Treatment

This very much depends on the underlying aetiology of the condition. Thus, establishing the cause is of prime importance in the treatment.

People with the following conditions should have these addressed with condition-specific interventions before healthcare professionals progress to initial management of faecal incontinence:

• faecal loading
• potentially treatable causes of diarrhoea (for example, infective, inflammatory bowel disease and irritable bowel syndrome)
• warning signs for lower gastrointestinal cancer
• rectal prolapse or third-degree haemorrhoids
• acute anal sphincter injury including obstetric and other trauma
• acute disc prolapse/cauda equina syndrome

Specific management intervention(s) offered should be based on the findings from the baseline assessment, tailored to individual circumstances and adjusted to personal response and preference (1):

• diet, bowel habit and toilet access should be addressed
• medication
  • healthcare professionals should consider alternatives to drugs that might be contributing to faecal incontinence
  • anti-diarrhoeal medication should be offered to people with faecal incontinence associated with loose stools once other causes (such as excessive laxative use, dietary factors and other medication) have been excluded
    • anti-diarrhoeal medication should be prescribed in accordance with the summary of product characteristics
    • anti-diarrhoeal drug of first choice should be loperamide hydrochloride. It can be used long term in doses from 0.5 mg to 16 mg per day as required. For doses under 2 mg, loperamide hydrochloride syrup should be considered. People who are unable to tolerate loperamide hydrochloride should be offered codeine phosphate or co-phenotrope
    • loperamide hydrochloride should not be offered to people with:
      • hard or infrequent stools
      • acute diarrhoea without a diagnosed cause
      • an acute flare-up of ulcerative colitis
    • when loperamide hydrochloride is used:
      • it should be introduced at a very low dose and the dose should be escalated, as tolerated by the individual, until the desired stool consistency has been achieved
      • it should be taken as and when required by the individual
      • individuals should be advised that they can adjust the dose and/or frequency up or down in response to stool consistency and their lifestyle
• people who continue to have episodes of faecal incontinence after initial management should be considered for specialised management. This may involve referral to a specialist continence service, which may include:
  • pelvic floor muscle training
  • bowel retraining
  • specialist dietary assessment and management
  • biofeedback
  • electrical stimulation
  • rectal irrigation.
• surgical treatment
  • people with a full-length external anal sphincter defect that is 90º or greater (with or without an associated internal anal sphincter defect) and faecal incontinence that restricts quality of life should be considered for sphincter repair
  • people with internal sphincter defects, pudendal nerve neuropathy, multiple defects, external sphincter atrophy, loose stools or irritable bowel syndrome should be informed that these factors are likely to decrease the effectiveness of anal sphincter repair
  • people undergoing anal sphincter repair should not routinely receive a temporary de-functioning stoma.

Reference:

1. NICE (2007).Faecal incontinence: the management of faecal incontinence in adults.