# Fecal Incontinence - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Fecal Incontinence - StatPearls - NCBI Bookshelf (NBK459128) - https://www.ncbi.nlm.nih.gov/books/NBK459128/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS17 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt) ## Treatment metadata - Recognise, exclude the reversible causes, refer (Recognition & Referral) - Loperamide — 2 mg — oral.solid ## Complete treatment card ```text FECAL INCONTINENCE Sources: Fecal Incontinence - StatPearls - NCBI Bookshelf (NBK459128) - https://www.ncbi.nlm.nih.gov/books/NBK459128/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS17 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Passive leakage of stool with no awareness at all points to a neurological problem or sphincter dysfunction [faecal incontinence] - Being unable to hold stool despite actively trying, with sensation intact, points to sphincter dysfunction or a rectum that cannot store stool - Unwanted leakage after an otherwise normal bowel movement, with continence intact, describes fecal seepage - A woman's obstetric history - forceps use, perineal tears, and number of deliveries - is relevant to the workup SIGNS - what you find (3) - Inspection checks for hemorrhoids, stool soiling, scarring, skin breakdown, prolapse, and perineal descent greater than 3 cm [faecal incontinence · haemorrhoids · scarring] - A missing anal wink reflex on stroking the skin around the anus suggests loss of the spinal reflex arc and possible neurological disease - Digital rectal exam checks resting sphincter tone, puborectalis function on bearing down, and squeeze strength on voluntary contraction TESTS (6) - When diarrhea is driving the leakage, stool tests check for infection, fat content, osmolality, and evidence of pancreatic insufficiency - Colonoscopy looks for mucosal disease, a mass, an ulcer, or a stricture as the cause - Anorectal manometry and endoscopic ultrasound are the two most useful tests when leakage occurs without diarrhea - Endoscopic ultrasound with the patient lying on their side or in stirrups measures how thick the sphincter muscle is - Anal manometry measures resting and squeeze pressure in the rectum - Defecography, reserved for cases that do not respond or before surgery, films rectal emptying under fluoroscopy IF NOT THIS - what else fits (3) - A foreign body lodged in the vagina or anus is also on the list - A fistula linking the rectum to the vagina, or the anus to the skin, can present the same way - An abscess near the anus or a rectal prolapse are also considered Source StatPearls "Fecal Incontinence" - disease-level clinical article Status traced to the source above Rx: Main treatment | Symptom control - stool consistency, frequency and urgency MAIN TREATMENT 1. RECOGNISE, EXCLUDE THE REVERSIBLE CAUSES, REFER (RECOGNITION & REFERRAL)[1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. SYMPTOM CONTROL - STOOL CONSISTENCY, FREQUENCY AND URGENCY 2. LOPERAMIDE [1st line] Adult 4 mg 3 times a day Peds The formulary contraindicates loperamide under 2 years of age, and confines its own indication to children of 12 years and over - it indicates the drug for treating the symptoms of acute diarrhoea in adults and in children from that age up. Egyptian National Drug Formulary - Gastrointestinal Tract 2025, loperamide monograph. No paediatric faecal-incontinence dose is stated in any document held here. Source Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt) Why The condition's own article gives the drug and the dose in one sentence, so a single trusted disease-level document discharges both claims: loperamide, 4 mg 3 times a day, which can cut how often stool is passed, ease the urgency, slow transit through the colon, and raise the resting tone of the anal sphincter. The Egyptian formulary's loperamide monograph covers acute diarrhoea, IBS-associated diarrhoea and post-surgical diarrhoea, not faecal incontinence, and gives a different regimen; both its indication silence and its regimen are stated on the row rather than hidden. Caution The Egyptian formulary gives a different regimen for the diarrhoea it does cover. For acute diarrhoea in adults it starts at 4 mg, then 2 mg after every loose stool, with a daily ceiling of 12-16 mg. For chronic diarrhoea its usual maintenance is 4 to 8 mg a day. The 4 mg three times a day above is the disease article's figure and is 12 mg/day - inside the formulary's ceiling, but higher than its maintenance range. The formulary's indication list does not name faecal incontinence - it licenses the drug to relieve the symptoms of acute diarrhoea, in adults and in children of 12 years and above. The link to this condition comes from the disease article. CONTRAINDICATED, on the formulary's own list: hypersensitivity to loperamide or to anything else in the product; a child under 2 years; abdominal pain with no diarrhoea; acute dysentery, meaning blood in the stool with a high fever; and acute ulcerative colitis. Also contraindicated in bacterial intestinal inflammation caused by invasive pathogens (Salmonella, Shigella, Campylobacter), in antibiotic-associated colitis, and wherever inhibiting peristalsis risks ileus, megacolon or toxic megacolon. Exclude faecal impaction with overflow before slowing the bowel - constipating an impacted patient makes them worse. Avoid in the first trimester of pregnancy; the formulary permits use in the second and third. Not recommended during lactation. Egypt MOTIJUST 2 MG 30 CAPS INTERNATIONAL... 27.00 EGP (0.90/unit) STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 10.00 EGP IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS. MCNEIL PRODUCTS LTD. > JOHNSO... 80.00 EGP STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 96.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)