RECOGNISE, EXCLUDE THE REVERSIBLE CAUSES, REFER (RECOGNITION & REFERRAL)
Involuntary leakage of stool or flatus. Exclude the reversible causes first - faecal impaction with overflow, infection, and the drugs and foods that loosen the stool. The article asks the patient to keep off foods that bring on diarrhoea, a diet heavy in lactose or fructose among them, and to treat any underlying disorder suspected alongside it - bile salt malabsorption, irritable bowel disease, or irritable bowel syndrome. Then skin care and containment: keep the perianal skin clean and unsoiled, apply zinc oxide, and use incontinence pads. Drug therapy aimed at stool consistency is the next step and the rows below carry it. If that fails, anorectal manometry, then biofeedback - retraining the pelvic floor and the abdominal muscles to work around the defect - and finally surgery, which the article keeps for symptoms that hold out against everything above. Refer to colorectal surgery for the last two. - Refer, with advice
Children follow the same pathway: recognise and refer. No primary-care medicine is implied.
No dose - referral pathway, no medicine given in primary care
Involuntary leakage of stool or flatus. Exclude the reversible causes first - faecal impaction with overflow, infection, and the drugs and foods that loosen the stool. The article asks the patient to keep off foods that bring on diarrhoea, a diet heavy in lactose or fructose among them, and to treat any underlying disorder suspected alongside it - bile salt malabsorption, irritable bowel disease, or irritable bowel syndrome. Then skin care and containment: keep the perianal skin clean and unsoiled, apply zinc oxide, and use incontinence pads. Drug therapy aimed at stool consistency is the next step and the rows below carry it. If that fails, anorectal manometry, then biofeedback - retraining the pelvic floor and the abdominal muscles to work around the defect - and finally surgery, which the article keeps for symptoms that hold out against everything above. Refer to colorectal surgery for the last two.
- This card DOES carry a drug row now - loperamide, for stool consistency, frequency and urgency. It is symptom control, not a cure, and it must never be started before faecal impaction with overflow has been excluded. The definitive treatments are physical: pelvic floor retraining, biofeedback, and surgery.
- Four further drugs are named by the article cited here and none of them is dosed, each for a stated reason. Bulking agents - the article says only that methylcellulose may firm the stool up (Fecal Incontinence - StatPearls - NCBI Bookshelf, NBK459128) - carry no dose in it, and every methylcellulose product in the Egyptian register is an eye lubricant, not an oral bulking agent. Diphenoxylate (Lomotil) - the article reports that patients improve on it while the objective tests do not - has no dose there and ZERO products in the Egyptian register. Oestrogen - raised only as something that might help a woman past the menopause - names a class, not a drug, and no dose. Amitriptyline - raised only where incontinence of urine and of stool go together, and again with no dose - is dosed for incontinence by no document held here.
- RED FLAG - An associated neurological deficit (possible spinal cord or cauda equina lesion), or rectal prolapse or a mass found on examination: refer.