Editing Incontinence (section)

== '''Initial management''' ==

=== Supportive care ===

** Wait 9-12 months after      childbirth to investigate
** Avoid food or activities      known to worsen symptoms
*** Avoid incompletely digested       sugars (fructose, lactose) and caffeine
** Keep a food or symptom diary
** Improve perianal skin      hygiene
*** Keep clean and dry, without       excessive wiping
*** Can use wet wipes
*** Barrier cream eg zinc oxide       to perianal skin
*** Incontinence pads

=== Medical therapy - aimed at     reducing stool frequency or improving stool consistency ===

** Bulking agents, esp in      patients with low-volume, loose stools
*** Fibre - psillium husk
** Anti-diarrhoeal agents - can      trial loperamide
*** Be aware this can       exacerbate things in patients with decreased rectal compliance       (radiation proctitis, rectal stricture)
*** If no response to       loperamide, bismuth subsalicylate or cholestyramine may provide benefit,       especially in patients post-cholecystectomy or post-ileal resection
** If faecal impaction, should      be disimpacted
** Evacuation of rectum with      suppositories or enemas
*** Esp useful for patients       with neurogenic bowel dysfunction - reduces rectal load