Fecal incontinence

involuntary passage of bowel contents for at least one month in a patient  age > 3.

Dx

clinical history and fexible sigmoidoscopy or anoscopy (best initial test).

The most accurate test is anorectal manometry. Patients with a history of anatomic injury should undergo endorectal manometry.

Treatment

Best initial treatment: Combine bulking agents (e.g., fber) with biofeedback techniques (e.g., control exercises and muscle strengthening exercises).

The best next step is endoscopic injection of dextranomer/hyaluronic acid in an efort to create a pseudo-sphincter. This technique has reduced incontinence episodes by 50 percent.

If this fails, colorectal surgery is needed.