Fecal Incontinence

Fecal incontinence, defined as the involuntary loss of gas, liquid, or solid stool through the anal canal, occurs in an estimated 18 million adults in the United States. Fecal incontinence causes social isolation and confines patients to their homes; additionally, it contributes to medical morbidity, including urinary tract infections, perianal skin breakdown, and decubitus ulcers. Causes for fecal incontinence can be broken down into three broad categories: neurologic disease; functional gastrointestinal diseases or abnormalities; and structural injuries or abnormalities in the pelvic floor, rectum, or anal sphincter. This review describes the clinical evaluation of, investigative studies related to, and management of fecal incontinence. Tables review common causes of sphincter injury, the Fecal Incontinence Severity Index, and daily life factors measured by the Fecal Incontinence Quality of Life questionnaire. Figures show an obstetric sphincter injury, an algorithm outlining the workup and management of fecal incontinence, ultrasonograms of a normal anal sphincter and a sphincter defect, the steps involved in sphincteroplasty, sacral nerve stimulation, and an artificial anal sphincter. This review contains 6 figures, 3 tables, and 54 references.