Nat Rev Dis Primers. 2022 Aug 10;8(1):53. doi: 10.1038/s41572-022-00381-7.

Adil E Bharucha ¹, Charles H Knowles ², Isabelle Mack ³, Allison Malcolm ⁴, Nicholas Oblizajek ⁵, Satish Rao ⁶, S Mark Scott ², Andrea Shin ⁷, Paul Enck ⁸

Author information

¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. bharucha.adil@mayo.edu.

²Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK.

³University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany.

⁴Department of Gastroenterology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia.

⁵Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.

⁶Department of Gastroenterology, University of Georgia, Augusta, GA, USA.

⁷Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA.

⁸University Hospital, Department of Psychosomatic Medicine, Tübingen, Germany. paul.enck@uni-tuebingen.de.

Abstract

Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.