Diagnosis and treatment of "fecal incontinence", list of recommendations from the latest guidelines

In March 2022, the European Federation of Gastroenterology (UEG), together with the European Society of Anorectology (ESCP), the European Society of Neurogastroenterology and Kinesiology (ESNM), and the European Society of Primary Care Gastroenterology (ESPCG), jointly issued guidelines for the diagnosis and treatment of fecal incontinence, the main purpose of which is to provide the latest European joint guidelines for the diagnosis and treatment of fecal incontinence, which provides a total of 45 guidelines for the classification, diagnosis and treatment of patients with fecal incontinence

The recommended scales were, from highest to lowest: moderate-certainty evidence, low-certainty evidence, and expert opinion

According to the Rome IV standard, fecal incontinence (FI) is defined as "repeated uncontrolled excretion of stool≥ 3 months

2.

3.

4.

5.

6.
The physical examination should be performed
in a position that is conducive to diagnostic reliability and patient comfort.

(Expert opinion)

7.
Patient education such as general behavioral advice (toilet routine/bowel exercise) and dietary advice can be used as first-line treatment
for FI.

(Very low-quality evidence)

8.
Lifestyle modification, especially weight loss in overweight patients and smoking cessation in smokers, can be used as first-line treatment
for FI.

(Expert opinion)

9.
Patients prone to incontinence-related dermatitis can be prevented and treated
with barrier creams.

(Low-quality evidence)

10.
Adsorbents may be considered to control the effects of FI symptoms and provide additional safety
.

(Very low-quality evidence)

11.
Pelvic floor training with or without digital/instrumental guidance or biofeedback training can be used as first-line treatment
for FI.

(Low-quality evidence)

12.
Stool bulking agent can be used as the first-line treatment for patients with FI dilute stools, and patients should be individualized according to the evaluation at follow-up
.

(Low-quality evidence)

13.
Antidiarrheal agents can be used as first-line treatment for patients with Fl stool and should be individualized based on the patient's evaluation at follow-up
.

(Low-quality evidence)

14.
Patients who still have refractory symptoms after trying first-line therapy should be referred to the public
.

(Expert opinion)

15.
For patients considering further management strategies, anorectal function and integrity can be examined
on a case-by-case basis.

(Expert opinion)

16.
Reference may be made to the consensus document of the International Working Group on Anorectal Physiology to help guide the choice of when and which anorectal function tests (including anorectal manometry and sensory testing, intraanal ultrasound, fecal angiography, and pelvic MRI).


(Expert opinion)

17.
PPTNS therapy (Percutaneous retrotibial nerve stimulation) can be used as a second-line treatment
for patients with FI.

(Low-quality evidence)

18.
Patients with FI should not use TPTNS therapy (Transcutaneous retrotibial nerve stimulation).


(Low-quality evidence)

19.
Transanal lavage can be used as a second-line treatment
for patients with FI.

(Very low-quality evidence)

20.
For patients with FI who can tolerate devices, devices such as plugs may be considered as their second-line treatment
.

(Very low-quality evidence)

21.
Sacral neuromodulation (SNM) can be used in patients with FI who
do not respond well to first- and second-line non-surgical treatments.

(Low-quality evidence)

22.
Patients with FI should not use injectable agents (silicone rubber, polysaccharide gels
).

(Low-quality evidence)

23.
For patients with FI who do not respond well to first- and second-line non-surgical treatments, delayed (second-line) sphincteroplasty
may be considered.

(Very low-quality evidence)

24.
An ostomy
may be considered when requested or otherwise undergoing surgery.

(Very low-quality evidence)