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Anal Incontinence
Diagnosis/Definition
Inability to control the passage of flatus or stool (liquid or formed which is differentiated from minor leakage without social consequences).
Initial Diagnosis and Management
- Diagnosis is made by history.
- Bulking agents are used to eliminate diarrhea if present.
- Trial of avoiding diary products should also be attempted in patients with diarrhea.
- Proctosigmoidoscopy/flexible sigmoidoscopy to rule out inflammatory lesions of the rectum.
- Barium enema to rule out proximal partial obstructive lesions.
- Examination of the sphincter muscles for tone or defect.
Ongoing Management and Objectives
Attempt to control gross incontinence medically with bulking agents or bowel transit slowing agents (Bentyl/Lomotil) and teach avoidance of dietary motility stimulants (caffeine).
Indications for Specialty Care Referral
Persistence of incontinence with firm stool.
Patients who defer social activities due to fear of accidents.
Criteria for Return to Primary Care
Patient followed in General Surgery until successful medical or operative intervention achieves continence.
