Controlling Anal Incontinence by Performing Anal Exercises With Biofeedback or Loperamide (CAPABLe)

Inclusion Criteria:

• Age ≥18 years

• Fecal incontinence defined as any uncontrolled loss of liquid or solid fecal materialthat occurs at least monthly over the last 3 months that is bothersome enough todesire treatment

Exclusion Criteria:

• Stool consistency over the last 3 months that includes items 1 or 7 based on theBristol Stool form scale

• Current or past diagnosis of colorectal or anal malignancy

• Diagnosis of inflammatory bowel disease

• Current or history of rectovaginal fistula or cloacal defect

• Rectal prolapse (mucosal or full thickness)

• Prior removal or diversion of any portion of colon or rectum

• Prior pelvic floor or abdominal radiation

• Refusal or inability to provide written consent

• Inability to conduct telephone interviews conducted in English or Spanish

• Fecal impaction by exam

• Untreated pelvic organ prolapse beyond the hymen; Patients with prolapse beyond thehymen who are currently using a pessary are eligible

• Incontinence only to flatus

• Has taken any loperamide (Imodium®) or diphenoxylate plus atropine (Lomotil®) in thelast 30 days

• Previously received and failed treatment of fecal incontinence using loperamide (Imodium®) or diphenoxylate plus atropine (Lomotil®) over the last 3 months

• Current supervised anal sphincter exercise/pelvic floor muscle training withbiofeedback

• Previously received and failed treatment of fecal incontinence using supervised analsphincter exercise/pelvic floor muscle training with biofeedback

• Previous allergy or intolerance to loperamide

• Pregnant, nursing, or planning to become pregnant before the end of the studyfollow-up period.

• Childbirth within the last 3 months

• Currently taking anti-retroviral drugs

• Neurological disorders known to affect continence, including spinal cord injury,advanced multiple sclerosis or Parkinson's disease and debilitating stroke

• Known diagnosis of hepatic impairment

• Chronic abdominal pain in the absence of diarrhea