Drug treatment for faecal incontinence in adults

Mark J. Cheetham, Miriam Brazzelli, Christine C. Norton, Cathryn M. A. Glazener

Research output: Contribution to journalArticle

Abstract

Background

Faecal incontinence is a common symptom which causes significant distress and reduction in quality of life.
Objectives

To assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities.
Search methods

We searched the Cochrane Incontinence Group Specialised Register of Trials (searched 4 July 2007) and the reference lists of relevant articles.
Selection criteria

All randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults.
Data collection and analysis

Working independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data.
Main results

Thirteen trials were identified, including 473 participants. Eleven trials were of cross-over design. Nine trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea, following ileoanal pouch surgery or due to use of a weight-reducing drug). Two trials were amongst people with weak anal sphincters, one in participants with faecal impaction and bypass leakage, and one in geriatric patients.

Seven trials tested anti-diarrhoeal drugs to reduce faecal incontinence and other bowel symptoms (loperamide, diphenoxylate plus atropine and codeine). Four trials tested drugs enhancing anal sphincter function (phenylepinephrine gel and sodium valproate). Two trials evaluated osmotic laxatives (lactulose) for the treatment of faecal incontinence associated with constipation in geriatric patients. No studies comparing drugs with other treatment modalities were identified.

There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. Loperamide was associated with more adverse effects than placebo, such as constipation, abdominal pain, diarrhoea, headache, and nausea. However, the dose may be titrated to the patient's symptoms to minimise side effects while achieving continence. The drugs acting on the sphincter sometimes resulted in local dermatitis, abdominal pain or nausea. Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses. However, the trials were all small and of short duration.
Authors' conclusions

The small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.
Original languageEnglish
Article numberCD002116
Number of pages41
JournalCochrane Database of Systematic Reviews
Issue number3
DOIs
Publication statusPublished - 22 Jul 2002

Fingerprint

Fecal Incontinence
Pharmaceutical Preparations
Anal Canal
Geriatrics
Loperamide
Diarrhea
Laxatives
Therapeutics
Constipation
Drug Therapy
Nausea
Abdominal Pain
Diphenoxylate
Fecal Impaction
Antidiarrheals
Lactulose
Colonic Pouches
Codeine
Placebo Effect
Valproic Acid

Cite this

Drug treatment for faecal incontinence in adults. / Cheetham, Mark J.; Brazzelli, Miriam; Norton, Christine C.; Glazener, Cathryn M. A.

In: Cochrane Database of Systematic Reviews, No. 3, CD002116, 22.07.2002.

Research output: Contribution to journalArticle

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N2 - BackgroundFaecal incontinence is a common symptom which causes significant distress and reduction in quality of life.ObjectivesTo assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities.Search methodsWe searched the Cochrane Incontinence Group Specialised Register of Trials (searched 4 July 2007) and the reference lists of relevant articles.Selection criteriaAll randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults.Data collection and analysisWorking independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data.Main resultsThirteen trials were identified, including 473 participants. Eleven trials were of cross-over design. Nine trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea, following ileoanal pouch surgery or due to use of a weight-reducing drug). Two trials were amongst people with weak anal sphincters, one in participants with faecal impaction and bypass leakage, and one in geriatric patients.Seven trials tested anti-diarrhoeal drugs to reduce faecal incontinence and other bowel symptoms (loperamide, diphenoxylate plus atropine and codeine). Four trials tested drugs enhancing anal sphincter function (phenylepinephrine gel and sodium valproate). Two trials evaluated osmotic laxatives (lactulose) for the treatment of faecal incontinence associated with constipation in geriatric patients. No studies comparing drugs with other treatment modalities were identified.There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. Loperamide was associated with more adverse effects than placebo, such as constipation, abdominal pain, diarrhoea, headache, and nausea. However, the dose may be titrated to the patient's symptoms to minimise side effects while achieving continence. The drugs acting on the sphincter sometimes resulted in local dermatitis, abdominal pain or nausea. Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses. However, the trials were all small and of short duration.Authors' conclusionsThe small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.

AB - BackgroundFaecal incontinence is a common symptom which causes significant distress and reduction in quality of life.ObjectivesTo assess the effects of drug therapy for the treatment of faecal incontinence. In particular, to assess the effects of individual drugs relative to placebo or other drugs, and to compare drug therapy with other treatment modalities.Search methodsWe searched the Cochrane Incontinence Group Specialised Register of Trials (searched 4 July 2007) and the reference lists of relevant articles.Selection criteriaAll randomised or quasi-randomised controlled trials of the use of pharmacological agents for the treatment of faecal incontinence in adults.Data collection and analysisWorking independently, reviewers selected studies from the literature, assessed the methodological quality of each trial, and extracted data.Main resultsThirteen trials were identified, including 473 participants. Eleven trials were of cross-over design. Nine trials included only people with faecal incontinence related to liquid stool (either chronic diarrhoea, following ileoanal pouch surgery or due to use of a weight-reducing drug). Two trials were amongst people with weak anal sphincters, one in participants with faecal impaction and bypass leakage, and one in geriatric patients.Seven trials tested anti-diarrhoeal drugs to reduce faecal incontinence and other bowel symptoms (loperamide, diphenoxylate plus atropine and codeine). Four trials tested drugs enhancing anal sphincter function (phenylepinephrine gel and sodium valproate). Two trials evaluated osmotic laxatives (lactulose) for the treatment of faecal incontinence associated with constipation in geriatric patients. No studies comparing drugs with other treatment modalities were identified.There was limited evidence that antidiarrhoeal drugs and drugs which enhance anal sphincter tone may reduce faecal incontinence in patients with liquid stools. Loperamide was associated with more adverse effects than placebo, such as constipation, abdominal pain, diarrhoea, headache, and nausea. However, the dose may be titrated to the patient's symptoms to minimise side effects while achieving continence. The drugs acting on the sphincter sometimes resulted in local dermatitis, abdominal pain or nausea. Laxative use in geriatric patients reduced faecal soiling and the need for help from nurses. However, the trials were all small and of short duration.Authors' conclusionsThe small number of trials identified for this review assessed several different drugs in a variety of patient populations. The focus of most of the included trials was on the treatment of diarrhoea, rather than faecal incontinence. There is little evidence to guide clinicians in the selection of drug therapies for faecal incontinence. Larger, well-designed controlled trials, which include clinically important outcome measures, are required.

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