Clinical assessment, conservative management, specialized diagnostic testing, and quality of life for fecal incontinence: Update on research and practice recommendations

Aims:: To summarize recent evidence and practice recommendations from a literature review of the clinical assessment, conservative management, specialized diagnostic testing, and quality of life related to fecal incontinence. Methods:: Medline, PUBMED, CINAHL, and EMBASE literature databases were searched from 2016 to the end of 2020 for English language publications. Study abstracts and relevant full-text articles were retrieved and reviewed. Reference lists from articles were examined for additional studies. Recommendations for practice were made following procedures of the International Continence Society and International Consultation on Incontinence. Results:: New evidence was identified for the following topics related to FI assessment and conservative interventions: clinical assessment, patient education, diet, dietary fiber, and fluid modifications, anti-motility medications, weight loss and physical activity, PFMT, trans-anal irrigation, biofeedback, and specialized diagnostic testing as well as effects of FI on quality of life. Recommendations for practice were reviewed and updated as appropriate based on the new evidence. Conclusions:: Research examining FI assessment and conservative interventions continues to grow. Some topics in this area are understudied or in need of studies with strong, randomized, controlled designs. The results of this review serve as a summary of the state of the science and can direct future research directions.