Chapter 53 - Fecal incontinence and CRC

Abstract

The lack of voluntary stool control is a problem that affects many people, deteriorating their quality of life. To this day, it continues to be an underdiagnosed and stigmatized entity in the population. In the context of colorectal cancer (CRC), a reversible incontinence condition known as low anterior resection syndrome (LRA) has been described, which resolves in the first months after performing this particular type of surgery. There is no gold standard treatment, so it requires careful and multidisciplinary management with not always entirely satisfactory results. The initial treatment involves dietary measures, the suppression of certain drugs that can aggravate the symptoms, and the prescription of specific therapeutic agents: loperamide and methylcellulose in addition to topical phenylephrine gel. If this is not effective, treatment is usually escalated with more invasive measures depending on the response obtained. From less to greater aggressiveness, biofeedback is continued, a feedback technique that requires the integrity of the sphincter complex, and other more complex measures such as the possibility of sacral neuromodulation, with which by inserting an electrode in the sacral foramen improvement of continence or sphincter correction surgery is achieved in case of injury to the same. In addition, in recent years new techniques have emerged for its handling, which at the moment have little experience, being considered experimental.