Surgical treatment of fecal incontinence

Introduction Fecal incontinence is defined as the involuntary loss of feces, either solid or liquid. More specifically, the ROME III definition is the “Recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years.” Incontinence can be further subdivided by degree, based on the type of material that is eliminated (gas, liquid stool, or solid stool) and the frequency with which it occurs. Incontinence can also be categorized based on the timing in the defecatory cycle, as passive incontinence, urge incontinence, postdefecation leakage, or a combination of the three. A number of scoring systems have been established to try to obtain objective criteria for grading fecal incontinence, with the Wexner (Cleveland Clinic) scoring system being the most commonly used (Table 30.1). These systems appear to be more useful in determining the effectiveness of treatment and establishing the prevalence of incontinence within populations for the purpose of research rather than in determining the best modality of treatment for each individual patient.