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FECAL INCONTINENCE

Men's Health, Women's Health / By

FECAL INCONTINENCE

Fecal incontinence is the inability to control bowel movements, resulting in involuntary fecal elimination.

  • Fecal incontinence can range in severity from an involuntary leakage of small amounts of stool while passing gas to total loss of bowel control.
  • Although treatable, fecal incontinence is one of the most socially and psychologically debilitating conditions in an otherwise healthy individual.
  • It is not life-threatening, but it can affect the quality of life, and self-esteem of affected individuals as they may avoid social activities for fear of embarrassment.
  • It is also known as bowel incontinence.
  • Fecal incontinence is a common condition, and more slightly common among women.

CAUSES

  • Damage to the anal sphincters, the muscle around the anus. The anal sphincter can get damaged as a result of vaginal childbirth. This is why women are more affected. Anal surgery can also damage the anal sphincter.
  • Diarrhea
  • Inflammatory bowel disease including Chron’s disease or ulcerative colitis.
  • Nerve damage due to diabetes, multiple sclerosis, constant straining during bowel movements, stroke, spinal cord injury.
  • Chronic constipation
  • Radiation damage to the rectum such as after prostate cancer treatment
  • Loss of storage capacity in the rectum from scarring or surgery
  • Rectal prolapse, where the rectum drops down into the anus
  • Rectocele in women, where the rectum protrudes through the vagina
  • Hemorrhoids
  • Cognitive and behavioral dysfunction due to dementia, learning disabilities
  • Irritable bowel syndrome
  • Disability-related to being unwell, frail, or chronic/acute disabilities
  • Idiopathic, where causes are unknown
  • Congenital abnormalities such as anorectal anomalies
  • Brain damage or defects such as tumor
  • Fecal incontinence may occur during epileptic seizures

Certain medications can worsen the condition including:

  • Drugs that alter the sphincter tone such as selective serotonin reuptake inhibitors (SSRIs), sildenafil, beta-blockers
  • Topical drugs applied to anus such as bethanechol cream, botulinum toxin A injection, glyceryl trinitrate ointment, diltiazem gel
  • Drugs such as codeine, opioids, tricyclic antidepressants

SYMPTOMS

The symptoms of fecal incontinence depend on the type.

  • In urge fecal incontinence, affected individuals will be aware of a need to pass stool but may not be able to stop the urge to defecate. This is because the urge will come on so suddenly that they are unable to make it to the toilet in time.
  • In passive fecal incontinence, affected individuals will pass stool or mucus without being aware or knowing it.

Other symptoms may include:

  • Abdominal pain
  • Bloating
  • Itchy or irritated anus

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will review your medical history, ask questions about your symptoms, bowel habits, diet, and lifestyle and perform a physical examination. During the physical examination, the doctor may examine the anus and surrounding area for damage, hemorrhoids, and infections.  A probe may be used to examine this area of skin and check for nerve damage. Other tests that may help with a diagnosis may include:

  • A digital rectal examination may be necessary. During this procedure, the doctor inserts a sterile glove into the anus and up into your rectum to evaluate the strength of your sphincter muscles.
  • Stool testing to identify infection or other cause if diarrhea is present
  • Anorectal ultrasonography to produce video images that allow the doctor to evaluate the structure of your sphincter.
  • Colonoscopy to inspect your entire colon
  • Anal manometry to measure the tightness of the anal sphincter as well as the functioning of the rectum.
  • Proctography to measure the amount of stool your rectum can hold and evaluate how much your body expels stool
  • MRI defecography to provide information about the muscles and supporting structures in the anus, rectum, and pelvis
TREATMENT

Treatment options may include:

Medications depending on the cause of your incontinence. Options include:

  • Loperamide hydrochloride (Imodium-D)
  • Methylcellulose

Dietary changes including taking more fluids, getting adequate fiber

Exercise such as Kegel exercises and other therapies to restore muscle strength and improve anal sphincter control. Therapies including bowel training, biofeedback, sacral nerve stimulation

Surgery to correct underlying problems, such as rectal prolapse or sphincter damage. Surgical options include sphincteroplasty, colostomy, sphincter replacement.