disorders (psychosis), and drug use (altered rectal sensation and changes in intestinal transit), as well as excessive consumption of fermentable carbohydrates that can lead to diarrhea and episodes of FI.

• #4 Fecal incontinence – Wikipedia

  https://en.wikipedia.org/wiki/Fecal_incontinence

  FI is a sign or a symptom, not a diagnosis, and represents an extensive list of causes. Usually, it is the result of a complex interplay of several coexisting factors, many of which may be simple to correct. […] Up to 80% of people may have more than one abnormality that is contributing. […] Deficits of individual functional components of the continence mechanism can be partially compensated for a certain period, until the compensating components themselves fail. […] The most common factors in the development are thought to be obstetric injury and after-effects of anorectal surgery, especially those involving the anal sphincters and hemorrhoidal vascular cushions. […] The majority of incontinent persons over the age of 18 fall into one of several groups: those with structural anorectal abnormalities (sphincter trauma, sphincter degeneration, perianal fistula, rectal prolapse), neurological disorders (multiple sclerosis, spinal cord injury, spina bifida, stroke, etc.), constipation or fecal loading (presence of a large amount of feces in the rectum with stool of any consistency), cognitive or behavioral dysfunction (dementia, learning disabilities), diarrhea, inflammatory bowel diseases (e.g. ulcerative colitis, Crohn’s disease), irritable bowel syndrome, disability related (people who are frail, acutely unwell, or have chronic or acute disabilities), and those cases which are idiopathic (of unknown cause). […] The mechanisms and factors contributing to normal continence are multiple and interrelated. […] Problems affecting any of these mechanisms and factors may be involved in the cause.

• #5 Fecal Incontinence: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/268674-overview

  Bowel function is controlled by multiple factors including anal sphincter pressure, anorectal sensation, rectal compliance, colonic transit time, and stool volume and consistency. In addition, adequate cognitive function with appropriate ability to access bathroom facilities are necessary for continence. If any of these factors are compromised, incontinence can occur. […] Fecal continence is maintained by the structural and functional integrity of the anorectal unit. Normal anal sphincter function is a critical part of continence. The anal sphincter is comprised of 2 components: the internal anal sphincter (IAS), which is a 0.3-0.5 cm expansion of the circular smooth muscle layer of the rectum and the external anal sphincter (EAS), a 0.6-1.0 cm expansion of the levator ani muscles. The IAS is chiefly responsible for maintaining continence at rest and contributes approximately 70-80% of the resting sphincter tone. This barrier is reinforced during voluntary squeeze by the EAS, the anal mucosal folds, and the anal endovascular cushions.

• #6 Fecal Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459128/

  Fecal incontinence is the inability to control bowel movements, leading to the involuntary release of gas or stool. Numerous factors, including muscle or nerve damage, digestive disorders, and other underlying medical conditions, can contribute to its development. […] Fecal incontinence can also result from enlarged skin tags, poor hygiene, hemorrhoids, rectal prolapse, and fistula in ano. Other common causes include the use of laxatives, inflammatory bowel disease, and parasitic infections. […] Understanding the physiology of continence is important to understand the pathophysiology of incontinence. The anatomical structures that help maintain control of bowel function include the rectum, internal anal sphincter, external anal sphincter, and puborectalis muscle. […] To maintain fecal continence, there is a complex interplay of several organ systems and nerves. As the fecal mass presents to the rectum, this causes distension. The parasympathetic nerves (S2-S4) transmit the sensation of rectal distension, which induces relaxation of the rectoanal inhibitor reflex and contraction of the rectoanal contractile reflex. […] Any pathology that interferes with these processes, like trauma, stroke, vaginal delivery, or paralysis, can result in fecal incontinence.

• #7 Urology & Continence Care Today | May 2025

  https://www.ucc-today.com/journals/issue/launch-edition/article/faecal-incontinence-forgotten-symptom

  The rectum absorbs the remaining water, electrolytes and further solidifies waste products. […] The internal anal sphincter (IAS) is an involuntary circular smooth muscle approximately 0.3cm wide and ends 10mm above the anal verge. It is able to maintain tonic contraction for long periods of time and contributes to 85% of the resting anal tone. […] The anorectal inhibitory reflex enables the internal sphincter to relax, allowing anal sensory receptors to sense rectal contents. This helps to differentiate solid or liquid stool from gas. […] The puborectalis muscle is part of the pelvic floor complex. It is a mixture of slow and fast twitch muscles and contains both types of muscle fibres. Its function is to close the upper anal canal and forms part of the anorectal angle. […] The whole pelvic floor/anorectal angle mechanism works in conjunction with the anal sphincters during defaecation.

• #8 Pathophysiology of adult fecal incontinence – PubMed

  https://pubmed.ncbi.nlm.nih.gov/14978634/

  Fecal incontinence occurs when the normal anatomy or physiology that maintains the structure and function of the anorectal unit is disrupted. Incontinence usually results from the interplay of multiple pathogenic mechanisms and is rarely attributable to a single factor. The internal anal sphincter (IAS) provides most of the resting anal pressure and is reinforced during voluntary squeeze by the external anal sphincter (EAS), the anal mucosal folds, and the anal endovascular cushions. Disruption or weakness of the EAS can cause urge-related or diarrhea-associated fecal incontinence. Damage to the endovascular cushions may produce a poor anal „seal” and an impaired anorectal sampling reflex. The ability of the rectum to perceive the presence of stool leads to the rectoanal contractile reflex response, an essential mechanism for maintaining continence. Pudendal neuropathy can diminish rectal sensation and lead to excessive accumulation of stool, causing fecal impaction, mega-rectum, and fecal overflow. The puborectalis muscle plays an integral role in maintaining the anorectal angle. Its nerve supply is independent of the sphincter, and its precise role in maintaining continence needs to be defined. Obstetric trauma, the most common cause of anal sphincter disruption, may involve the EAS, the IAS, and the pudendal nerves, singly or in combination. It remains unclear why most women who sustain obstetric injury in their 20s or 30s typically do not present with fecal incontinence until their 50s. […] There is a strong need for prospective, long-term studies of sphincter function in nulliparous and multiparous women.

• #9 Fecal Incontinence: From Anatomy to Recent Advances | IntechOpen

  https://www.intechopen.com/chapters/1148953

  Neurological: pudendal nerve injury, hypogastric nerve (sympathetic) injury, pelvic nerve (parasympathetic) injury, intrinsic nerve (enteric) injury. […] Central nervous system disorders: cerebrovascular accidents, Parkinsons disease, multiple sclerosis, spinal cord injury. […] Secondary causes: dysfunctional autonomic nervous system (e.g., diabetic patients), intestinal disorders, inflammatory bowel disease, pelvic non-intestinal surgery, rectal resection, pelvic radiotherapy, and rectal prolapse. […] The structural and functional integrity of the pelvic floor, rectum, sigmoid colon, and anus, along with the IAS and EAS, maintain continence in humans. […] A study has shown that the contributing factors to continence include, in descending order, nerve-induced activity in the IAS (45%), EAS (35%), anal hemorrhoid plexus (15%), and myogenic tone in IAS (10%). […] The IAS provides the resting tone of the sphincter, i.e., the resting pressure, while the EAS provides voluntary control of the sphincter, i.e., the squeeze pressure. […] Loose stool often decreases resting and squeeze pressures, leading to loss of physiological continence mechanisms.

• #10 Pathophysiology of adult fecal incontinence | health.am

  http://www.health.am/digestive/more/pathophysiology-of-adult-fecal-incontinence/

  Impaired rectal sensation may lead to excessive accumulation of stool, causing fecal impaction, mega-rectum (extreme dilation of the rectum), and fecal overflow. […] An intact sampling reflex allows the individual to choose whether to discharge or retain rectal contents. Conversely, an impaired sampling reflex may predispose a subject to incontinence. […] In some patients, particularly the elderly, prolonged retention of stool in the rectum or incomplete evacuation may lead to seepage of stool or staining of undergarments.

• #10 Pathophysiology of adult fecal incontinence | health.am

  http://www.health.am/digestive/more/pathophysiology-of-adult-fecal-incontinence/

  Fecal incontinence occurs when the normal anatomy or physiology that maintains the structure and function of the anorectal unit is disrupted. Incontinence usually results from the interplay of multiple pathogenic mechanisms and is rarely attributable to a single factor. […] Disruption or weakness of the EAS can cause urge-related or diarrhea-associated fecal incontinence. Damage to the endovascular cushions may produce a poor anal “seal” and an impaired anorectal sampling reflex. The ability of the rectum to perceive the presence of stool leads to the rectoanal contractile reflex response, an essential mechanism for maintaining continence. […] Fecal incontinence is often due to multiple pathogenic mechanisms and is rarely attributable to a single factor. […] Disruption or weakness of the EAS muscle causes urge-related or diarrhea-associated fecal incontinence. In contrast, damage to the IAS muscle or the anal endovascular cushions may lead to a poor seal and an impaired sampling reflex. These changes may cause passive incontinence or fecal seepage, often under resting conditions.

• #10 Pathophysiology of adult fecal incontinence | health.am

  http://www.health.am/digestive/more/pathophysiology-of-adult-fecal-incontinence/

  The most common cause of anal sphincter disruption is obstetric trauma. However, it is unclear why most women who have sustained an obstetric injury in their 20s or 30s typically do not present with fecal incontinence until their 50s. […] Fecal incontinence occurs when one or more mechanisms that maintain continence are disrupted to an extent that other mechanisms are unable to compensate. Hence, fecal incontinence is often multifactorial. […] Sphincter degeneration secondary to pudendal neuropathy and obstetric trauma may cause fecal incontinence in women. […] The role of extrinsic autonomic innervation is somewhat controversial. […] If rectal wall compliance is impaired, a small volume of stool material can generate high intrarectal pressure that can overwhelm anal resistance and cause incontinence.

• #11 New concepts in the pathophysiology of fecal incontinence – Knowles – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/8307/html

  The control of rectal contractility, like the bladder, is subject to intrinsic reflexes. […] The rectum must contract or be compressed to evacuate fecal contents. […] The rectum should therefore not be considered a passive reservoir. Rather, it is a contractile and sensate organ, that like the bladder, is subject to fine reflex control. […] Overall, rectal sensory disturbances in FI are common (~20% overall) with hypersensitivity more frequently found in females, and hyposensitivity in males. […] The important functions of the rectum, colon and CNS can be integrated with the classical barrier-centric model of FI pathophysiology. […] This new version of the barrier is more than just the goalkeeper (it also controls play in the defence and midfield).

• #11 New concepts in the pathophysiology of fecal incontinence – Knowles – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/8307/html

  The pathophysiology of fecal incontinence (FI) is often considered to primarily depend on disturbed mechanisms of faecal containment. […] However, this barrier-centric containment model is insufficient to explain many lived observations of FI, including the origin of the symptom of urgency and continence development over the life course. […] This review presents a revisionist view where reflex control of rectal contractility is considered central to FI pathogenesis and the anorectum is considered a single functional unit that cooperates with the colon and central nervous system (CNS) to maintain continence. […] This revised understanding implicates the barrier not only as a means of containment but also as a reflex controller of rectal function. […] The major factor missing from this conceptualisation is recognition of the sensation of urge that is described by the majority of patients before they become aware of incontinence.

• #12 Pathophysiology of Faecal Incontinence | SpringerLink

  https://link.springer.com/chapter/10.1007/978-88-470-0638-6_3

  Fecal incontinence occurs when one or more of these mechanisms are impaired and the remaining mechanisms are unable to compensate. […] Although integrity of the sphincteric mechanism plays a major part, there are other important aspects, such as stool volume and consistency, colonic transit, rectal compliance and sensation, anorectal sensation and anorectal reflexes. […] In the majority of cases (80% according to Rao et al.), the cause of faecal incontinence (FI) is multifactorial.

• #13 Fecal incontinence – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397

  Fecal incontinence is accidental passing of solid or liquid stool. Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. Fecal incontinence can affect a person’s ability to work, socialize or do typical daily activities. […] The muscles of the anus, rectum and pelvic floor control the holding and passing of stool. Damaged or weak muscles can cause fecal incontinence. Conditions that can weaken or damage muscles include: Injury during vaginal delivery, particularly with forceps. […] Injury or illness can affect how the nerves and muscles of the anus, rectum or pelvis work. Nervous system disorders also may affect a person’s awareness of the need for passing stool. […] Irregular physical changes in the anus or rectum can contribute to fecal incontinence. These include: Scarring or inflammation of the rectum from injury or long-term disease that affects the ability of the rectum to hold stool.

• #14 Voiding Troubles, Fecal Incontinence and Anal Intercourse

  https://www.longdom.org/open-access/voiding-troubles-fecal-incontinence-and-anal-intercourse-54621.html

  Injury of the IAS leads to fecal incontinence (FI). The injury is mostly traumatic from childbirth trauma (CBT) but it can be the result of anal intercourse. […] The IAS in women is intimately lying on the posterior vaginal wall. Childbirth trauma (CBT), distension of the vagina causes unseen lacerations in the strong collagen chassis of the posterior vaginal wall causing its weakness, redundancy and its prolapse. It also lacerate the stout collagen chassis of the IAS leading to FI. […] Torn IAS allowing passage of rectal contents (feces /or flatus) to an open anal canal can, sometimes, can be interpreted as urine in the urethra and give sensations of urgent desire to void (OAB). […] Fecal incontinence is the result of lacerations of the IAS and not lacerations of the external anal sphincter (EAS) only. This explains the poor results after repair of complete perineal tear, repair of the EAS whether by end-to end or overlapping techniques.

• #15 Urinary and Fecal Control and Incontinence: Pathogenesis and Mana

  https://www.longdom.org/open-access/urinary-and-fecal-control-and-incontinence-pathogenesis-and-management-17707.html

  Urinary and Fecal Control depends on two factors, the first is an inherent, and the second is an acquired. The inherent factor is the presence of an intact sound IUS and IAS. The acquired factor is, through toilet training, having and maintaining high sympathetic tone at the IUS and the IAS. This keeps the sphincters contracted and the urethra and the anal canal empty and closed all the time. […] Similarly, lacerations of the collagen chassis of the IAS lead to its weakness and subsequent fecal incontinence (FI). […] The lacerations affecting the collagen chassis of the IUS get worse near and after menopause, as pelvic collagen gets weaker because it is estrogen dependent. […] Structural damage of the IAS will lead to fecal incontinence (FI). The structural damage is caused mainly by CBT, but may be caused by direct injury like anal intercourse or forcing a hard object into the anal canal.

• #16 Anal Incontinence

  https://urogynecology.nm.org/anal-incontinence.html

  Anal incontinence or accidental bowel leakage usually occurs because the anal sphincter and pelvic floor muscles are not functioning properly. […] Damage to these muscles is usually attributed to childbirth, aging, or other conditions that affect stool consistency. The muscles may be torn or the nerves that help them function may be damaged leading to impaired function of the continence mechanism. […] Many women may experience anal incontinence from loss of muscle strength as they get older.

• #17 Fecal incontinence | PPT

  https://www.slideshare.net/slideshow/fecal-incontinence-71028504/71028504

  Patients with neurological disorders (e.g., multiple sclerosis, spinal cord injury, stroke, DM related neuropathy etc.), extensive straining at stool from constipation leading to stretching of the pudendal nerves over the ischial spines as the perineum descends. […] Sacral nerve stimulation has been used to treat patients with incontinence who have an intact anal sphincter. Electrical stimulation increases squeeze pressure of the external sphincter. […] The goal of drug therapy is to reduce the fecal volume: 1. increased intestinal water and ion absorption 2. slowed motility. […] Sphincteroplasty is the preferred treatment of an isolated tear in the external sphincter. The most common cause of reparable injury is obstetrical trauma.

• #17 Fecal incontinence | PPT

  https://www.slideshare.net/slideshow/fecal-incontinence-71028504/71028504

  Fecal incontinence is defined as the inability to defer the elimination of liquid or solid stool until there is a socially acceptable time and place to do so. […] Aging has been consistently identified as a major risk factor for the development of fecal incontinence: 1. Decreased strength of EAS, Week anal squeeze 2. Decreased resting tone in IAS 3. altered rectal compliance 4. Decreased anal sensation […] Significant independent risk factors included: age, depression, dementia, neurological diseases, immobility constipation Female sex, vaginal parity, and a history of operative vaginal delivery. women with pelvic floor dysfunction (urinary incontinence and/or pelvic organ prolapse). […] 1. Structural abnormality 2. Change fecal volume and consistency 3. Altered mental control 4. Neurological diseases 5. Pelvic Floor Dyssynergia (Anismus) 6. Idiopathic

• #18 Obesity Linked to Higher Risk for Fecal Incontinence, Altered Rectal Sensitivity

  https://www.gastroenterologyadvisor.com/news/obesity-linked-to-higher-risk-of-fecal-incontinence-altered-rectal-sensitivity/

  Class II and III obesity have been independently associated with a significantly higher risk of fecal incontinence (FI), with altered rectal sensitivity identified as a possible underlying mechanism, according to results of a retrospective cohort study published in the American Journal of Gastroenterology. […] Among patients with FI, class II+III obesity was also associated with altered rectal sensation, which may be an important contributor to the pathophysiology of FI symptoms related to obesity. […] The investigators concluded, Among patients with FI, class [II or III] obesity was also associated with altered rectal sensation, which may be an important contributor to the pathophysiology of FI symptoms related to obesity. Given the potential role of rectal hyposensitivity in FI in patients with obesity, after a thorough history and physical examination, anorectal function testing should be considered to help guide diagnosis and treatment.

• #19 Fecal (Bowel) Incontinence: What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence

  Muscle damage can occur during a difficult vaginal delivery, when doctors have to use forceps or make a small cut (an episiotomy) to make a larger opening for your baby to come out. Surgery on your anal or rectal area (like surgery to remove hemorrhoids or to treat an abscess or fistula) can also cause muscle damage, leading to incontinence. […] Nerve damage: Many of the same things that can damage your muscles, like surgery and a difficult vaginal delivery, can also damage the nerves that control their movement. This includes nerves that control rectal sensation, the signal that tells you its time to poop. Several chronic conditions affecting your nerves increase your risk of fecal incontinence. Overusing laxatives can also damage these nerves. […] The muscles of your rectum should be stretchy to help you hold poop. If theyre not elastic enough, poop can seep out. Conditions and procedures that cause scarring can prevent your rectum from stretching. Scar tissue isnt as stretchy as healthy tissue. For example, Crohn’s disease can lead to scarring that prevents stretching, and so can radiation therapy.

• #19 Fecal (Bowel) Incontinence: What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence

  POP is when weakened pelvic muscles cant fully support your pelvic organs. These organs include your rectum, vagina, uterus and bladder. As a result, the organs slip or sag. A rectal prolapse occurs when your rectum falls into your anus. A rectocele occurs when your rectum slips onto your vaginas back wall. Both forms of prolapse can lead to fecal incontinence.

• #20 Fecal Incontinence: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/268674-overview

  The decreased anorectal sensation and abnormal sampling likely contribute in the pathogenesis of anal incontinence as sampling facilitates the fine tuning of the continence barrier. This process is incompletely understood. […] In essence, any process that interferes with these mechanisms, including trauma from vaginal delivery or a neurological insult, can result in fecal incontinence.

• #21

  https://journals.lww.com/ajg/fulltext/2007/09002/dyssynergia___key_pathophsyiologic_mechanism_for.386.aspx

  We performed anorectal measurements in nursing home subjects to explain the high prevalence of coexistence of FI and constipation. […] Nursing home residents with FI demonstrate weak internal and external anal sphincter pressures and severely impaired rectal sensation. Our novel finding (75% showing a dyssynergic pattern) could explain both the high prevalence of constipation and incontinence in these elderly nursing home subjects.

• #22 Treatments for Fecal Incontinence | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/fecal-incontinence/research-protocol

  Fecal incontinence (FI) involves recurrent involuntary loss of fecal material. FI is defined by the frequency of episodes (such as daily or weekly episode counts) and by the consistency of the fecal material (solid, liquid, or mucus). FI severity varies widely and the amount of leakage can vary across episodes. The condition can dramatically impede daily activities and socialization because those affected aim to avoid embarrassment. FI can also result in severe skin breakdown and ulceration, particularly in nursing home residents and immobile adults. […] FI can result from a number of causes that fall into two broad categories: nonneurological or neurological. Nonneurological causes of FI may be structural (e.g., muscle damage after episiotomy or surgery), functional (e.g., post-radiation or muscle atrophy), due to an underlying gastrointestinal (GI) disorder (e.g., inflammatory bowel disease), due to stool consistency issues, or from other factors. Neurological causes of FI include damage to the nervous system or advanced cognitive impairment.

• #22 Treatments for Fecal Incontinence | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/fecal-incontinence/research-protocol

  Treatments for FI may be nonsurgical or surgical. Nonsurgical treatments include pelvic floor muscle training exercises (PFMT), dietary modification (including dietary fiber), medications, biofeedback, bowel schedules, anal plugs, rectal irrigation, or combinations thereof. Surgical procedures used to treat FI in the United States include implanted sacral nerve stimulators, radiofrequency anal sphincter remodeling, anal sphincter repair (sphincteroplasty or muscle transposition), sphincter replacement (artificial anal sphincter), surgical correction of conditions that can result in FI (rectal prolapse, hemorrhoids, or rectocele), or, when all other treatments fail, colostomy. […] FI etiologies and other patient factors dictate feasible treatment options. For example, the range of treatment approaches used for FI in adults with spinal cord (neurologic) injury would differ from those used to treat pelvic floor muscle atrophy (structural weakness) or anal sphincter injury (structural damage). Treatment goals are to decrease the frequency and severity of FI episodes in affected adults. In general, initial FI treatments tend to be conservative (diet, drugs, exercises, etc.) and become progressively more invasive (local injections of tissue-bulking material, surgical procedures) if desired treatment effects are not obtained with less invasive approaches.

• #23 Cary Gastroenterology Associates | Dealing With Fecal Incontinence:…

  https://www.carygastro.com/blog/dealing-with-fecal-incontinence-causes-and-treatment

  Fecal incontinence is a symptom of an underlying condition rather than a primary condition, so there are a variety of potential causes. Damage to or malfunction of any one of the components of defecation can result in some form of fecal incontinence. […] When any of the muscles involved in defecation are weakened or damaged, fecal incontinence can result. […] Damage to the nerves in the vicinity of the anus (part of the enteric nervous system) can be related to the same causes as muscle damage, but it can also be a result of nerve damage related to a spinal cord injury or even a stroke. […] Chronic constipation is a long term bowel irregularity problem that can cause you to frequently attempt to pass hard, dry stools; over time, excessive straining to pass these stools can lead to a weakening of the sphincter muscles on either side of the anal canal.

• #23 Cary Gastroenterology Associates | Dealing With Fecal Incontinence:…

  https://www.carygastro.com/blog/dealing-with-fecal-incontinence-causes-and-treatment

  The watery, loose stools associated with diarrhea are more difficult to hold in the rectum than solid stools. […] Though relatively rare, it is possible for the rectum to become prolapsed; this means that the rectum is pushed out into the anal canal and causes the anal sphincter muscles to be stretched. […] Similar to general nerve damage, some neurological conditions like multiple sclerosis, Parkinsons disease, and even dementia can cause fecal incontinence because of the impact of those diseases on the neurological health of the digestive system and the body as a whole. […] Depending on the underlying cause, medication, therapeutic exercises, or surgery may be used to treat or manage incontinence.

• #24

  https://www.grepmed.com/images/8356/incontinence-pathophysiology-stool-fecal-geriatrics

  Fecal Incontinence – Pathogenesis and Complications Continence mechanisms are impaired […] Local neuronal damage […] External and Internal anal sphincter impairment […] Continence mechanisms are intact, but overwhelmed or ignored […] Movement Disorders […] Inflammation of colon (e.g., Ulcerative colitis, Radiation proctitis) […] Chronic diarrhea, diarrhea-predominant irritable bowel syndrome, laxatives […] Chronic constipation […] Sensory neuropathy (e.g. Diabetes) […] Altered mental conditions (e.g. stroke, dementia)

• #25 Anal Incontinence

  https://exxcellence.org/list-of-pearls/anal-incontinence/

  Anal incontinence may be caused by anatomical abnormalities of the muscle (sphincter or puborectalis), or nerve injury, including the pudendal nerve or functional factors such as anorectal sensation, stool characteristics including consistency, and medications. […] The greatest risk factor for anal sphincter injury Patients is operative vaginal delivery (forceps higher risk than vacuum), followed by primiparity, midline episiotomy, occiput posterior head position, macrosomia, and prolonged second stage. […] Additionally, rectal urgency is a significant risk factor for fecal incontinence in women. […] Digital exam may evaluate for sphincter tone and weakness but may not always provide accurate assessment. […] Sphincteroplasty is reserved for patients with evidence of an anatomic defect who do not respond to initial management.

• #26 Faecal incontinence – O&G Magazine

  https://www.ogmagazine.org.au/16/1/faecal-incontinence/

  An accepted and standardised definition of faecal incontinence (FI) does not exist, but usually it incorporates the involuntary loss of control of bowel motions, occurring with any level of frequency. It usually also includes flatus incontinence, particularly in patient-generated definitions. […] Normal bowel continence is a multifactorial mechanism, which is important to keep in mind when assessing a patient reporting these symptoms. The mechanism can be considered as five main components: […] Approximately 2025 per cent of primiparous women will experience some early postpartum alteration of faecal continence after vaginal delivery. […] This last point reinforces the fact that, while a significant obstetric tear can cause IAS and EAS damage, several other events in parturition can affect bowel continence. […] Faecal incontinence is a multifactorial disorder and there is a move away from a sphincter-centric treatment approach. Patients may present several years following an apparent obstetric anal injury and this often reflects a multifactorial failure of the continence mechanism.

• #27 Neuromodulation for fecal incontinence: An effective surgical intervention

  https://www.wjgnet.com/1007-9327/full/v19/i41/7048.htm

  Fecal incontinence (FI) is defined as the accidental loss of solid or liquid stools and is a common disabling condition that is often under-reported at medical consultation because of fear and embarrassment. […] Sacral nerve electrostimulation, later also called neuromodulation (NRM), was first applied in 1995 by Matzel et al with encouraging results in a small group of patients with FI without evidence of anal sphincter defects. The technique was attractive because of its limited side effects and for being minimally invasive. Since then, the effectiveness of NRM in improving FI has been proven in a number of studies, although its mechanism of action remains ill defined. […] In 1999, Vaizey et al first reported the effect of NRM on anorectal physiology measured by 24-h solid state catheter manometry in a small group of 10 patients with FI. Resting anal pressure did not change significantly and some evidence of modification of rectal sensitivity and tone was observed. The authors speculated that NRM worked via complex neuromodulation of sacral reflexes to regulate rectal sensitivity and anorectal motility.

• #28 Neuromodulation for fecal incontinence: An effective surgical intervention

  https://www.wjgnet.com/1007-9327/full/v19/i41/7048.htm

  However, subsequent studies had inconsistent results, with RCTs and long-term studies failing to show a relevant influence of NRM on anal pressure. […] This is not commensurate with the large clinical effects seen for FI and suggests that the mechanism by which NRM improves continence is not primarily an improvement in anal canal pressure. […] The authors speculated on three potential mechanisms: (1) somatovisceral reflex; (2) modulation of the perception of afferent information; and (3) increase in external anal sphincter activity. However, no definitive evidence could be found to support any of these and a multifactorial component was further speculated to justify the efficacy of NRM. The authors concluded that NRM is effective almost certainly via modulation of spinal and/or supraspinal afferent inputs, but many gaps remain in the understanding of the mechanism of action of NRM.

• #29 Sacral Nerve Stimulation and Fecal Incontinence: Current Uses and Emerging Trends | ClinMed International Library | Obstetrics and Gynaecology Cases – Reviews |

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-088.php?jid=ogcr

  Fecal incontinence (FI) is a socially devastating condition affecting both men and women. […] Its mechanism of action is incompletely understood though is thought to work on afferent pathways. […] How SNS effects improvement in FI has yet to be fully elucidated. […] SNS mechanism of action was initially thought to be due to augmentation of anal sphincter function. […] Instead, current evidence points to SNS working on afferent (sensory) pathways, though whether this is via modulating somato-visceral reflexes or by moderating the perception of afferent signalling remains to be defined.

• #30 Efficacy and mechanism of sub-sensory sacral (optimised) neuromodulation in adults with faecal incontinence: study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2689-1

  Pulling the above evidence together it is clear that the clinical efficacy of SNM has never been rigorously determined in a trial setting. There is, therefore, a need for a well-designed study of SNM that seeks to determine definitive proof of clinical effect size and which notably improves on the small number of existing randomised studies and observational data. Such a study has the opportunity to embed a hypothesis-led mechanistic study.

• #31 Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence

  https://www.mdpi.com/2624-5647/6/3/53

  The purpose of this study is to examine the effect of pelvic floor muscle training on faecal incontinence. Faecal incontinence is a condition in which stool leaks from the anus involuntarily or uncontrollably. […] The pathophysiology of faecal incontinence is diverse, and treatment methods must be varied accordingly. […] Pelvic floor muscle training can improve urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles such as the external anal sphincter and levator ani. […] However, the specific types of faecal incontinence patients that can effectively benefit from pelvic floor muscle training is unclear. […] The causes of faecal incontinence in frail patients are often neurogenic and involve conditions such as stroke, dementia, diabetes, and faecal embolism, as well as limitations in movement and visual impairment.

• #32 Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence

  https://www.mdpi.com/2624-5647/6/3/53

  The initial treatment basically involves conservative therapy for faecal incontinence. […] Faecal incontinence has a negative impact on quality of life, makes it difficult for individuals to be independent, and leads to isolation from society. […] The specific types of faecal incontinence patients that can benefit from pelvic floor muscle training is currently unknown. […] Pelvic floor muscle training is a method of improving urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles, such as the external anal sphincter and levator ani muscles. […] The effectiveness of pelvic floor muscle training for treating faecal incontinence ranges from 41% to 66%, and there are reports that this rate of effectiveness is lower than that of biofeedback therapy.

• #33 Effectiveness of Pelvic Floor Muscle Training for Treating Faecal Incontinence

  https://www.mdpi.com/2624-5647/6/3/53

  Pelvic floor muscle training may have a lower efficacy rate than biofeedback therapy, but 41% of patients who did not improve with other conservative treatments received pelvic floor muscle training alone. […] Pelvic floor muscle training is useful as a simple treatment method. […] Other conservative treatments for faecal incontinence require a combination of dietary therapy, lifestyle modification, and bowel habit guidance.

• #34 Fecal Incontinence – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/600_699/0611.html

  Fecal incontinence is the involuntary loss of flatus, liquid, or stool. Fecal incontinence may be caused by damage to the anal sphincter (eg, childbirth, surgery), diarrhea, fecal impaction, illnesses that cause the inability to expand and store fecal matter (eg, inflammatory bowel disease [IBD], Crohns disease or injury). […] The initial assessment includes basic office tests, a history and physical, and laboratory tests. Anorectal manometry is a test that uses a pressure sensitive tube to check the sensitivity and function of the rectum. It also measures the ability of the anal sphincter muscles to respond to signals. Anorectal ultrasonography is an ultrasound that is specific to the anus and rectum. This is utilized to evaluate the structure of the anal sphincter muscles. Rectal sensory testing is utilized to detect abnormal rectal sensation. When rectal sensation is reduced, stool may leak before the external sphincter contracts.

• #35 Faecal Incontinence | IntechOpen

  https://www.intechopen.com/chapters/61729

  Another functional evaluation is the anal neurophysiological testing. External anal sphincter electromyography, motor-evoked potentials, somatosensory evoked potentials, and sacral anal reflex latency measurement are currently available to evaluate neurogenic anorectal disorders. […] Endoanal ultrasound allows to visualize the complete ring of the internal anal sphincter (IAS), the complete ring of the superficial external anal sphincter (EAS) and the thickness of both anal sphincters in the middle level of the anal canal. […] An imaging assessment is mandatory in evaluating anal incontinence as sphincter tears are overlooked at clinical examination. Loss of ring continuity and loss of homogeneous intensity signal of the sphincters are pathologic detections due to damage of muscle fibers. […] The first step of therapy is conservative approaches, especially in patients with mild symptomatology, as dietary changing, medical therapy, muscles exercises (exercises of Kegel), biofeedback, and nonsurgical electrical nerve stimulation.

• #36 Fecal Incontinence – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/600_699/0611.html

  The Acticon Neosphincter artificial bowel sphincter for members 18 years of age or older with severe fecal incontinence (i.e., when there is involuntary loss of solid stool or liquid stool on a weekly or more frequent basis) who have failed, or are not candidates for, medical interventions (e.g., biofeedback, dietary management, pharmacotherapy, strengthening exercises) or surgical sphincter repair (e.g., post-anal repair, sphincteroplasty, or total pelvic floor repair); […] Sacral nerve stimulation (sacral neuromodulation) for the treatment of members with chronic fecal incontinence, who have had an inadequate response to conservative treatments (e.g., biofeedback, dietary management, pharmacotherapy, strengthening exercises), and who have a weak but structurally intact anal sphincter. […] Sacral nerve stimulation, also known as sacral neuromodulation, has been used successfully to treat urinary incontinence as well as non-obstructive urinary retention. However, its mechanism of action remains unclear. Sacral neuromodulation is also a novel treatment for fecal incontinence.

• #37 Fecal Incontinence – Medical Clinical Policy Bulletins | Aetna

  https://www.aetna.com/cpb/medical/data/600_699/0611.html

  For some patients with a sphincter defect, surgical procedures such as direct sphincter repair (sphincteroplasty), post-anal repair, or total pelvic floor repair may be attempted. Sphincteroplasty is utilized to repair a defect in the sphincter muscle in which the two ends of the muscle are cut and overlapped onto one another and then sewn into place to restore the complete circle of muscle. […] For individuals with severe fecal incontinence who have failed medical interventions and who are not candidates for sphincter repair, the choices are limited. An alternative surgical procedure, a dynamic muscle transposition, may be used in patients where the anal sphincter is either denervated or anatomically absent. It involves the transposition of muscle, usually the gracilis (gracilisplasty) or gluteus maximus, to create a barrier to the passage of stool.

• #38 Best conservative options for fecal incontinence – Price – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/8325/html

  The Renew Medical insert has been validated specifically by a single arm, non-randomized study that examined its efficacy using primary end points of 50% or greater reduction in FI episodes. […] The Eclipse Vaginal insert has been clinically evaluated in the 2015 LIFE study, which involved a total of 61 participants in an intention-to-treat group with primary end-point of 50% or greater reduction in FI episodes. […] All of the conservative treatments in this chapter can be considered as part of a comprehensive treatment strategy for FI, with patients who fail to improve then moving on to more advanced therapy such as sacral neuromodulation or sphincteroplasty if appropriate.

• #39

  https://fascrs.org/patients/diseases-and-conditions/a-z/fecal-incontinence-expanded

  Patients may report a minor loss of liquid stool which only stains undergarments sometimes referred to as seepage or staining. […] Further testing may be required to confirm the exact cause of the patients incontinence. […] The specific risks and benefits of each treatment option should be discussed with a provider. […] Regardless of what type of therapy is offered, patients must have realistic expectations regarding the outcomes of treatment. […] Surgical therapies for fecal incontinence include injection of biomaterials into the anal canal, radiofrequency treatment of the anal canal, repair of anal muscle injuries, sacral nerve stimulation, artificial bowel sphincter, muscle transposition to reinforce the anal sphincter, and creation of a stoma. […] The exact mechanism of how sacral nerve stimulation works is not well understood. […] The main risk of this procedure is infection, bleeding, and need for revisions.

• #40

  https://journals.lww.com/ajg/fulltext/2015/01000/epidemiology,_pathophysiology,_and_classification.17.aspx?generateEpub=Article%7Cajg:2015:01000:00017%7C10.1038/ajg.2014.396%7C

  In August 2013, the National Institutes of Health sponsored a conference to address major gaps in our understanding of the epidemiology, pathophysiology, and management of fecal incontinence (FI) and to identify topics for future clinical research. […] The pathophysiological mechanisms responsible for FI include diarrhea, anal and pelvic floor weakness, reduced rectal compliance, and reduced or increased rectal sensation; many patients have multifaceted anorectal dysfunctions. […] Despite the basic understanding of FI, there are still major knowledge gaps in disease epidemiology and pathogenesis, necessitating future clinical research in FI.

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