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Fecal incontinence is a life-altering condition. Due to the embarrassment of the patient and many physicians' lack of knowledge, its true incidence has been underestimated. In the past it was felt to have an incidence of ~4% but now is believed to affect as many as 1 out of 13 individuals (7.7%). Increased awareness of fecal incontinence has led to advances in its evaluation and treatment.
This issue of Clinics in Colon and Rectal Surgery is dedicated to the complex problem of fecal incontinence and many of the questions surrounding its treatment. The first article reviews the etiology of this condition and focuses on the complete evaluation of anal incontinence. The remaining articles are devoted to the treatment of fecal incontinence, nonsurgical and surgical. Nonsurgical treatment is of course the first line of therapy and thus is highlighted.
Among the surgical therapies, overlapping sphincteroplasty has long been regarded as the operation of choice in the patient with a sphincter defect and functional muscle. Recent studies, though, have called into question the long-term results of this therapy and with multiple new therapies in existence, one must ask if the sphincteroplasty is still the standard of care. This question is addressed along with some of the controversies associated with this classic repair.
New and innovative therapies have been developed for the treatment of fecal incontinence, including an artificial bowel sphincter, sacral nerve stimulation, and radiofrequency energy. Which patients are good candidates for these therapies and do they work? Each of these new techniques is discussed at length with regard to appropriate patient selection, technique, and outcomes. With these techniques now available, one must also question if there is still a role for the complex procedure of muscle transposition and if so, what is that role? Finally, a significant number of patients with fecal incontinence also suffer with pelvic floor prolapse. What must the surgeon look for and how should these patients be treated differently?
I am grateful to my esteemed colleagues who have contributed to this issue and tackled these difficult questions. Their expertise in this field along with their precious time and efforts have resulted in an informative and pleasurable issue to read. It has been an honor and a pleasure for me to serve as Guest Editor on this issue of Clinics in Colon and Rectal Surgery.