Fecal incontinence: three steps to successful management.

Fecal incontinence is a socially disruptive problem that occurs with increased frequency in older individuals. The causes of incontinence in this age group include abnormalities of rectal storage capacity, fecal impaction with overflow incontinence and disorders of rectosphincteric continence mechanisms. Evaluation consists of a careful history and physical examination, followed by studies of anorectal structure and function in selected patients. Therapeutic approaches include disimpaction and colonic cleansing, dietary modifications, pharmacologic agents, biofeedback techniques, and surgery. Most patients can be treated successfully with nonsurgical measures, with improvement in their quality of life.