Fecal incontinence. Effective nonsurgical treatments.

Management of the patient with fecal soiling begins with a careful evaluation of possible contributing factors, followed by anorectal examination, neurologic and psychosocial testing, and workup for chronic diarrhea, if present. In many patients, these procedures should be supplemented by radiologic and manometric studies to determine if structural or functional anorectal abnormalities are present. Therapeutic approaches include behavioral, pharmacologic, and surgical methods, which should be carefully considered in relation to the underlying cause of incontinence. For the experienced physician, therapy can be gratifyingly effective in many patients with fecal soiling and can dramatically improve their quality of life.