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Investigation and treatment of faecal incontinence

University of Hull, Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK

Correspondence to:
Correspondence to:
MrG S Duthie
University of Hull, Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK; g.s.duthie{at}hull.ac.uk

Faecal incontinence is a debilitating condition affecting people of all ages, and significantly impairs quality of life. Proper clinical assessment followed by conservative medical therapy leads to improvement in more than 50% of cases, including patients with severe symptoms. Patients with advanced incontinence or those resistant to initial treatment should be evaluated by anorectal physiology testing to establish the severity and type of incontinence. Several treatment options with promising results exist. Patients with gross sphincter defects should undergo surgical repair. Those who fail to respond to sphincteroplasty and those with no anatomical defects have the option of either sacral nerve stimulation or other advanced procedures. Stoma formation should be reserved for patients who do not respond to any of the above procedures.

Abbreviations: FI, faecal incontinence; EAUS, endoanal ultrasonography; IAS, internal anal sphincter; EAS, external anal sphincter; IP, impedance planimetry; PNTML, pudendal nerve terminal motor latency; ACE, antegrade continence enema; ABS, artificial bowel sphincter; SNS, sacral nerve stimulation

Keywords: anal sphincter; faecal incontinence; anal sphincter repair; sacral nerve stimulation; anorectal physiology; review

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