eMedicine Specialties > Obstetrics and Gynecology > Prolapse and Incontinence

Fecal Incontinence: Follow-up

Author: Sonia Ranganath, MD, Resident Physician, Department of Obstetrics and Gynecology, Tufts Medical Center
Coauthor(s): Tanaz R Ferzandi, MD, Assistant Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Division Director, Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center
Contributor Information and Disclosures

Updated: Sep 30, 2009

Outcome and Prognosis

Initial outcome after sphincteroplasty is 64–90% with short-term follow-up.62,68 The success rate starts to fall after the first few years and continues to fall with longer follow-up. Two long-term studies demonstrate that only half of the patients have satisfactory continence at 69-80 months postoperatively.69,70

Future and Controversies

The disappointing results of the artificial anal sphincter have led investigators to explore other therapies for severe fecal incontinence.

Sacral spinal nerve stimulation has been used successfully for the treatment of female patients with urinary incontinence associated with overactive bladder and nonobstructive urinary retention. The Medtronic InterStim device (Medtronic, Inc, Minneapolis, MN) is FDA approved in the United States for this indication. In Europe, sacral spinal nerve stimulation has given patients with fecal incontinence an option that is minimally invasive and appears to offer significant improvement. A recent randomized control trial of 120 patients with severe fecal incontinence demonstrated a significant improvement of incontinence symptoms, decreasing from 9.5 to 3.1 mean incontinence episodes per week when compared with optimal medical therapy that comprised bulking agents, pelvic floor exercises, and dietary management. These results are even more encouraging given that half of the patients had evidence of a sphincter defect and two thirds had evidence of pudendal neuropathy.

Interestingly, neither the maximal resting pressure, squeeze anal pressures, or pudendal nerve terminal latency had any association with improvement. In addition to a sustained functional improvement, quality of life was significantly enhanced as measured by fecal incontinence quality of life (FIQL) scores. Medtronic InterStim has been the modality of choice of investigators in this and other studies treating fecal incontinence.71 Long-term data of greater than 5 years since implantation is reassuring. In 52 patients who had undergone implantation, at least 50% improvement occurred in three quarters of the patients.72 Successful results have been demonstrated even with significant anal sphincter disruption.73

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Stephen D Seymour, DO to the development and writing of this article.



More on Fecal Incontinence

Overview: Fecal Incontinence
Workup: Fecal Incontinence
Treatment: Fecal Incontinence
Follow-up: Fecal Incontinence
Multimedia: Fecal Incontinence
References
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Further Reading

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Keywords

fecal incontinence, anal incontinence, anal sphincter disruption, spina bifida, myelomeningocele, prolonged second stage of labor, forceps delivery, significant tears, episiotomy, pudendal nerve injury, birth trauma, anterior overlapping sphincteroplasty

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Contributor Information and Disclosures

Author

Sonia Ranganath, MD, Resident Physician, Department of Obstetrics and Gynecology, Tufts Medical Center
Sonia Ranganath, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Tanaz R Ferzandi, MD, Assistant Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Division Director, Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center
Tanaz R Ferzandi, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Urogynecologic Society, International Urogynaecology Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Jose A Perez Jr, MD, MSEd, MBA, Consulting Physician, Department of Internal Medicine, Residency Director, Vice Chair of Education Department of Medicine, The Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College
Jose A Perez Jr, MD, MSEd, MBA is a member of the following medical societies: American College of Physician Executives, American College of Physicians, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals Obstetrics/Gynecology Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Department of Obstetrics/Gynecology, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals Obstetrics/Gynecology Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Department of Obstetrics/Gynecology, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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