Clinician Summary – Jul. 5, 2016
Treatments for Fecal Incontinence: Current State of the Evidence
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Table of Contents
- Focus of This Summary
- Background
- Conclusions
- Overview of Clinical Research Evidence
- Gaps in Knowledge and Limitations of the Evidence Base
- What To Discuss With Your Patients and Their Caregivers
- Source
Focus of This Summary
This is a summary of a systematic review evaluating the evidence regarding the potential benefits and adverse effects of surgical and nonsurgical treatments for fecal incontinence in adults. The systematic review included 63 unique studies plus 53 surgical case series published from 1980 to June 2015. While this summary is provided to assist in informed clinical decisionmaking, evidence reviews should not be construed to represent clinical recommendations or guidelines.
Background
Fecal incontinence is the recurrent involuntary loss of feces, which is defined by the frequency of episodes (such as daily or weekly episode counts) and by the consistency of the feces (solid, liquid, or mucus). The causes of fecal incontinence may be neurological or non-neurological. However, multiple causes of fecal incontinence in individuals are common and a dominant etiology may not be determinable. The negative psychological effects, social stigma, and reduced quality of life surrounding fecal incontinence can be devastating. Severe skin breakdown and ulceration can result from fecal incontinence, particularly in nursing home residents and immobile adults.
Treatment goals are to decrease the frequency and severity of fecal incontinence episodes. Treatments for fecal incontinence are often delivered in combination. Treatments typically follow a progression from less invasive nonsurgical interventions (dietary fiber, drugs, pelvic floor muscle training with biofeedback [PFMT-BF]) to more invasive nonsurgical (anal sphincter tissue-bulking injections) or surgical interventions.
Nonsurgical treatments include dietary fiber supplementation, bowel schedules, stool-modifying drugs, PFMT-BF, anal plugs, rectal irrigation, or combinations thereof. The U.S. Food and Drug Administration (FDA) approved a vaginal bowel-control device in February 2015. Injection of biocompatible tissue-bulking agents into the anal canal walls is a newer, nonsurgical procedure.
Surgical procedures used to treat fecal incontinence in the United States include implanted sacral nerve stimulation, radiofrequency anal sphincter remodeling, antegrade colonic enema, anal sphincter repair (sphincteroplasty), sphincter replacement (artificial anal sphincter), surgical correction of conditions that can result in fecal incontinence (rectal prolapse, hemorrhoids, or rectocele), or colostomy when all other treatments fail.
Access the full report for more background information.
AHRQ Research Summaries Support Decision Making About Treatments for Fecal Incontinence in Adults
Treatments for Fecal Incontinence: A Review of the Research for Adults - Consumer Summary | AHRQ Effective Health Care Program
Treatments for Fecal Incontinence: Current State of the Evidence - Clinician Summary | AHRQ Effective Health Care Program
Treatments for Fecal Incontinence - Research Review - Final | AHRQ Effective Health Care Program
New evidence-based research summaries are available from AHRQ to help clinicians, adults and their caregivers make informed treatment decisions about fecal incontinence – the recurrent and involuntary loss of feces, defined by the frequency of episodes and consistency of the feces. The summaries present the benefits and harms of both nonsurgical and surgical treatments for fecal incontinence. Because the evidence on treatments is limited, it is important that clinicians and patients work together to decide which treatment approaches might be best. A research summary for cliniciansand a companion brochure for patients and their caregiversprovide important discussion points that can most affect outcome priorities and quality of life of the patient. Access the full research review, or obtain more evidence-based clinician and consumer publications about treatment options for a variety of health conditions at the Effective Health Care Program website.
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