Clinical Challenges of Fecal Incontinence in the Elderly.

OPINION STATEMENT: Fecal incontinence (FI) is underreported, yet it is quite commonly experienced by the elderly patient. FI confers a significant direct and indirect burden on patients, their caregivers, and the health-care system. Due to the presence of multiple comorbid medical conditions in patients over 65 years of age and the number of medications taken by elderly patients, FI management poses several challenges to the treating physician. We emphasize the importance of a comprehensive history and physical exam with specific attention to diet, physical activity, cognitive function, medications, and comorbidities specific to patients in this age group. Symptomatic conservative therapy should be the first step in management. Evaluation of the underlying pathology causing FI and more invasive treatments should be considered in selected patients who are cognitively intact and can tolerate these procedures.