Diagnosis and management of faecal incontinence in primary care

Dear Editor

I would like to commend this article for a comprehensive and thorough review of an important topic that is often not addressed properly by clinicians and patients may feel to embarrassed to seek help.

I would also like to highlight the often overlooked diagnosis of microscopic colitis (MC) which is usually classified under the umbrella of inflammatory bowel disease, and the article does reference the latter; however it is important to consider MC as a separate disease process in a patient with persistent watery diarrhoea, especially in those aged over 50 with nocturnal symptoms(1). Examination, including endoscopy, is often unremarkable and almost every case requires a histological diagnosis which needs to be considered at the time of endoscopy. Treatment can be simple and life-changing for those affected, so it is a condition worth highlighting.

Reference

1. Miehlke S, Guagnozzi D, Zabana Y, et al. European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations. United European Gastroenterol J. 2021 Feb 22;9(1):13-37.