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©2013 UpToDate ® Print Email Approach to patients with fecal incontinence Obtain history Is the patient truly incontinent or does patient have frequency and urgency without incontinence? How long have symptoms been present? Does the patient have minor or major incontinence? Does the patient have urgency? Could the patient be impacted? Is there a background history of diarrhea? Could medications be contributing? Does the patient have a prior history of vaginal delivery or anorectal surgery? Does the patient have a history of prior pelvic irradiation? Does the patient have a neurological disturbance? Does the patient have diabetes mellitus? Perform physical examination Examine the external anoderm Test for an anal wink bilaterally Inspect for prolapsing hemorrhoids or other obvious pathology Perform a digital examination while asking the patient to bear down and to squeeze Obtain specific anorectal testing Flexible sigmoidoscopy in most patients Specific testing for patients with diarrhea Endorectal ultrasonography in patients with suspected sphincter disruption Anorectal manometry in patients with structurally intact sphincters Specific treatment Medical therapy and/or biofeedback for motivated patients who have intact sphincters and manometry showing preserved rectal sensation Surgical repair for patients with mechanical sphincter disruption in whom medical therapy is unsuccessful Other sphincter restoring procedures in patients with major incontinence in centers with available expertise