Fecal Incontinence Treatments

This policy covers surgical and device-based treatments for severe, chronic fecal incontinence—including sacral neuromodulation, anal sphincter repair (sphincteroplasty), artificial bowel sphincter (Acticon Neosphincter), and colostomy—after failure of adequate conservative measures. Coverage is limited to adults with acquired fecal incontinence (typically >2 episodes/week for >6 months) who previously had bowel control and meet procedure-specific criteria (e.g., ≥50% sustained improvement on percutaneous sacral nerve testing for neuromodulation; Acticon use ≥18 years), and excludes congenital anorectal malformations, neurologic causes of incontinence, irreversibly obstructed proximal bowel, large sphincter defects (>60°), mechanical outlet obstruction or planned diathermy, and several therapies considered unproven (e.g., Secca, injectable bulking agents, PTNS, vaginal bowel-control systems).

"Severe, chronic fecal incontinence defined as >2 incontinent episodes per week on average and duration >6 months."