Current Practice of Fecal Incontinence in Our Institution

Abstract

Fecal incontinence is a devastating and humiliating symptom that greatly affects patients' quality of life. Several factors are associated with anal continence, such as the internal and external anal sphincter, anorectal angle, rectal reservoir, anal sensation, and stool consistency. The evaluation of fecal incontinence is based on interviews, physical examinations, and anorectal functional tests including anal manometry, anal ultrasound, and pudendal nerve terminal motor latency tests. For patients with occasional passive incontinence, anti-diarrheal drugs such as polycarbophil calcium and lopermide are effective in reducing their symptoms. For some patients who complain of urgency, pelvic floor muscle exercise and biofeedback training are other treatment options. For patients with a previous history of third or fourth degree perineal tear, we prefer overlapping sphincteroplasy preserving the scar and reconstruction of the perineal body. The most challenging part of the treatment of FI is how to treat those patients without sphincter defects (so-called idiopathic FI) who do not respond to medical treatment or biofeedback training. We have performed and investigated since 2001 a novel procedure named the perineal puborectalis sling operation. The preliminary results of the first eight patients reported improving symptoms and QOL scores. The routing technique has been modified to avoid the risk of complications.