Treatment of fecal incontinence: State of the science summary for the national institute of diabetes and digestive and kidney diseases workshop

William E. Whitehead, Satish Sanku Chander Rao, Ann Lowry, Deborah Nagle, Madhulika Varma, Khalil N. Bitar, Adil E. Bharucha, Frank A. Hamilton

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

This is the second of a two-part summary of a National Institutes of Health conference on fecal incontinence (FI) that summarizes current treatments and identifies research priorities. Conservative medical management consisting of patient education, fiber supplements or antidiarrheals, behavioral techniques such as scheduled toileting, and pelvic floor exercises restores continence in up to 25% of patients. Biofeedback, often recommended as first-line treatment after conservative management fails, produces satisfaction with treatment in up to 76% and continence in 55%; however, outcomes depend on the skill of the therapist, and some trials are less favorable. Electrical stimulation of the anal mucosa is ineffective, but continuous electrical pulsing of sacral nerves produces a ≥50% reduction in FI frequency in a median 73% of patients. Tibial nerve electrical stimulation with needle electrodes is promising but remains unproven. Sphincteroplasty produces short-term clinical improvement in a median 67%, but 5-year outcomes are poor. Injecting an inert bulking agent around the anal canal led to ≥50% reductions of FI in up to 53% of patients. Colostomy is used as a last resort because of adverse effects on quality of life. Several new devices are under investigation but not yet approved. FI researchers identify the following priorities for future research: (1) trials comparing the effectiveness, safety, and cost of current therapies; (2) studies addressing barriers to consulting for care; and (3) translational research on regenerative medicine. Unmet patient needs include FI in special populations (e.g., neurological disorders and nursing home residents) and improvements in behavioral treatments.

Original languageEnglish (US)
Pages (from-to)138-146
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume110
Issue number1
DOIs
StatePublished - Jan 1 2015

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National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
Fecal Incontinence
Education
Electric Stimulation
Antidiarrheals
Therapeutics
Tibial Nerve
Pelvic Floor
Regenerative Medicine
Colostomy
Translational Medical Research
National Institutes of Health (U.S.)
Anal Canal
Patient Education
Nursing Homes
Nervous System Diseases
Cost-Benefit Analysis
Needles
Electrodes
Mucous Membrane

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Treatment of fecal incontinence : State of the science summary for the national institute of diabetes and digestive and kidney diseases workshop. / Whitehead, William E.; Rao, Satish Sanku Chander; Lowry, Ann; Nagle, Deborah; Varma, Madhulika; Bitar, Khalil N.; Bharucha, Adil E.; Hamilton, Frank A.

In: American Journal of Gastroenterology, Vol. 110, No. 1, 01.01.2015, p. 138-146.

Research output: Contribution to journalReview article

Whitehead, William E. ; Rao, Satish Sanku Chander ; Lowry, Ann ; Nagle, Deborah ; Varma, Madhulika ; Bitar, Khalil N. ; Bharucha, Adil E. ; Hamilton, Frank A. / Treatment of fecal incontinence : State of the science summary for the national institute of diabetes and digestive and kidney diseases workshop. In: American Journal of Gastroenterology. 2015 ; Vol. 110, No. 1. pp. 138-146.
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