I always use imodium
Studies have shown that it can improve sphincter function, slows transit and many patients can hold onto a solid stool but not a liquid one - classically middle aged women with a moderated reduction in external anal sphincter function
Well, for a short time to relief, you could prescribe a derivates morphin, like codein because its obstipation effects. I have already use in fecal incontinencia in a patient with severe diabetic neuropathy with good results
Imodium yes, as it also increases rectal capacity, but start with 0.5mg syrup nocte particularly in older patients and increase the dose by similar increments, every couple of weeks. Usually, there is some generalised sphincter weakness, a rectocoele and some pelvic floor descent, so adding in glycerine suppositories to use along with their gastro-colic reflex is very useful.
a detailed history and examination is vital, with a plan the patient understands and agrees with. Giving them a copy if your annotation if the first and lengthy consultation helps. It is important that anal canal exercises are not performed while sitting on the commode and that patients do not attempt to defaecate in response to a rectal urge alone. Though the first consultation takes forever without a nurse or physiologist to help, I find that more often than not I need to follow them up only once, to make minor tweaks to the plan; after that, they know how to adjust things themselves and can be discharged
Apart from Imodium and diphenoxylate, newer drugs like Rifaximin, Ramosetron and Eluxadoline can be tried in case of non optimum results (These drugs are used for IBS-D)
Their side effect profile and low efficacy rate are such that currently they are useful in only a small number of cases. Dietary modifications together with hypnotherapy appear as useful at the moment.
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