MYSTERIOUS FECAL INCONTINENCE
SHARI GAERBER, MD, of Vancouver, BC, would like to know: "What further work-up would you suggest for new-onset fecal incontinence?" She adds, "There are no bladder symptoms and the neurologic exam was unremarkable. No medications, either prescription or over-the-counter, are being taken. Stool cultures (including C. difficile toxin), occult blood and barium enema were negative."
Your patient with fecal incontinence requires further investigation. A sigmoidoscopy -- to rule out any rectosigmoid pathology -- is important. Rectal prolapse should be investigated and if your patient is a woman, consider rectocele. In my experience, I tend to see these problems in older patients where the pelvic muscle tone has deteriorated. I find that bulking agents sometimes help, so give them a try. Taking loperamide before going out is a practical approach, but pathology should always be ruled out first. AS