Incontinence, Fecal

Kalyanakrishnan Ramakrishnan, MD Reviewed 06/2020

BASICS

Continuous or recurrent involuntary passage of fecal material through the anal canal for >1 month in an individual at least 4 years of age

Diagnosis is based on history and physical findings.

Patients seldom volunteer information about fecal incontinence. Direct questioning is important.
Problem-specific history includes ...

In ambulatory patients, scheduled (or prompted) defecation is effective, particularly in those with overflow incontinence.
Kegel exercises to strengthen pelvic floor
If bed-bou...

Periodic rectal exam

Consider impaction if there is <1 bowel movement every other day in patients with fecal incontinence.

Tjandra JJ, Dykes SL, Kumar RR, et al. Practice parameters for the treatment of fecal incontinence. Dis Colon Rectum. 2007;50(10):1497–1507.

Omar MI, Alexander CE. Drug treatment for...

Menees SB. My approach to fecal incontinence: it’s all about consistency (stool, that is). Am J Gastroenterol. 2017;112(7):977–980.

Scheduled defecation after meals, bulking agents, and scheduled enemas minimize impaction and are helpful in mild/moderate fecal incontinence.
Differentiate true incontinence from pseud...

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