Fecal incontinence

Fecal incontinence (FI) is a common condition especially in elderly individuals, those with multiple co-morbidities, and nursing home residents. FI, or patient-preferred “accidental bowel leakage, " is grossly under-reported due to many patient-related and provider-related factors. FI causes significant patient embarrassment, seclusion, and devastating effects on quality life. The pathophysiology of FI is complex and often multifactorial, therefore, necessitating multiple diagnostic tests, including high-resolution anorectal manometry, anal ultrasound, and defecography. Translumbosacral anorectal magnetic stimulation (TAMS) is a new, non-invasive diagnostic test for assessing lumbosacral neuropathy that affects the anorectum. It demonstrated significantly higher diagnostic yield over the limited pudendal nerve terminal motor latency (PNTML) test. There have been many proposed treatments for FI, however, only biofeedback therapy (BFT), dextranomer injection, and sacral nerve stimulation (SNS) have sufficient randomized controlled trial (RCT) evidence to support their use in clinical practice. Home BFT using a voice-activated home program and a novel device is available and could increase accessibility, improve cost effectiveness, and increase treatment adherence. Translumbosacral neuromodulation therapy (TNT) is a promising, novel, non-invasive, and safe treatment for FI.