Faecal incontinence in adults: management

Reasons for the decision to not update the guideline

The recommendations in this guideline were largely based on consensus because of inadequate quantity and quality of evidence. The evidence base, and clinical practice, do not appear to have progressed enough to support an update of this guideline.

The evidence considered in this surveillance indicated that the following interventions may improve outcomes for people with faecal incontinence:

The guideline recommends rectal irrigation, anal plugs and sacral nerve stimulation, so no impact is expected for these interventions. Injectable bulking agents for faecal incontinence (NICE interventional procedures guidance 210) recommends this procedure under special arrangements. Although more evidence is available, it appears to be of a similar nature to that considered in developing the guidance (lower quality evidence, and no evidence of long-term effects). Therefore, no impact is expected on the guideline.

For the following interventions, the new evidence suggested no effect, or uncertainty in their effects:

Pelvic floor muscle training, biofeedback and electrical stimulation were noted to have limited evidence for their use during guideline development, so the guideline committee used consensus to recommend these interventions only for people who had inadequate response to initial management. Therefore, the new evidence is unlikely to affect recommendations.

Recommendations on surgery were clear that discussions should take place between the patient and a specialist surgeon including: the surgical and non-surgical options appropriate for their individual circumstances; the potential benefits and limitations of each option (with particular attention to long-term results); and realistic expectations of the effectiveness of any surgical procedures under consideration.

Evidence on surgery considered when developing the guideline often found some evidence of short-term benefit but no long-term benefit, and adverse events were common. The new evidence suggests much the same, so no impact on the guideline is expected.

Drug treatments for diarrhoea are recommended to reduce faecal incontinence. Evidence for these drugs remains focused on the outcome of diarrhoea rather than incontinence, therefore, no impact on the guideline is expected.

A further study (Duelund-Jakobsen et al. 2015), suggested by a topic expert, suggested that people with faecal incontinence whose symptoms improved were satisfied with their continence status after nurse-led care, but those whose symptoms did not improve were dissatisfied. However, this study does not tell us whether nurse-led care affected patients' outcomes compared with usual care, so no impact is expected.