Prognosis
Response to treatment is variable depending on underlying aetiology and the ability of the patient to adopt and follow particular treatment strategies.
Conservative therapy: the combination of dietary changes and antimotility drugs will control the majority of patients, particularly those with mild faecal incontinence, and avoid the need for specialist referral. Even if complete bowel control cannot be restored, the impact of incontinence on everyday life can still be lessened considerably for most patients, to a manageable level.
Biofeedback: it is difficult to combine and assess the data available regarding effectiveness of biofeedback as there is no standard therapeutic regimen. However, numerous studies from multiple centres have suggested an improvement in continence with therapy in up to 90% of patients.[67][68][74][106]
Anterior sphincter repair: initial success rates of 70% to 80% are possible after sphincter surgery but there is often a rapid deterioration with less than 45% of patients remaining satisfied after 5 to 10 years.[68][69][86]
Bulking agent injection: a definitive conclusion cannot be drawn regarding the long-term efficacy of perianal injection of bulking agents in reducing faecal incontinence, due to the limited poor-quality data available.[79]
Sacral nerve stimulation: the long-term prognosis of patients with sacral nerve stimulation is unknown at the present time. Battery life is approximately 7 to 10 years and will require replacement after this time.
Stoma formation: often results in a significant and maintained improvement in quality of life.[83]
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