John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Fecal incontinence and inflammatory bowel diseases Volume 29, issue 1, January 2022


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Groupe hospitalier Paris Saint-Joseph, Institut Léopold Bellan,
Service de proctologie médico-chirurgicale,
185 rue Raymond Losserand,
75014 Paris
* Correspondance

The prevalence of fecal incontinence is high in inflammatory bowel disease (IBD) (between 20-73% depending on the study). Diarrhea, lack of colorectal reservoir, rectal compliance disorder or sphincter rupture can cause fecal incontinence in IBD. Specific risk factors of fecal incontinence in IBD are: activity and duration of the disease, stenosing phenotype, a history of luminal surgery for IBD, pouchitis, perineal Crohn's disease or anal stenosis and a history of proctologic surgery. Fecal incontinence and perianal Crohn's disease affect quality of life: it is more difficult to access paid employment and periods of work stoppage are more frequent. Active perineal Crohn's disease increases thirteen times the risk of sexual dysfunction in women. Treatment of fecal incontinence is based on controlling luminal inflammation and symptomatic treatment of transit disorders. Second-line treatments of fecal incontinence such as colonic irrigations or sacral nerve stimulation are reserved for IBD patients with endoscopic remission and after failure of symptomatic treatment and anorectal rehabilitation. To prevent fecal incontinence in IBD, it is necessary to screen and to treat early perianal Crohn's disease, to control rectal inflammation, to treat anoperineal fistulas with surgical drainage in combination with medical treatment and to prefer sphincter saving/sparing techniques to fistulotomy. The permanent stoma remains the last resort treatment for refractory fecal incontinence to improve patient's quality of life.