Drug treatment for faecal incontinence in adults

Cheetham MJ, Brazzelli M, Norton CC, Glazener CMA

Published Online:

January 21, 2009

Faecal incontinence (inability to control bowel movements or leakage of stool or faeces) is a common health care problem, affecting up to 1 in 10 of adults living at home. This affects daily activities in about 1 or 2 in 100 people. It is more common in people living in residential care. Leakage of urine often occurs as well. Faecal incontinence can be debilitating and embarrassing. Treatments include pelvic floor muscle training, electrical stimulation, surgery and drugs. This review looked at drugs. Drugs used to try to relieve faecal incontinence include anti-diarrhoeal drugs or laxatives to regulate stools, and drugs to try to enhance the tone of muscles around the anus. Thirteen small trials were found, including 473 people. The review of these trials found some evidence that anti-diarrhoea drugs may reduce faecal incontinence for people having liquid stools. There was some evidence that drugs to enhance the tone of the muscle around the anus may help, but more research is needed.

Abstract (click to read)

Background:

Faecal incontinence is a common symptom which causes significant distress and reduction in quality of life.

Objectives:

To assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities.

Search strategy:

We searched the Cochrane Incontinence Group Specialised Register of Trials (searched 4 July 2007) and the reference lists of relevant articles.

Selection criteria:

All randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults.

Data collection and analysis:

Working independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data.

Main results:

Thirteen trials were identified, including 473 participants. Eleven trials were of cross-over design. Nine trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea, following ileoanal pouch surgery or due to use of a weight-reducing drug). Two trials were amongst people with weak anal sphincters, one in participants with faecal impaction and bypass leakage, and one in geriatric patients.

Seven trials tested anti-diarrhoeal drugs to reduce faecal incontinence and other bowel symptoms (loperamide, diphenoxylate plus atropine and codeine). Four trials tested drugs enhancing anal sphincter function (phenylepinephrine gel and sodium valproate). Two trials evaluated osmotic laxatives (lactulose) for the treatment of faecal incontinence associated with constipation in geriatric patients. No studies comparing drugs with other treatment modalities were identified.

There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. Loperamide was associated with more adverse effects than placebo, such as constipation, abdominal pain, diarrhoea, headache, and nausea. However, the dose may be titrated to the patient's symptoms to minimise side effects while achieving continence. The drugs acting on the sphincter sometimes resulted in local dermatitis, abdominal pain or nausea. Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses. However, the trials were all small and of short duration.

Authors' conclusions:

The small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.

This record should be cited as:

Cheetham MJ, Brazzelli M, Norton CC, Glazener CMA. Drug treatment for faecal incontinence in adults. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD002116. DOI: 10.1002/14651858.CD002116

Assessed as up to date:

July 4, 2007

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Primary Review Group:

Incontinence Group

Health topics:

Gastroenterology > Faecal incontinence > Pharmacological treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Drug treatment for faecal incontinence in adults

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