Results of the international audit for faecal incontinence on behalf of the European Society of Coloproctology (ESCP) collaborating group

AIM: The aim of this study was to evaluate the prevalence of faecal incontinence (FI) among patients attending colorectal clinics in a global setting, treatment choices and accessibility to diagnostic and treatment tools.

METHODS: An international, prospective, multi-centre snapshot audit and survey of patients undergoing consultation regarding FI was undertaken from January 9 to February 28, 2023. Participating units included patients in the audit who presented until March 28, 2023. Main outcomes measured included the prevalence of FI in clinical practice, diagnostic approaches, treatment patterns and availability of interventions.

RESULTS: A total of 1853 outpatients with FI and 363 surgical patients were included, representing a prevalence of 6.3% of total clinic attendance over the same period. The majority of patients were female (75.3%), parous (85% of females). Patients presented with passive and urge incontinence, or both, in fairly even proportions (34.8 vs. 29.4 vs. 33.7%, respectively). Aetiology was most commonly anal injury (surgical or obstetric: 15.4% vs. 19.8%, respectively), but with significant proportions of other surgical conditions, such as low anterior resection syndrome (11.1%) and rectal prolapse (12.7%). In the surgical audit (n = 363), the majority of patients had received previous treatment (61.1%), including pelvic floor physiotherapy (67.1%), bowel retraining with biofeedback (51.4%), and nurse-led continence support (40.5%). Of 395 procedures performed, sacral neuromodulation was the most common (28.9%), followed by sphincteroplasty (22.0%). In the global practice survey (n = 250 respondents), endoanal ultrasound (EAUS) (82.4%) and anorectal manometry (74.4%) were the most available diagnostic tools.

CONCLUSIONS: Globally, FI forms a significant part of colorectal surgeons' clinical workload, with a skew toward structural causes of FI. Practice varies according to the availability of diagnostics and procedures.