Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

AGA Clinical Practice Update: Tx for Fecal Incontinence

Clin Gastroenterol Hepatol; 2017 Dec; Bharucha, et al

The American Gastroenterological Association (AGA) has released its updated clinical practice recommendations for the use of surgery and device-assisted treatment of fecal incontinence and defecatory disorders. Among the best practices described in the update:

  • Clinicians should use a stepwise approach to managing fecal incontinence, starting with conservative therapies such as diet, fluids, techniques to improve evacuation, and a bowel training program.
  • If patients don’t respond to the aforementioned measures, consider biofeedback to assist in pelvic floor retraining.
  • Consider perianal bulking drugs, including intra-anal injection of dextranomer, if biofeedback and conservative therapy fails.
  • Patients with moderate or severe fecal incontinence may benefit from sacral nerve stimulation—assuming there are no contraindications—if symptoms persist after 3 or more months of conservative treatment or biofeedback.


Bharucha AE, Rao SS, Shin AS. Surgical interventions and the use of device-aided therapy for the treatment of fecal incontinence and defecatory disorders. Clin Gastroenterol Hepatol. 2017;15:1844-1854. doi:10.1016/j.cgh.2017.08.023.