Anal Incontinence (Fecal Incontinence)

Anal Incontinence (Fecal Incontinence) – Treatment Overview

Introduction
Anal incontinence, also known as fecal incontinence, is the involuntary loss of stool or flatus. It can significantly affect quality of life and may result from multiple factors including sphincter injury (e.g., obstetric trauma, anorectal surgery), neurological disease (spinal cord lesions, neuropathy), diarrhea, constipation with overflow, and reduced rectal compliance.

Management involves identifying and treating underlying causes, improving stool consistency, strengthening sphincter function, and using surgical options when conservative therapy fails.

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Treatment Options

1. Conservative Measures (first-line for all patients)

• Dietary modification: High-fiber diet (20–30 g/day) to bulk stool.

• Anti-diarrheal agents:

  • Loperamide 2–4 mg orally, up to 16 mg/day, to reduce stool frequency and increase anal sphincter tone.

  • Diphenoxylate-atropine as an alternative.

• Bowel training: Scheduled toileting, rectal emptying techniques.

• Pelvic floor exercises (Kegel exercises): Strengthens anal sphincter and pelvic floor muscles.

• Biofeedback therapy: Provides real-time feedback to improve coordination and sphincter control.

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2. Medical and Procedural Therapy

• Bulking agents: Psyllium, methylcellulose to normalize stool form.

• Biofeedback with electrical stimulation: Improves sphincter contraction and rectal sensation.

• Injectable bulking agents (e.g., dextranomer in hyaluronic acid): Endoscopic injection into the anal canal to improve closure.

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3. Surgical Options (for refractory cases)

• Sphincteroplasty: Repair of a damaged anal sphincter (commonly due to obstetric trauma).

• Artificial bowel sphincter implantation: Inflatable cuff placed around the anal canal, controlled by a pump.

• Sacral nerve stimulation (neuromodulation): Electrical stimulation of sacral nerves to improve continence; effective in many patients.

• Dynamic graciloplasty or muscle transposition: Rarely used; involves transposition of muscle to augment sphincter function.

• Colostomy: Last-resort option for severe, refractory incontinence when other measures fail.

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Supportive and Adjunctive Care

• Skin care: Barrier creams and gentle cleansing to prevent perianal dermatitis.

• Absorbent pads: For protection and confidence in daily activities.

• Psychological support: Counseling and support groups to address the emotional impact.