The perspective of a gynecologist on treatment-related research for fecal incontinence in women.

Fecal incontinence affects between 1% and 16% of women, with prevalence increasing with age. The most common cause of fecal incontinence in otherwise healthy women is damage to the anal sphincter(s) during childbirth. As such, the most important tool in the "treatment" of fecal incontinence is its prevention, which should be the first research priority for gynecologists. Routine midline (median) episiotomy has no place in modern obstetrics; when episiotomy must be performed for obstetric indications, use of mediolateral episiotomy should result in fewer anal sphincter injuries than use of midline episiotomy. Additional research questions that gynecologists hope to address are as follows. (1) When anal sphincter injury occurs at delivery, what is the most effective method of repair? Even when repair is performed, women frequently have symptoms of altered bowel function ranging from fecal urgency to frank fecal incontinence. (2) Is it possible to improve the relatively poor results of a strictly surgical repair? Does pelvic muscle rehabilitation (performed either after vaginal delivery or after secondary repair remote from delivery) add significantly to the outcome of women after anal sphincteroplasty? (3) Another more general research priority is to understand the shared and independent factors in the pathophysiology of fecal and urinary incontinence so as to identify modifiable risk factors in women.