Faecal (Fecal ) Incontinence : Initial approach

Fecal incontinence (FI) is a significant health concern, particularly among the elderly, affecting approximately 2.2% of Americans over the age of 65. It represents a complex and often embarrassing issue that can lead to severe social and psychological consequences, including increased rates of nursing home placement. The condition arises from a diverse range of causes that may include neuropathic damage, traumatic injuries, congenital defects, obstetric-related trauma, and complications from surgeries such as fistula repairs, hemorrhoidectomies, and lateral internal sphincterotomies.

The underlying mechanism of fecal continence is intricate, involving a finely tuned coordination of the sphincter muscles and the pelvic floor. Key anatomical components include the internal and external anal sphincters and the puborectalis muscle, each playing a critical role in maintaining continence. The internal anal sphincter, an involuntary smooth muscle, primarily contributes to the resting tone of the anus, while the external anal sphincter provides voluntary control over defecation. The puborectalis muscle adjusts the angle between the rectum and anus, which is crucial during defecation.

Innervation of these muscles is equally complex, involving both parasympathetic and sympathetic nervous systems, with critical input from the pudendal nerve. Damage or dysfunction in these neural pathways can lead to what is known as...