June 2004 · Vol. 16, No. 6Fecal incontinence: Current strategies for a debilitating disease
Diagnostic studies, noninvasive therapies, and surgical interventions have all evolved in recent years. The result: an improving outlook for women with this stigmatizing condition.
SUJATHA
RAJAN,
MD;
NEERAJ
KOHLI,
MD, MBADr. Rajan is a fellow and Dr. Kohli is chief, division of urogynecology and reconstructive pelvic surgery, Brigham and Women’s Hospital, Boston, Mass. Dr. Kohli is also a member of the OBG MANAGEMENT Board of Editors.
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KEY POINTS
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Endoanal ultrasound is superior to other diagnostic methods, with an accuracy of over 90% in detecting sphincter injuries, compared to 75% for manometry, 75% for electromyography, and 50% for clinical assessment.
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Pelvic floor rehabilitation with biofeedback/electrical stimulation is the mainstay nonsurgical treatment. Some centers report success rates as high as 70%.
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Consider surgery only for distinct anatomic defects, and only when nonsurgical interventions have not succeeded.
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Thanks to improvements in our understanding of the causes of uncontrolled defecation and an increasing array of diagnostic and treatment options, physicians can now manage this condition more effectively.
Fecal incontinence is a relevant clinical issue for Ob/Gyns, and requires compassion and emotional support on the part of the physician and health-care team. This debilitating problem is underreported, but is thought to affect 2.2% of the general population. Women are 8 times more likely to have fecal incontinence than men, in age-controlled groups.1
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