Conservative and Pharmacological Management of Faecal Incontinence in Adlts

Backgrounds: Fecal incontinence affects up to 36% of primary carepatients. Although effective treatments are available, doctorsrarely screen for this condition and patients seldomvolunteer complaints of fecal incontinence. Material and method: This article provides an up-to-date commentary onfecal incontinence for the primary care physician. Itincludes a short summary of the prevalence and impactof this problem on quality of life, recommendations fordiagnostic assessment, and a review of treatment optionsavailable to the community-based physician Result:Embarrassment about the stigma of havingfecal incontinence was important to many of the patientsinterviewed, but embarrassment did not separate thosewho consulted their doctor about this problem from theones who did not. However, 2 primary factors were differentin patients who consulted doctors: greater knowledgeabout fecal incontinence and available treatment options,and greater severity of the condition. Patients with morefrequent fecal incontinence were also more likely to talk totheir doctor.Conclusion: and do notscreen for this condition. Second, diagnosis and managementof fecal incontinence do not require referral to a specialistcenter; a good history and digital rectal examinationcan identify the most common causes of fecal incontinenceand guide treatment or referral. Third, conservative treatmentis within the community physician’s scope of practice;it includes patient education, normalizing stool consistencywith diet and nonprescription medications, and pelvic floorexercises. Such treatment can be expected to improve fecalincontinence by about 60%, and it eliminates the problemfor 1 in 5 patients. Finally, the University of North Carolina atChapel Hill is conducting several research programs fundedby the NIH that are attempting to reduce patients’ barriersto consulting about fecal incontinence, increase screeningby physicians, and develop online resources to support physicians’use of conservative treatment.