The Japan Society of Coloproctology Practice Guidelines for Fecal Incontinence 2024 (Revised Second Edition)

In 2024, the second edition of the Japan Society of Coloproctology (JSCP) Practice Guidelines for Fecal Incontinence was published in Japan, followed by the release of this English version. This marks the first major revision in 7 years since the publication of the first edition. The second edition was completed over a span of 3 years, and its overview and key features are summarized below. This guideline begins with a clinical flowchart outlining the general diagnostic and therapeutic approach. A notable update is the inclusion of insertable anal and vaginal continence devices, which are now considered a form of conservative therapy under clinical research frameworks. In Chapter I-B (Epidemiology), the prevalence of anal incontinence was newly reported: among a Japanese population with an average age of 35 years, 15.5% of men and 42.7% of women were affected. In Chapter II (Diagnosis), the utility of a bowel diary for patient assessment is discussed for the first time. The guideline also provides a detailed description of the evaluation method for digital rectal examination. Additionally, a new section was added addressing incontinence-associated dermatitis (IAD), including its risks and methods of assessment. In Chapter III (Diagnostic Testing), the guideline expands upon previously established diagnostic tests by newly including detailed descriptions of ultrasound techniques-specifically, endoanal ultrasound, transperineal ultrasound, and transvaginal ultrasound. Chapter IV (Treatment) outlines conservative treatment strategies, including dietary guidance, bowel habit instruction, and care for fecal incontinence. Pharmacologic therapies are presented with itemized explanations by drug type. Pelvic floor muscle training, biofeedback therapy, and transanal irrigation are classified under "specialized conservative therapies" and discussed in detail. For surgical treatment, a new Clinical Question (CQ) addresses postpartum fecal incontinence. It recommends early referral to a specialized center when a sphincter injury is present to be repaired, whereas observation for one year may be appropriate when no injury is identified. Another new CQ discusses the mode of delivery in subsequent pregnancies following obstetric anal sphincter injuries (OASIS), emphasizing the need to evaluate fecal incontinence severity, anal sphincter function, and its integrity before making clinical decisions. Stoma creation is described in detail as one of the surgical treatment options, including its implications for improved postoperative quality of life. For the first time, regenerative therapy for the anal sphincter is introduced as a novel surgical option, reporting promising long-term outcomes from trials involving the transplantation of autologous cultured myoblasts into the external anal sphincter. Finally, Chapter V addresses special clinical scenarios in detail, including fecal incontinence associated with neurological and spinal disorders, dementia, frailty, and bedridden elderly patients.