In the treatment of fecal incontinence, nonsurgical measures are often as important as the surgical, and in patients whose incontinence is neurogenic, as in paraplegia, only nonsurgical therapy can help. Nonsurgical measures for fecal incontinence fall into five phases: diet, drugs, irrigations, exercises for the anal muscles, and psychotherapy. Continence is maintained not so much by tonically contracted states of the internal or external sphincters of the anus as by reflex contractions of the external sphincter initiated in the rectum. An additional neuromuscular mechanism described as reservoir continence resides in the descending colon. Fecal incontinence is frequently the unfortunate price that has to be paid for lifesaving surgery, and at least half of the patients who complain of varying degrees of fecal incontinence date its onset to some surgical procedure. It is essential for their rehabilitation that they be instructed in the use of the nonsurgical measures here described.
Jackman RJ. FECAL INCONTINENCE-NONSURGICAL TREATMENT. JAMA. 1958;166(11):1281–1285. doi:10.1001/jama.1958.02990110017004
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