Fecal Incontinence: Therapy

General measures

Keeping a stool diary to detect triggering factors (lactose/fructose/sorbitol intolerance).
Toilet training:
- Be able to estimate the available warning time to go to the toilet in time.
- “Toileting by the clock”: taking advantage of the “gastrocolic reflex” triggered by the ingestion of a meal or a warm drink, which causes a defecation stimulus.
Anal hygiene after going to the toilet in the following steps:
- Rough cleaning with untreated toilet paper (dyed toilet paper contains dyes that can possibly cause allergy).
- Careful cleaning with water at a comfortable temperature without the use of soap (over a bidet or in the shower; when traveling, use disposable washcloths for babies).
- Drying
Attention. Do not use wet wipes (contain preservatives and often fragrances). These may contain, despite dermatological testing, substances that can lead to contact dermatitis with prolonged use.
In case of disorders of discharge:
- Incomplete emptying: clysms as well as bisacody and/or lecicarbon CO2 suppositories at defined times.
- Overflow incontinence (involuntary evacuation of stool when rectum is overfilled): complete bowel evacuation required before other measures will help
In cases of incomplete evacuation, prolapse (prolapse) or overflow incontinence, priority should be given to toilet training.

Causal drug therapy for causative underlying disease (e.g., inflammatory bowel disease).
Psyllium (psyllium)/psyllium husks: swelling agent and stool softener (swelling number > 40; binds more than 40 times its own volume of water):
- Thickens diarrhea-like, watery stool → stool consistency becomes firmer.
- Makes hard stool more voluminous and softer → stimulation of intestinal peristalsis, stool becomes softer/easier defecation (defecation).
Psyllium husks thus have a continence-promoting effect in diarrhea (diarrhea) and constipation (constipation).
Nonspecific medicinal measures essentially to slow intestinal transit and increase fluid absorption:
- Opioid loperamide (3 to 4 x 2-4 mg/day).
- Combination of diphenoxylate/atropine

Bowel pacemaker or the sacral nerve stimulation system (SNS): this involves activating the nerves of the pelvic floor via one or more stimulation probes, using electrical impulses. Before a definitive implantation of the system, the effect must be verified in advance within the framework of a test simulation (duration: 2 – 4 weeks). For this purpose, a stool log is kept during this time.Indications: idiopathic and therapy-resistant fecal incontinence.

Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
Observance of the following specific dietary recommendations:
- Balanced intake of fluids and dietary fiber; the following dietary fibers can be taken as a supplement:
  - Wheat bran
  - Plantogo seeds
  - Psyllium (psyllium husks)
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)” – Taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Light endurance training (cardio training).
Physical activity prevents lack of exercise and thus serves, among other things, the prevention of constipation, which in turn would increase intraluminal pressure (intestinal pressure).
For detailed information on sports medicine, please contact us.

Targeted muscle training to stabilize the pelvic floor and sphincter apparatus. The following phases are distinguished:
- Establishment of the targeted perception
- Isolated muscle tension and relaxation
Exercise under modulated load and gradual integration into daily routines.

The combination of the following two procedures is recommended:

Biofeedback training-measurement of shincter ani externus muscle activity using an anal EMG sensor and visual or auditory signal feedback (electromyography-triggered biofeedback (EMG-BF) training). This is intended to improve the perception of rectal stretch travel and help increase the contraction force of the anal sphincter (sphincter).
Electrostimulation* (medium-frequency anal electrostimulation, LFS) – the patient feels the passive muscle contraction under it. This leads to a conscious awareness of the same and improves the understanding of targeted muscle work; the method should be further combined with targeted muscle training.

* The LFS is insufficient as a sole therapy!