Albuquerque A, Rao SSC. Controversies in fecal incontinence. World J Gastroenterol 2025; 31(3): 97963 [DOI: 10.3748/wjg.v31.i3.97963]
Corresponding Author of This Article
Andreia Albuquerque, MD, PhD, Associate Professor, Professor, School of Medicine and Biomedical Sciences, Fernando Pessoa University, Av. Fernando Pessoa 150, Gondomar 4420-096, Porto, Portugal. a.albuquerque.dias@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 21, 2025; 31(3): 97963 Published online Jan 21, 2025. doi: 10.3748/wjg.v31.i3.97963
Controversies in fecal incontinence
Andreia Albuquerque, Satish S C Rao
Andreia Albuquerque, School of Medicine and Biomedical Sciences, Fernando Pessoa University, Gondomar 4420-096, Porto, Portugal
Andreia Albuquerque, Precancerous Lesions and Early Cancer Management Research Group RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto, Porto 4200-072, Portugal
Satish S C Rao, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, GA 30912, United States
Author contributions: Albuquerque A conceived the article, conducted the literature search, wrote the manuscript, and was responsible for the submission; Rao SSC revised the manuscript for important intellectual content.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreia Albuquerque, MD, PhD, Associate Professor, Professor, School of Medicine and Biomedical Sciences, Fernando Pessoa University, Av. Fernando Pessoa 150, Gondomar 4420-096, Porto, Portugal. a.albuquerque.dias@gmail.com
Received: June 13, 2024 Revised: November 1, 2024 Accepted: November 26, 2024 Published online: January 21, 2025 Processing time: 189 Days and 11.8 Hours
Abstract
Fecal incontinence is a common condition that can significantly impact patients’ quality of life. Obstetric anal sphincter injury and anorectal surgeries are common etiologies. Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients. There are various treatment options, including diet, lifestyle modifications, drugs, biofeedback therapy, tibial and sacral nerve neuromodulation therapy, and surgery. In this editorial, we will discuss current controversies and novel approaches to fecal incontinence. Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended, but may be helpful in selected patients. The Garg incontinence score is a new score that includes the assessment of solid, liquid, flatus, mucous, stress and urge fecal incontinence. Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options, for both fecal incontinence and neuropathy. Home biofeedback therapy can overcome some limitations of the office-based therapy. Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option. Sacral neuromodulation may be useful in scleroderma, congenital fecal incontinence and inflammatory bowel disease but merits further study.
Core Tip: In this article we will discuss some controversies and novel approaches to diagnosing and treating fecal incontinence, namely screening for asymptomatic anal sphincter defects, new incontinence scores, novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation, home biofeedback therapy, skeletal muscle-derived cell implantation and unconventional indications for sacral neuromodulation.
