Table 2.
Conservative Treatment Recommendations for Fecal Incontinence in Different Guidelines
| ICS | NICE | ASCRS | Italian | French | |
|---|---|---|---|---|---|
| Dietary advice | Control the diet to have ideal stool consistency. Attention to the effects of lactose, yogurt, sorbitol, fructose, caffeine and alcohol | List of food and drinks that may exacerbate FI: excessive doses of vitamin C, magnesium, phosphorus, lactose, chilli, alcohol (stout, beers and ales), artificial sweeteners, olestra fat substitute |
Recommends use of a diary to detect triggering factors Attention to the effects of caffeine, sugar replacements, lactose, and other dietary components that may result in fecal urgency or diarrhea |
Not mentioned | Recommends asking about eating habits, or any dietary triggers |
| Stool bulking agents | Fiber | Fiber | Kaopectate | Polycarbophil calcium | Dietary fibre |
| Psyllum (moderately fermentable soluble fiber) | Fiber | Fiber | Mucilage (not for patients with hard or normal consistency stools) | ||
| Probiotics: initial short evidence | |||||
| Anti-diarrheal medication | Loperamide | Loperamide | Loperamide | Loperamide | Loperamide |
| Diphenoxylate | Codein phosphate | Diphenoxylate | Codeine | Codeine | |
| Co-phenotrope when intolerant | Atropine | Amitriptyline | |||
| Atropine | |||||
| Diphenoxylate | |||||
| Laxatives | Not enough evidence to recommend them | For people with faecal loading | Not enough evidence to recommend them | In incontinent patients with faecal impaction | Laxatives, rectal suppositories or enemas to control incontinent episodes associated with constipation |
| Cholestyramine | Not enough evidence to recommend it | Not mentioned | Particularly in patients with a history of cholecystectomy or ileocolonic resection | Not mentioned | Recommended |
| Antidepressant drugs | Recommends them for patients with stress UI or bladder pain associated to FI | Not mentioned | Benefits and risks must be weighed on an individual basis (tricyclic antidepressants and opioids) | Limited evidence | Amitryptyline is not recommended |
| Other drugs | Sodium valproate: may have a modest role in postsurgical faecal incontinence | Attention to Drugs that may exacerbate FI: some antibiotics, metformine, calcium channel antagonists | Clonidine to manage urgency and reduce rectal sensibility | Oral valproate, diazepam not recommended | |
| General or local hormone replacement therapy in postmenopausal women not recommended | |||||
| Perianal skin care | Topical phenylephrine, zinc–aluminum ointment, estrogen creams (insufficient evidence), for elderly and frail patients | Products for containment and skin care advice should also be available for initial treatment. Recommended both cleansing and using barrier products | Protective ointments (eg, zinc oxide based), gentle soaps and wipes, as well as deodorants and pads | Not mentioned | Topical phenylephrine, zinc, and aluminium are not recommended |
| Posterior Tibial Nerve Stimulation | Remains an investigational treatment protocol which cannot currently be recommended for clinical practice | If conservative management failures | Weak recommendation | It could offer a relatively affordable treatment in patients who have failed conservative treatment | Weakly recommended after SNM fails in the algorithm. Also stated as a potential alternative to be use with the same indications as SNM being a less invasive option |
ICS International Continence Society, NICE National Institute for Health and Care Excellence, ASCRS American Society of Colon and Rectal Surgeons, FI Fecal Incontinence, UI Urinary Incontinence