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Source created 2026-08-27 · updated 2026-08-27
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ASCRS Ch61 - Fecal Incontinence: Evaluation and Treatment

Sixty-first chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (da Silva G, Mellgren A), part of "Part V: Pelvic Floor Disorders." Book pages 1035–1046, PDF pages 1021–1032. Offset confirmed +14 (a further +1 jump from Ch60's +13 — see ASCRS Ch60 - Rectal Prolapse for the discovery of the Ch59/Ch60 jump and the "chapter starts on an odd/recto book page" pattern) via the copyright-line cross-check on this chapter's own first page, and cross-verified against two further pages early in the chapter. A check at the Ch61/Ch62 boundary found no further jump — Ch62 ("Low Anterior Resection Syndrome (LARS)") begins at book page 1047 (offset still +14), consistent with the pattern: Ch61 itself ends on an even book page (1046), so no blank page is needed to force Ch62 to start on an odd page, and the offset holds steady.

Summary

The dedicated fecal incontinence (FI) chapter that ASCRS Ch03 - Anorectal Physiology had explicitly deferred evaluation/treatment content to. Covers FI epidemiology (1–19% prevalence range per a 4,840-article systematic review) and a four-category etiology framework (anatomical, neurologic, stool-characteristic, rectal). Evaluation: history/exam, the Cleveland Clinic Florida Fecal-Incontinence Score (CCF-FIS), anorectal manometry correlations (internal vs. external sphincter pressure to passive vs. urge incontinence; hypo/hypersensitivity associations), ultrasound (anal and combined pelvic floor), neurophysiology testing (PNTML's declining clinical role), defecography (intussusception as a negative SNM predictor), and colonoscopy.

Treatment is presented as a ladder: conservative measures (diet, bowel management, anal irrigation), pelvic floor exercises/biofeedback, anal insertion devices, the vaginal bowel control system, sacral neuromodulation (SNM — two-stage procedure, FDA-approval trial data, complications/ reoperation rates, a newer rechargeable device), bulking agents (NASHA Dx), percutaneous tibial nerve stimulation (PTNS), radiofrequency energy delivery (SECCA®), stem cell therapy (investigational), the TOPAS anal sling, overlapping sphincteroplasty (full technique), ventral mesh rectopexy for prolapse/intussusception-associated FI, dynamic graciloplasty, magnetic anal sphincter augmentation (Fenix™), the artificial bowel sphincter (ABS), and last-resort options (ileostomy/colostomy, MACE). Several devices (TOPAS, dynamic graciloplasty, Fenix, ABS) are explicitly noted as not currently available in the USA.

Wiki impact

  • Substantially expanded Fecal Incontinence with new Evaluation and Treatment sections — the single largest resolution of a previously-flagged deferred-content gap in the wiki's pelvic floor arc (originally flagged when ASCRS Ch03 - Anorectal Physiology was ingested).
  • Light cross-reference addition to Anorectal Physiology Testing's PNTML discussion, corroborating its existing methodologic-criticism framing from the treatment-outcome side.
  • FI-specific outcome data (Samaranayake et al. systematic review, expanded Oxford grade III–IV indication) added to Fecal Incontinence's ventral rectopexy section, cross-referencing Rectal Prolapse Repair for full technique rather than duplicating it.

Open items / gaps

  • No primary literature independently ingested for any of the chapter's named RCTs/systematic reviews — five are flagged in Research Priorities.md.
  • Sphincteroplasty is documented in full technique detail on Fecal Incontinence rather than as its own procedure page — revisit if the wiki's granularity conventions change.