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

Background: To study variation in Dutch hospitals in applying diagnostic and treatment options for faecal incontinence. 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.