Efficacy of methylcellulose and loperamide in managing fecal incontinence

Objective. To evaluate the efficacy of methylcellulose (Citrucel®) and loperamide (Imodium®) in managing fecal incontinence by comparing cure rates with expectant management. Design. Prospective controlled study. Setting. Urogynecology clinic in a university hospital. Population. Sixty-nine women with fecal incontinence. Methods. All incontinent women received one heaping tablespoon of methylcellulose twice a day, which was increased to two heaping tablespoons twice a day as needed. If the incontinence persisted after taking the maximum dose of methylcellulose for two weeks, loperamide, one capsule twice a day was added, which was increased to two capsules three times a day as needed. If both fecal urgency and incontinence resolved, the therapy was continued for a three-month treatment period. Women, who declined the proposed treatment and did not undergo any other therapy during the subsequent eight weeks, served as controls. A subject or control was considered cured if she stated that her incontinence was cured, had zero Pescatori incontinence point, resolution of fecal urgency, and her incontinence did not affect her emotional, social, occupational, and physical functions during the three-month treatment or eight-week observation period. Main outcome measures. Difference in the cure rate between subjects and controls. Results. Fifty-nine subjects were treated with methylcellulose. Forty (68%) also required loperamide. Ten women served as controls. Women treated with methylcellulose and loperamide had a higher cure rate than those managed expectantly (46% vs. 0%, p