The American Gastroenterological Association (AGA) has released its updated clinical practice recommendations for the use of surgery and device-assisted treatment of fecal incontinence and defecatory disorders. Among the best practices described in the update:

• Clinicians should use a stepwise approach to managing fecal incontinence, starting with conservative therapies such as diet, fluids, techniques to improve evacuation, and a bowel training program.
• If patients don’t respond to the aforementioned measures, consider biofeedback to assist in pelvic floor retraining.
• Consider perianal bulking drugs, including intra-anal injection of dextranomer, if biofeedback and conservative therapy fails.
• Patients with moderate or severe fecal incontinence may benefit from sacral nerve stimulation—assuming there are no contraindications—if symptoms persist after 3 or more months of conservative treatment or biofeedback.