Treatments for Fecal Incontinence [entered retrospectively]

Project Summary Title and Description

Treatments for Fecal Incontinence [entered retrospectively]
Objective. To assess the efficacy and comparative effectiveness of surgical and nonsurgical treatments for fecal incontinence (FI) in adults. Data sources. Ovid MEDLINE®, Embase®, PEDro®, CINAHL, AMED, and the Cochrane Central Register of Controlled Trials (CENTRAL), hand searches of systematic reviews. Methods. Two investigators screened abstracts of identified references for eligibility (examined treatments in adults with FI, published from 1980 to present, had a control/comparator group; case series were included for surgical interventions). Full-text articles were reviewed to identify patient-reported outcomes (FI episodes, FI severity, quality of life, urgency, pain, other). We extracted data, assessed risk of bias of individual studies, and evaluated strength of evidence for each comparison and outcome. Results. Sixty-three unique studies met inclusion criteria; an additional 53 surgical case series were examined for surgical adverse effects. Enrolled adults were mostly female with mixed FI etiologies. Most RCTs were nonsurgical (n=38); 13 examined pelvic floor muscle training (PFMT) and PFMT with biofeedback (PFMT-BF). Meta-analysis was not possible because numerous outcomes were used. Low strength evidence suggests that dietary fiber (psyllium) decreases FI episodes (-2.5 per week) at 1 month; clonidine has no effect; and PFMT-BF with electrostimulation is no more effective than PFMT-BF for FI severity and quality of life over 2 to 3 months. Low-strength evidence at 6 months suggests that dextranomer anal bulking injections are more effective than sham injections on FI quality of life, the number of FI-free days, and the percent of adults with at least 50 percent reduction from baseline in FI episodes; but no more effective than PFMT-BF with or without electrostimulation on FI severity (PFMT-BF -5.4 vs. dextranomer -4.6 point Vaizey score improvements) and quality of life; and no more effective than sham injection on FI severity (-2.5 versus -1.7 point sham improvement in Cleveland Clinic FI score [CCFIS]) or FI episode frequency. Moderate-strength evidence suggests that Durasphere® (off-label) bulking injections reduce FI severity up to 6 months (-4 to -5 points CCFIS) but gains diminish thereafter. Evidence was insufficient for all other surgical and nonsurgical comparisons. Surgical improvements varied. Noninvasive nonsurgical treatments had few minor adverse effects (AEs). Surgical treatments were associated with more frequent and more severe complications than nonsurgical interventions. AEs were most frequent for the artificial bowel sphincter (22-100 percent of adults). Surgical AEs ranged from minor to major (infection, bowel obstruction, perforation, fistula). Major surgical complications often required reoperation; fewer required permanent colostomy. Only 12 percent of randomized controlled trials (RCTs) were high quality. Conclusion. There is limited evidence to support any FI treatments beyond 3 to 6 months. It is difficult to compare the effectiveness of surgical to nonsurgical FI treatments because nonsurgical approaches generally precede surgery, and adults who undergo surgery have typically failed more nonsurgical treatment. Most current interventions show modest improvements in FI outcomes that meet minimal important differences (MID) in the short term, where MID is known. More invasive surgical procedures have substantial complications. Numerous outcome measures and lack of compliance with study reporting standards are modifiable impediments in the field. Future studies should focus on longer-term effects and attempt to identify subgroups of adults by FI etiology that might benefit from specific interventions.
Authors of Report
Methodology description
Funding Source

Key Questions

1. What is the comparative effectiveness of treatments to improve quality of life and continence and lessen the severity of fecal incontinence in affected adults?
2. What adverse effects are associated with specific treatments for adults with fecal incontinence?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Biofeedback for fecal incontinence: a randomized study comparing exercise regimens.
Supplementation with dietary fiber improves fecal incontinence.
Dietary fiber supplementation for fecal incontinence: a randomized clinical trial.2014
Rectal balloon training as add-on therapy to pelvic floor muscle training in adults with fecal incontinence: a randomized controlled trial.2012
Randomized, controlled trial of topical phenylephrine for fecal incontinence in patients after ileoanal pouch construction.
Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence.2000
A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients.2006
The need for manual evacuation and oral laxatives in the management of neurogenic bowel dysfunction after spinal cord injury: a randomized controlled trial of a stepwise protocol.2010
Adjuvant biofeedback following anal sphincter repair: a randomized study.2004
Randomized trial comparing three forms of pelvic floor repair for neuropathic faecal incontinence.1993
Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial.2013
Sacral nerve stimulation at subsensory threshold does not compromise treatment efficacy: results from a randomized, blinded crossover study.2013
Randomized double-blind crossover study of alternative stimulator settings in sacral nerve stimulation for faecal incontinence.2012
A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma.1999
Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, sham-controlled trial.2011
Loperamide improves anal sphincter function and continence after restorative proctocolectomy.1994
Randomized trial of fecal diversion for sphincter repair.2000
The effects of low-frequency endo-anal electrical stimulation on faecal incontinence: a prospective study.2006
Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence.
A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of faecal incontinence in women.2005
Usefulness of valproate sodium for treatment of incontinence after ileoanal anastomosis.1990
Fibre supplementation in addition to loperamide for faecal incontinence in adults: a randomized trial.2008
Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study.2005
Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence.2004
A prospective, randomized study: switch off the sacral nerve stimulator during the night?
Comparison of bulking agents in the treatment of fecal incontinence: a prospective randomized clinical trial.2013
Biofeedback vs. electrostimulation in the treatment of postdelivery anal incontinence: a randomized, clinical trial.2007
Randomized controlled trial of biofeedback for fecal incontinence.2003
Randomized, controlled trial of anal electrical stimulation for fecal incontinence.2006
A prospective, randomized, controlled clinical trial of placement of the artificial bowel sphincter (Acticon Neosphincter) for the control of fecal incontinence.2004
Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence.2004
Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea.1980
The efficacy and adverse effects of topical phenylephrine for anal incontinence after low anterior resection in patients with rectal cancer.2007
Are topical oestrogens useful in faecal incontinence? Double-blind randomized trial.
New treatment for faecal incontinence using zinc-aluminium ointment: a double-blind randomized trial.2012
Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency.1982
Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents.2002
A controlled trial of an intervention to improve urinary and fecal incontinence and constipation.
Triple-target treatment versus low-frequency electrostimulation for anal incontinence: a randomized, controlled trial.2011
Triple target treatment (3T) is more effective than biofeedback alone for anal incontinence: the 3T-AI study.
Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence.
Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence.1997
Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence.2015
Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study.2008
Injectable silicone biomaterial (PTQ) is more effective than carbon-coated beads (Durasphere) in treating passive faecal incontinence--a randomized trial.2009
Pelvic floor procedures produce no consistent changes in anatomy or physiology.1998
Biofeedback treatment of fecal incontinence in geriatric patients.1985
A pilot study of total pelvic floor repair or gluteus maximus transposition for postobstetric neuropathic fecal incontinence.1999
Effects of clonidine in women with fecal incontinence.
Perineal retraining improves conservative treatment for faecal incontinence: a multicentre randomized study.2014
Clinical outcome of anterior overlapping external anal sphincter repair with internal anal sphincter imbrication.1998
Telephone vs. face-to-face biofeedback for fecal incontinence: comparison of two techniques in 239 patients.2005
Comparison of clinical outcome between open and percutaneous lead insertion for permanent sacral nerve neurostimulation for the treatment of fecal incontinence.2009
What is the best option for failed sphincter repair?2014
Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function.1990
Results of surgical treatment for faecal incontinence.2000
Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair.2010
Cholestyramine--a useful adjunct for the treatment of patients with fecal incontinence.2008
Is there a role for concomitant pelvic floor repair in patients with sphincter defects in the treatment of fecal incontinence?2006
Efficacy of methylcellulose and loperamide in managing fecal incontinence.2009
Advantages of a posterior fourchette incision in anal sphincter repair.2001
A prospective non-randomized two-centre study of patients with passive faecal incontinence after birth trauma and patients with soiling after anal surgery, treated by elastomer implants versus rectal irrigation.2012
The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence.2011
Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence?2012
Radiofrequency treatment for fecal incontinence: is it effective long-term?2012
Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up?2010
SECCA procedure for the treatment of fecal incontinence: results of five-year follow-up.2008
Temperature-controlled radio frequency energy delivery (Secca procedure) for the treatment of fecal incontinence: results of a prospective study.2008
Temperature-controlled radiofrequency energy (SECCA) to the anal canal for the treatment of faecal incontinence offers moderate improvement.2007
Safety and effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure) for the treatment of fecal incontinence.2003
Antegrade colonic enema for faecal incontinence in adults: long-term results of 75 patients.2011
Long-term results of antegrade colonic enema in adult patients: assessment of functional results.2008
Antegrade continence enema in the treatment of congenital fecal incontinence beyond childhood.2008
Malone antegrade continence enema for faecal incontinence and constipation in adults.1998
Anterior sphincteroplasty for fecal incontinence: a single center experience in the era of sacral neuromodulation.2009
Cloaca-like deformity with faecal incontinence after severe obstetric injury--technique and functional outcome of ano-vaginal and perineal reconstruction with X-flaps and sphincteroplasty.2008
Anterior anal sphincter repair can be of long term benefit: a 12-year case cohort from a single surgeon.2007
Manometric squeeze pressure difference parallels functional outcome after overlapping sphincter reconstruction.2001
Overlap repair of damaged anal sphincter. A single surgeon's series.1996
Audit of sphincter repair. Factors associated with poor outcome.1996
Overlapping sphincteroplasty for acquired anal incontinence.1993
Postanal repair for faecal incontinence.1984
Sacral nerve stimulation for fecal incontinence improves symptoms, quality of life and patients' satisfaction: results of a monocentric series of 119 patients.2013
Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence.2013
Sacral nerve stimulation for fecal incontinence.2011
Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence.2011
Suboptimal outcome following sacral nerve stimulation for faecal incontinence.2011
Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study.2010
Six years of experience with sacral nerve stimulation for fecal incontinence.2010
Sacral nerve stimulation for fecal incontinence: causes of surgical revision from a series of 87 consecutive patients operated on in a single institution.2010
Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up.2009
Sacral nerve stimulation for faecal incontinence in the UK.2004
Stapled transanal rectal resection and sacral nerve stimulation - impact on faecal incontinence and quality of life.2012
Technical and functional results of the artificial bowel sphincter for treatment of severe fecal incontinence: is there any benefit for the patient?2013
The artificial bowel sphincter: a single institution experience over a decade.
Artificial anal sphincter for severe fecal incontinence implanted by a transvaginal approach: experience with 32 patients treated at one institution.2010
Long-term results of artificial bowel sphincter for the treatment of severe faecal incontinence. Are they what we hoped for?2009
The artificial bowel sphincter for faecal incontinence: a single centre study.2008
Artificial bowel sphincter in severe anal incontinence.2004
Artificial bowel sphincter: long-term experience at a single institution.2003
The safety and efficacy of the artificial bowel sphincter for fecal incontinence: results from a multicenter cohort study.
Complications and functional outcome following artificial anal sphincter implantation.
Artificial anal sphincter: complications and functional results of a large personal series.2002
Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for severe faecal incontinence.2001
Artificial anal sphincter: prospective clinical and manometric evaluation.2000
Long-term results of artificial anal sphincter implantation for severe anal incontinence.1999
Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results.2014
Outcomes associated with Interstim therapy for medically refractory fecal incontinence.2014
Outcome of sacral nerve stimulation for fecal incontinence at 5 years.2014
Neuromodulation for fecal and urinary incontinence: functional results in 57 consecutive patients from a single institution.2012
Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence.2007
Sacral nerve stimulation in fecal incontinence.2004
Medium-term results of permanent sacral nerve stimulation for faecal incontinence.2002
Restoration of fecal continence after functional gluteoplasty: long-term results, technical refinements, and donor-site morbidity.2006
Restoring control: the Acticon Neosphincter artificial bowel sphincter in the treatment of anal incontinence.2000
Anterior Anal Sphincter Repair for Faecal Incontinence: Anorectal Manometric and Endoanal Ultrasound Assessment1999
Medium-term results with Sacral Nerve Stimulation for management of faecal incontinence, a single centre experience2013

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