Specific Treatment

1. Pharmacologic therapy: antidiarrhoeal agents, such as Loperamide, suppositories or enemas are usually prescribed [5].

2. Biofeedback: this is a "non-surgical, non-invasive, and relatively inexpensive method of treating faecal incontinence on an outpatient basis" [7]. Biofeedback has proven effective in the strengthening of "the external sphincter and anorectal sensation" [8], providing "immediate and long-term improvement of faecal incontinence" and "restoring a normal quality of life" [9]. The patient is trained to recognise small volumes of rectal distension and contract the external anal sphincter while simultaneously keeping intraabdominal pressure low. This is accomplished by measuring anal canal pressure, showing this on a visual display to the patient, and providing verbal feedback. Usually, better results are observed with motivated, mentally capable patients. Patients should also have some degree of rectal sensation and be able to contract the external anal sphincter [10]. Among other approaches, the augmented biofeedback program is also to be mentioned. This programme includes electrical stimulation of the anal sphincter with electromyogram (EMG) feedback. To achieve a sustained improvement of bowel function, however, these neuromuscular conditioning techniques must be used together with pelvic muscle strengthening or other supportive measures.

3. Plugs, sphincter bulkers and electrical stimulation: At present, these devices should be considered as experimental and deserve further controlled clinical trials [5,11].

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