Diagnosis and conservative therapy of anal fecal incontinence

Abstract

The main diagnostic tool for patients with anal incontinence is the anorectal physiology. The anorectal sphincter can be reliably tested. Due to the fact that an obstetric damage is the most common cause of anal incontinence, the transanal endosonography is the imaging method of choice for detecting a muscle defect. With high frequency ultrasound probes (preferable 10 Mhz) the pathomorphology of the sphincter can be studied in details. If conservative treatment is failing, the neurophysiology testing is helpful in deciding which surgical method (sphincter repair in case of an intact nervus pudendus, artificial sphincter or sacral stimulation in case of neuropathy). The conservative treatment includes increasing the internal sphincter muscle tonus by applying Phenylephrine locally or Loperamid per os. The biofeedback is basically a physical muscle training of the external sphincter with a visual or acoustic feedback of the muscle function to the patient. However, newer studies show that by this method the sensory function and the coordination of the anal sphincter are improving as well. With these conservative treatment options most of the patients suffering from anal incontinence can be treated satisfactorily.