Physiotherapy and surgery in fecal incontinence: an overview

Fecal incontinence (fi) is a major healthcare problem that is particularly embarrassing and affects about 2 to 24% of the adult population. Apart from being a social burden to the patient, fi is also a major economic burden. Several diagnostic measures are available to assess the nature and severity of fi, although guidance for conservative or surgical therapy is not always obvious. Conservative treatment consists of dietary and pharmacological treatment, bowel management, use of products and appliances and physiotherapeutic interventions. Physiotherapy is often tried before surgical treatment because it is safe and inexpensive; it is also possible to employ other treatments after its use. Promising results of physiotherapy in fi have been published, although its effectiveness should be further elucidated. Surgical treatment aims at correcting the anal sphincters and pelvic floor, using encirclement procedures and sacral nerve stimulation. When the outcomes of both conservative and surgical treatment are unsatisfactory, colostomy is the only remaining solution.