Issue: 2005 > July-August > original article

Diagnostic work-up for faecal incontinence in daily clinical practice in the Netherlands

A.C. Dobben, M.P. Terra, M. Deutekom, P.M.M. Bossuyt, R.J.F. Felt-Bersma, J. Stoker


Background: To study variation in Dutch hospitals in
applying diagnostic and treatment options for faecal
Methods: Surgeons, gastroenterologists, internists and
gynaecologists were contacted by phone or mail and
requested to complete a questionnaire. The questionnaire asked for general information about patients with faecal incontinence, the use and availability of diagnostic techniques, the use of incontinence scores and therapeutic options.
Results: In total 306 specialists were contacted and data
were collected from 203 specialists from 86 hospitals
(response rate 66%). The most frequently applied diagnostics were sigmoidoscopy (64%), endoanal sonography (58%), evacuation proctography (56%) and/or anorectal manometry (51%). The choice seemed to be related to the availability of the techniques. Sigmoidoscopies were performed significantly more often in local hospitals (p<0.001), while in academic medical centres significantly more endoanal MRI examinations were conducted (p<0.05). The most stated treatment option was physiotherapy (90%), followed by dietary measures (83%), medication (71%) and surgery (68%). However, in general, combinations of treatment
options were used.
Conclusions: A substantial variety exists in the diagnostic
work-up of faecal incontinence. In general, at least one
anorectal functional test and an imaging technique are the diagnostic techniques of choice. Pelvic floor physiotherapy is the first choice in conservative treatment.