Nonsurgical fecal incontinence Tx often works: biofeedback, bowel management.(Gynecology)

ST. LOUIS--Nonsurgical treatment for fecal incontinence is often sufficient, Dr. Wayne B. Tuckson said at the 13th International Pelvic Reconstructive and Vaginal Surgery Conference.

Changes in dietary habits, such as avoiding gaseous foods, limiting caffeine, and increasing bulk, can help, as can certain medications. In those patients with chronic diarrhea--which can cause or worsen incontinence--constipating medications like Imodium and phenylephrine can help, said Dr. Tuckson, a colorectal surgeon in private practice in Louisville, Ky.

Imodium acts on the circular smooth muscle and increases resting anal tone and sphincter contraction. Topical phenylephrine increases anal canal resting pressure, and in a small, double-blind crossover study, 6 of 12 patients treated with it experienced improvements in their incontinence while 4 of 12 had complete cessation of incontinence.

Bowel management can also be achieved in some patients with stimulated defecation, which empties the bowel, reducing the likelihood of inadvertently passing stool. Enemas or suppositories can be used for this purpose, and are most effective when used 30 minutes after eating.

Biofeedback is another option for some patients. Indications for this approach include a weak but intact sphincter, intact innervation, and a motivated patient.

Biofeedback is not helpful in those with sphincter disruption or complete denervation, Dr. Tuckson said at the meeting, which was sponsored by the Society of Pelvic Reconstructive Surgeons and Emory University. When surgical treatment is warranted, options include occlusion, sphincteroplasty, neosphincter, radio-frequency energy, and fecal diversion.

Occlusion, such as with the ProCon A200 device, involves the use of an anal plug with a sensor that indicates when feces is present. The plug is removed to allow defecation and then ...