ABSTRACT
A number of anatomical and functional abnormalities are frequently associated with fecal incontinence. These can be etiologically responsible, such as complete rectal prolapse, or pathologically related, such as rectovaginal fistula or solitary rectal ulcer syndrome (SRUS). Rectovaginal fistulas frequently occur in the setting of abnormal sphincter function, which leads to incontinence, or they may cause pseudoincontinence by allowing passage of flatus and stool through the vagina. Repairs of simple rectovaginal fistulas are usually performed using a perineal approach and do not require fecal diversion. SRUS is a poorly understood condition that is difficult to treat and frequently frustrating for patient and physician alike. Paradoxically, fecal impaction is frequently complicated by overflow fecal incontinence. Impaction associated with incontinence is often attributed to reflex relaxation of the internal anal sphincter in response to chronic fecal distention. Fecal impaction is largely preventable and should be prevented.
