Surgical management of faecal incontinence in adults

Abstract

Faecal incontinence has a long list of aetiology. Definitive treatment depends on the underlying condition. If a non‐surgical cause is identified, conservative treatment is often appropriate. Surgical management is more often successful when a structural damage of the anal sphincter is found. Overlapping sphincter repair has a high success rate when the anal sphincter is disrupted. Surgery has a clear role to play in the case of idiopathic faecal incontinence; and sacral nerve stimulation is the most promising treatment presently available. Dynamic muscle transposition and artificial bowel sphincter are the remaining alternatives after unsuccessful attempts at sphincter repair or in the case of end‐stage faecal incontinence. Spinal cord injury or diseases contribute significantly to faecal incontinence. Malone’s antegrade continence enema has been shown to be helpful to these patients. The greatest benefit of this treatment modality appears to occur with children. With adults, experience is sparse. For the debilitated geriatric patient whose faecal incontinence has led to perianal skin excoriation, bed sores or perianal sepsis, a well‐sited colostomy is sometimes the kindest option apart from diligent nursing care. Biofeedback and pelvic floor exercises are helpful adjuncts and sometimes the primary mode of therapy. It carries no risk in its own right and is worth trying provided the patient is motivated and a dedicated therapist is available.