{ "schema_version": 1, "kind": "condition", "id": "fecal-incontinence", "name": "Fecal Incontinence", "category": "chronic", "sources": "Fecal Incontinence - StatPearls - NCBI Bookshelf (NBK459128) - https://www.ncbi.nlm.nih.gov/books/NBK459128/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS17 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt)", "review_status": "reviewed", "verified_against": "No dose - referral pathway, no medicine given in primary care · Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 719, "generic": "Recognise, exclude the reversible causes, refer (Recognition & Referral)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Involuntary leakage of stool or flatus. Exclude the reversible causes first - faecal impaction with overflow, infection, and the drugs and foods that loosen the stool. The article asks the patient to keep off foods that bring on diarrhoea, a diet heavy in lactose or fructose among them, and to treat any underlying disorder suspected alongside it - bile salt malabsorption, irritable bowel disease, or irritable bowel syndrome. Then skin care and containment: keep the perianal skin clean and unsoiled, apply zinc oxide, and use incontinence pads. Drug therapy aimed at stool consistency is the next step and the rows below carry it. If that fails, anorectal manometry, then biofeedback - retraining the pelvic floor and the abdominal muscles to work around the defect - and finally surgery, which the article keeps for symptoms that hold out against everything above. Refer to colorectal surgery for the last two.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Involuntary leakage of stool or flatus. Exclude the reversible causes first - faecal impaction with overflow, infection, and the drugs and foods that loosen the stool. The article asks the patient to keep off foods that bring on diarrhoea, a diet heavy in lactose or fructose among them, and to treat any underlying disorder suspected alongside it - bile salt malabsorption, irritable bowel disease, or irritable bowel syndrome. Then skin care and containment: keep the perianal skin clean and unsoiled, apply zinc oxide, and use incontinence pads. Drug therapy aimed at stool consistency is the next step and the rows below carry it. If that fails, anorectal manometry, then biofeedback - retraining the pelvic floor and the abdominal muscles to work around the defect - and finally surgery, which the article keeps for symptoms that hold out against everything above. Refer to colorectal surgery for the last two.", "cautions": [ "This card DOES carry a drug row now - loperamide, for stool consistency, frequency and urgency. It is symptom control, not a cure, and it must never be started before faecal impaction with overflow has been excluded. The definitive treatments are physical: pelvic floor retraining, biofeedback, and surgery.", "Four further drugs are named by the article cited here and none of them is dosed, each for a stated reason. Bulking agents - the article says only that methylcellulose may firm the stool up (Fecal Incontinence - StatPearls - NCBI Bookshelf, NBK459128) - carry no dose in it, and every methylcellulose product in the Egyptian register is an eye lubricant, not an oral bulking agent. Diphenoxylate (Lomotil) - the article reports that patients improve on it while the objective tests do not - has no dose there and ZERO products in the Egyptian register. Oestrogen - raised only as something that might help a woman past the menopause - names a class, not a drug, and no dose. Amitriptyline - raised only where incontinence of urine and of stool go together, and again with no dose - is dosed for incontinence by no document held here.", "RED FLAG - An associated neurological deficit (possible spinal cord or cauda equina lesion), or rectal prolapse or a mass found on examination: refer." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "fecal-incontinence" }, { "id": 720, "generic": "Loperamide", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.0, "adult_dose": "4 mg 3 times a day", "adult_duration": null, "dose_source": "Fecal Incontinence - disease-level clinical article (fecal-incontinence-full.txt)", "rationale": "The condition's own article gives the drug and the dose in one sentence, so a single trusted disease-level document discharges both claims: loperamide, 4 mg 3 times a day, which can cut how often stool is passed, ease the urgency, slow transit through the colon, and raise the resting tone of the anal sphincter. The Egyptian formulary's loperamide monograph covers acute diarrhoea, IBS-associated diarrhoea and post-surgical diarrhoea, not faecal incontinence, and gives a different regimen; both its indication silence and its regimen are stated on the row rather than hidden.", "cautions": [ "The Egyptian formulary gives a different regimen for the diarrhoea it does cover. For acute diarrhoea in adults it starts at 4 mg, then 2 mg after every loose stool, with a daily ceiling of 12-16 mg. For chronic diarrhoea its usual maintenance is 4 to 8 mg a day. The 4 mg three times a day above is the disease article's figure and is 12 mg/day - inside the formulary's ceiling, but higher than its maintenance range.", "The formulary's indication list does not name faecal incontinence - it licenses the drug to relieve the symptoms of acute diarrhoea, in adults and in children of 12 years and above. The link to this condition comes from the disease article.", "CONTRAINDICATED, on the formulary's own list: hypersensitivity to loperamide or to anything else in the product; a child under 2 years; abdominal pain with no diarrhoea; acute dysentery, meaning blood in the stool with a high fever; and acute ulcerative colitis.", "Also contraindicated in bacterial intestinal inflammation caused by invasive pathogens (Salmonella, Shigella, Campylobacter), in antibiotic-associated colitis, and wherever inhibiting peristalsis risks ileus, megacolon or toxic megacolon.", "Exclude faecal impaction with overflow before slowing the bowel - constipating an impacted patient makes them worse.", "Avoid in the first trimester of pregnancy; the formulary permits use in the second and third. Not recommended during lactation." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary contraindicates loperamide under 2 years of age, and confines its own indication to children of 12 years and over - it indicates the drug for treating the symptoms of acute diarrhoea in adults and in children from that age up. Egyptian National Drug Formulary - Gastrointestinal Tract 2025, loperamide monograph. No paediatric faecal-incontinence dose is stated in any document held here.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MOTIJUST 2 MG 30 CAPS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA", "price_egp": 27.0, "pack_count": 30, "unit_price": 0.9, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MCNEIL PRODUCTS LTD. > JOHNSON & JOHNSON SCIENTIFIC OFFICE", "price_egp": 80.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA", "price_egp": 96.0, "pack_count": null, "unit_price": null, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "fecal-incontinence" } ] }