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Fecal incontinence, according to the most used definition, is the “involuntary loss of the stool or soiling at a socially inappropriate time or place” []. It is an important health issue that strongly affects patient quality of life and restricts their social activities. It is a common problem, with prevalence ranging from 2.2% to 15% in the community and up to 40% in nursing homes []. The prevalence of fecal incontinence in neurological patients is higher than in the general population. Many neurological disorders are associated with fecal incontinence, and this chapter is a review of the current clinical knowledge regarding the pathogenesis and clinical findings. When considering the possible effects of central and peripheral neurological lesions on fecal continence, it is important to keep in mind that continence depends on intact neural pathways and normal function of the cerebral, spinal, and cauda equina centers, and peripheral nerves. It should be remembered, however, that signs, symptoms, and gastrointestinal dysfunction may differ from expectations by virtue of incomplete neuronal lesions, coexisting involvement of supraspinal or spinal centers, or damage to the distal parts of the autonomic or somatic innervation of the pelvic floor sphincter muscles.

It is now recognised, albeit relatively recently, that chronic gastrointestinal symptoms represent a clinically important problem in a substantial number of people who have type 1 or type 2 diabetes [, ]. Whereas the amount of information relating to anorectal function in diabetes is limited, it is clear that faecal incontinence occurs relatively frequently [, , ] and is often overlooked as a cause of morbidity.

At any age, fecal incontinence is one of the most devastating of all nonfatal illnesses, resulting in considerable embarrassment, anxiety, and social isolation to those who suffer from it. So embarrassing is it that individuals with incontinence frequently do not volunteer this complaint to their physicians and must be asked directly about fecal incontinence []. The physician should also be aware that patients might complain of “diarrhea,” which may be a euphemism for fecal incontinence.

Radiation injury is a well-known complication after external radiotherapy of cancers within the pelvic cavity. Radiation therapy might be the primary treatment for such cancers (prostate, uterine, cervical, bladder, and anal cancers), or it might be combined with surgery (rectal cancer).

Double incontinence (DI) is the concomitant presence of urinary and anal incontinence in the same subject. This condition is widely underreported due to social stigma and embarrassment. In fact, women who suffer from both diseases have greater impairment regarding their physical and psychosocial wellbeing than do women suffering from isolated urinary incontinence (UI) or fecal incontinence (FI) [], resulting in social isolation and reduced quality of life []. Few studies have evaluated the prevalence of DI. The different results of these studies depend on the method utilized for data collection and on the demographic features of the study population. Table 1 shows the prevalence of DI reported by various authors [3-9].

Fecal incontinence represents a devastating problem for all those who suffer from it. It often prevents a person from becoming socially accepted, which in turn provokes serious psychological sequelae. It is a problem that impacts more children than previously thought, affecting those born with anorectal malformations and Hirschsprung’s disease as well as children with spinal cord problems or spinal injuries.

As a common denominator of all the clinical aspects treated in this book, there is the awareness of potential benefits derived from rational management of fecal incontinence (FI) and the need for further efforts to improve the effectiveness of traditional and new treatments. Indeed, although progress made in this field during the last few decades has been significant, the lack of detailed knowledge in the physiology of fecal continence far too frequently makes the application of therapeutic procedures empiric and pragmatic. Moreover, there are discrepancies between countries and regions in referring patients to centers dedicated to FI management. This causes different attitudes in performing a homogeneous diagnostic workup, in application of similar strict selection criteria to the variety of available treatments, and in reporting results of the applied therapies. Worldwide, national institutes for health inadequately support medical research on FI treatment, even though the social, economic, and clinical importance of FI to society has been very well recognized. On the other hand, research into FI is all too frequently sponsored only by companies with a commercial interest in the subject.