#210 Fecal Incontinence

Question 1

Fecal incontinence is estimated to affect what % of community-dwelling women?

Answer 1

7-15%

Question 2

What % of women that self-report fecal incontinence will have this diagnosis in their medical record?

Answer 2

<3%

Question 3

What is the definition of fecal incontinence?

Answer 3

Recurrent, involuntary loss of solid or liquid stool or mucus from the rectum

Question 4

What is the definition of anal incontinence?

Answer 4

Recurrent, involuntary loss of solid or liquid stool or mucus from the rectum, but also includes loss of flatus with or without the loss of liquid and solid stool.

Question 5

What is the risk of fecal incontinence in age 20-29? Adults 70 years and older?

Answer 5

2. 6% in age 20-29.

15. 3% in age 70+

Question 6

Is fecal incontinence more prevalent in men or women?

Answer 6

Similar. Women 8.9%; Men 7.7%

Question 7

What % of individuals with fecal incontinence symptoms do not seek help or report them to their health care provider?

Answer 7

75-80%

Question 8

What are common nonneurologic etiologies of fecal incontinence?

Answer 8

Diarrheal diseases, IBD, fistula, severe constipation with overflow, rectal prolapse, hemorrhoids, sphincter lacs/anal trauma, systemic diseases, medications

Question 9

What are risk factors associated with fecal incontinence?

Answer 9

Loose or watery stools, increased frequency of stools (more than 21 per week), two or more chronic illnesses. Urinary incontinence, obesity, smoking, increasing age, decreased physical activity, anal intercourse, hx of OASIS, hx pelvic irradiation, other med comorbidities (eg DM, IBD)

Question 10

What are nonsurgical treatment options for fecal incontinence?

Answer 10

Protective devices, dietary manipulations (fiber, fluid), anticonstipation meds, fiber supplement, antidiarrheal med, pelvic floor physical therapy, devices (anal plugs, vaginal bowel control devices)

Question 11

What is an invasive, non surgical option for management of fecal incontinence?

Answer 11

Perianal tissue bulking injection

Question 12

What surgical options are available for treatment of fecal incontinence?

Answer 12

Neuromodulation, anal sphincter repair, radiofrequency anal sphincter remodeling, sphincter muscle transposition, artificial anal sphincter, colostomy

Question 13

What questions should be asked regarding symptom assessment for fecal incontinence?

Answer 13

Questions about type and timing of accidental bowel leakage (solid, liquid, gas, mucus), frequency, severity (volume), relationship to fecal urgency, and effective on daily activities and quality of life

Question 14

What is the name of the scale that describes form of stool?

Answer 14

Bristol stool form scale

Question 15

What is the “dovetail” sign (Re: Fecal incontinence)?

Answer 15

Loss of the normal puckering around the anus anteriorly – may indicate a disruption of the external anal sphincter

Question 16

What is the sensitivity and specificity of the digital rectal examination for detection of complete anal sphincter disruption?

Answer 16

82% sensitivity

32% specificity

Question 17

Why do stool-modifying agents help with fecal incontinence?

Answer 17

Improve stool consistency because the fecal continence mechanism works best for patients with formed, bulky, soft stool

Question 18

What symptoms are associated with rapid increase in fiber intake?

Answer 18

Flatus, bloating, abdominal cramping

Question 19

How many grams of fiber should a woman consume per day (ages 19-30, 31-50, 51+)?

Answer 19

19-30yo: 28g
31-50yo: 25.2g
51+yo: 22.4g

Question 20

What is the medical mainstay therapy for overflow fecal incontinence associated with constipation or impaction?

Answer 20

Osmotic laxatives such as lactulose or polytheylene glycol

Question 21

In which cases of fecal incontinence would you primarily offer surgery prior to lifestyle changes?

Answer 21

Fistulas or rectal prolapse

Question 22

True or false, fecal incontinence surgeries are associated with longterm improvement in symptoms

Answer 22

False. Provide only short-term improvement (3-6mo)

Question 23

What neuromodulation exists to address fecal incontinence?

Answer 23

Sacral nerve stimulation and peripheral tibial nerve stimulation

Question 24

What nerve is targeted with sacral nerve stimulation?

Answer 24

Third sacral nerve root

Question 25

True or false, sacral nerve stimulation is a treatment option for women with fecal incontinence with or without anal sphincter disruption?

Answer 25

True

Question 26

What typical adverse events can occur after sacral nerve stimulation?

Answer 26

Pain, infection, lead migration, hematoma, need for battery replacement or revisions to the wire or battery pocket site

Question 27

Is end-to-end or overlapping manner of sphincteroplasty better?

Answer 27

Similar outcomes

Question 28

What is radiofrequency anal sphincter remodeling?

Answer 28

Radiofrequency energy is directed toward the submucosa at the anorectal juncture to create scarring and fibrosis of the anal sphincter. Currently no data from high-quality studies to support its use

Question 29

For how long would you expect anal sphincter bulking agents to be effective in decreasing fecal incontinence episodes?

Answer 29

Up to 6 months

Question 30

Which women are candidates for anal sphincteroplasty?

Answer 30

Women with anal sphincter disruption and fecal incontinence symptoms who have failed conservative treatments

Question 31

Which women with fecal incontinence should be considered for colonoscopy?

Answer 31

Change in bowel habbits especially with “red flag” symptoms, including unexplained weight loss, abdominal pain, rectal bleeding, melena, or anemia.