Non-surgical Management of Anal Incontinence

Anal incontinence (AI) is an embarrassing problem for many women following childbirth. This condition affects physical, psychological, social, and sexual well-being. This is particularly challenging in the immediate postpartum when woman are caring for a new-born baby. During the immediate postpartum time, the mainstay treatments for AI are conservative measures to allow management of symptoms. A thorough assessment is needed to establish a differential diagnosis and, ultimately, a plan of care for each individual can be established. Women should be educated on what is the likely aetiology of their symptoms and what treatments are available including the following: dietary modifications, pelvic floor exercises, bowel emptying techniques, medications, the use of bowel products, and low or high-volume irrigation. This chapter examines conservative management strategies for women with AI, as usually this is the first line treatment for this problem. It will detail what lifestyle aspects can affect AI such as body mass index, smoking, diet, fluid intake, and physical activity. It will then go on to look at the importance of a detailed assessment; this ensures that the treatment delivered is appropriate for each individual patient, as no one treatment plan fits all. Following on from this, the conservative treatments will be discussed.