Causes of fecal incontinence

• All psychoneurological disorders can cause constipation and thus fecal overflow incontinence for rectal impaction.
• Neurological disorders affecting at or below the sacral parasympathetic outflow, extrinsic and intrinsic innervation of the recto-ano-pelvic area.

Diagnosis of fecal incontinence

In all patients

• Exclude structural recto-ano-pelvic alterations and fecal impaction.
• Evaluate the presence of liquid stools.
• Anorectal Manometry
• Neurophysiologic investigations of the pelvic floor

In specific patients

• Autonomic tests
• Psychiatric assessment

Management of fecal incontinence

Fecal impaction (see constipation)

Liquid stools (see diarrhea)

Recto-Ano-Pelvic dysfunction with only partial or no denervation

• *Toilet training
• *Manometry-controlled biofeedback
• *Physiotherapy
• *Electrostimulation
• *Loperamide

Recto-Ano-Pelvic dysfunction with total denervation

• *Trigger defecatory reflex with physical maneuvers + glycerin, stimulant laxative suppository *Electrostimulation of S2-S3 roots.
• *Malone anterograde enema
• *Colostomy