Medical treatment of fecal incontinence

Fecal incontinence is an infirmity reaching 2 % of the french population.The aim of the medical treatment is to improve or removethe troubles of fecal incontinence on personal, social, family andprofessional life. Medical treatment of fecal incontinence consistson disparition or improvement of transit disorders associated withincontinence. One half of patients suffering of fecal incontinencemay be improved by medical treatment. Passive incontinence meaningloss of stools without defecation feeling is often associated withconstipation. Passive incontinence can be improved by laxative useto clean rectal and colonic impaction. The colonic transit timemeasurement and a spontaneous or provoked defecation, or loss ofstools timetable is useful for treatment adaptation with rectal enemasand/or osmotic laxatives. Active incontinence meaning loss ofstools after an urge of defecation is often associated with diarrhea.Since an organic cause of diarrhea is suppressed, the use of transitregulators is allowed. In conclusion we propose a three levels management:the transit disorders are treated by general practitionersand gastroenterologists (first level), in case of lack of transit disordersor of treatment failure, the research of pelvic floor troubles isdone and treated in specialised centers (second level), and in case oflack of pelvic floor troubles the anal deficiency is investigated andthe treatment is effected in a few of very specialised centers (thirdlevel).