Best conservative options for fecal incontinence

Abstract

Fecal incontinence (FI) is most commonly addressed by more advanced techniques such as sacral neuromodulation or in the appropriate setting, sphincteroplasty. Prior to progressing to more advanced therapeutic measures, clinicians should be aware of all available conservative options. It is the aim of this chapter to discuss the most prominent conservative therapeutic options for the control of FI and to outline the data available to support their use. Specifically, we will discuss dietary modification, biofeedback, bulking injections, tibial nerve stimulation, and insert devices. Dietary modification involves the use of adoptive or restrictive consumption strategies with or without the use of fiber replacement or supplementation therapy. Biofeedback is a strategy that uses instrument-guided objective measurement to gain awareness of physiologic function for the purpose of improving control over these functions. Bulking injections are a form of treatment for FI that involve injection of various biocompatible bulking agents, primarily NASHA Dx, into the anal canal submucosal space. Tibial nerve stimulation utilizes either percutaneous or transcutaneous repetitive electrical nerve stimulation completed over a prescribed interval for the purposes of improving FI. Finally, our discussion of insert devices includes an overview of both anal and vaginal insert devices currently available for use in controlling FI.