Diagnosis and Management of Fecal Incontinence in the Elderly

Abstract

The incidence of fecal incontinence in elderly patients (age≥65 years) ranges from 3.0%-16.9%, and is more prevalent in women. It is associated with significant psychosocial morbidity. The causes of fecal incontinence include sphincter injury, impaired sensation, incomplete evacuation, and neuropathy. The most common cause is obstetrical injury during forceps delivery. Some drugs such as oxybutinin, antidepressants, caffeine, and laxatives can also result in fecal incontinence. Eighty percent of patients have more than one causative abnormality. Fecal incontinence can be classified as passive incontinence, urge incontinence, or fecal seepage (soiling). Fecal seepage involves incomplete evacuation and impaired rectal sensation. When fecal incontinence is associated with urinary incontinence, it usually suggests significant pelvic floor abnormality. Physical examination should include a thorough perineal and rectal examination including the anocutaneous reflex. Laboratory data including anal manometry, anal endosonography, and pudendal nerve latency are usually informative for an accurate diagnosis. The treatment of fecal incontinence in the elderly should focus on treating underlying conditions, providing supportive measures, and following specific measures. Education and counseling for patients, including dietary control (with attention to fructose and caffeine), are important. Medications such as lomotil, loperamide, cholestyramine, amitryptyline, and alosetron are sometimes useful. Evidence-based data shows that biofeedback is beneficial in the elderly population. Surgical methods including sphincteroplasty, anterior repair, graciloplasty, and an artificial sphincter vary in treatment efficacy, and can be applied to the elderly population after deliberation of their comobidities. Other less invasive treatment modalities such as anal plugs, sphincter bulking, electrical stimulation, and sacra l nerve stimulation are sometimes particularly beneficial in improving the quality of life of elderly patients.