Faecal incontinence: Current knowledges and perspectives

Table 1 Main aetiologic factors for faecal incontinence

Localized perineal pathologies

Sphincter injury

Traumatic lesion (obstetric lesion, sexual abuse)

Surgical lesion (anal fistula surgery, hemorrhoidectomy, anal sphincterotomy)

Anoperineal lesion in Crohn’s disease

Anal cancer

Pudendal neuropathy

Obstetric lesion

Dyschezia

Deficient rectal function

Chronic inflammatory bowel diseases

Radiation proctitis

Rectal cancer

Faecal impaction

Rectal surgery (anterior rectal resection, ileoanal pouch surgery)

Rectal prolapse

General pathologies

Acute or chronic diarrhea

Chronic inflammatory bowel diseases

Irritable bowel syndrome

Coeliac disease

Infectious diarrhea

Bile acid induced

Neurological diseases

Central (post stroke lesion, multiple sclerosis, medullary lesions)

Peripheral (diabetic or alcoholic neuropathy)

Systemic diseases (systemic sclerosis)

Table 2 Level of scientific evidence for current treatments in faecal incontinence according to the Haute Autorité de Santé (French High Autority of Health)

Therapeutic modality	Levels of scientific evidence
Conservative treatment
Hygiene and diet control
Diet restriction	V
High fiber diet	II (Liquid stools)
	I (Constipation)
Pharmacological therapy
Anti-motility drugs	I (Liquid stools)
Stool-bulking agents	IV
Cholestyramine	IV
Topical agents or oral treatment to enhance anal canal tone	V
Hormone replacement therapy	V
Suppositories, rectal irrigation, oral laxatives	I (Constipation)
Perineal rehabilitation
Pelvic floor exercises	V
Anal electrostimulation	IV
Biofeedback therapy	II
Other conservative treatments
Posterior tibial nerve stimulation	III
Transanal irrigation	I
Anal plugs	V
Minimally invasive treatment
Sacral neuromodulation	IV
Antegrade irrigation	V
Anal radiofrequency	V
Intrasphincteric injections	V
Surgical treatment
Sphincter repair	II
Graciloplasty	V
Artificial sphincter	V
Colostomy	V

Table 3 Level of scientific evidence (Haute Autorité de Santé, High Autority of Health)

I	Large randomized controlled trials with undeniable results
II	Small randomized controlled trials and uncertain outcomes
III	Non-randomized trials with control groups contemporaries
IV	Comparative non-randomized groups with historical controls and case-control studies
V	No control groups, patient series
	Case reports
	Expert recommandation