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Fecal incontinence

Definition


Disease: Fecal incontinence Fecal incontinence
Category: Digestive diseases

Disease Definition:

The inability to control bowel movements is called fecal incontinence, which causes stool to leak unexpectedly from the rectum. Fecal incontinence, also called bowel incontinence, could range from an occasional leakage of stool while passing gas to a complete loss of bowel control.

 

Constipation, diarrhea and muscle and nerve damage are some of the causes of fecal incontinence. Bowel incontinence is usually due to a weakened anal sphincter, which is associated with aging or injury to the nerves and muscles of the rectum and anus from giving birth.

 

Fecal incontinence could be embarrassing no matter the reason; however, a person shouldn’t shy away from talking to a doctor. Fecal incontinence could be improved or even corrected by many treatments, some of which are simple.
 

Work Group:


Symptoms, Causes

Symptoms:

Except during an occasional short-lived bout of severe diarrhea, adults usually don’t have “accidents”. However, for people with recurring or chronic fecal incontinence, that is not the case. Someone who has fecal incontinence won't be able to:

 

  • Control the passage of gas or stools, which could be either liquid or solid, from the bowels
  • Make it to the toilet in time to avoid accidents

 

Fecal incontinence is a relatively minor problem for some people, limited to occasional soiling of their underwear, including children. However, in the case of a complete lack of bowel control, the condition could be devastating for some others.

 

In some cases, fecal incontinence could be accompanied by other bowel troubles, including:

 

  • Diarrhea
  • Constipation
  • Gas and bloating
  • Abdominal cramping

 

In case an adult or a child develops fecal incontinence, they should see a doctor. Usually, after childbirth, new mothers are reluctant to tell their doctors about their fecal incontinence. However, in order to prevent long-term complications, a torn anal sphincter muscle should be repaired soon after delivery.

 

In order to help diagnose what’s causing the problem and determine the right treatment, a number of tests are available.
 

Causes:

Critical to normal bowel function include:

Anal sphincter muscles:

The external and internal muscles contract in order to prevent stool from leaving the rectum.

Rectal sensation:

This is the feeling that warns a person to go to the toilet.

Rectal accommodation:

Rectal stretching will allow a person to hold stool for a while until they can get to a toilet.

 

In order to hold stool someone should have a normal function of their rectum, anus and nervous system. They should also have the mental and physical capabilities to recognize and appropriately respond to the urge to defecate. Fecal incontinence could occur in case something is wrong with any of these factors.

 

Fecal incontinence could be caused due to a wide range of conditions and disorders, such as:

Constipation:

Ironically, constipation is one of the most common causes of fecal incontinence because chronic constipation could lead to impacted stool, which is a large mass of dry and hard stool within the rectum. The muscles of the rectum and intestines stretch and then eventually weaken in case the mass is too large to pass. Fecal incontinence could be caused when watery stool from farther up in the digestive system moves around the hard stool and leaks out.
Chronic constipation causes the muscles of the anus to stretch and weaken, in addition to making the nerves of the anus and rectum less responsive to the presence of stool in the rectum. When these muscles are weakened, they won’t be able to move stool through the digestive system as efficiently.

Diarrhea:

Loose stools of diarrhea could cause or even worsen fecal incontinence because they are harder to retain than solid stools.

Muscle damage:

Injury to the anal sphincter, the rings of muscle at the end of the rectum that help hold in stool, is usually the cause of fecal incontinence. When these muscles are damaged they won’t be strong enough to hold stool back properly and some may leak out. Usually, this sort of damage occurs during childbirth, particularly if forceps are used during delivery or if an episiotomy is performed; but this damage might not be evident until years of the incident.

Nerve damage:

Fecal incontinence could be due to damage to the nerves that control the anal sphincter or the nerves that sense stool in the rectum. A stroke, spinal cord injury, childbirth and constantly straining when having a bowel movement could cause nerve damage. Multiple sclerosis and diabetes are diseases that could affect these nerves and cause damage leading to fecal incontinence.

 

Loss of storage capacity (accommodation) in the rectum:
The rectum normally stretches in order to accommodate stool. However, the rectum won't be able to stretch as much as it needs to, leading to stool leakage, in case the rectum is scarred or the rectal walls are stiffened due to surgery, radiation treatment or inflammatory bowel disease, including Crohn’s disease or ulcerative colitis.

Rectal cancer:

In case the cancer has invaded the muscle walls of the anus or rectum or has disrupted the nerve impulses needed for defecation, fecal incontinence could be caused.

Surgery:

Fecal incontinence could be caused when damage is done to the anus during surgery to treat hemorrhoids, which are enlarged veins in the rectum or anus. More complex operations that involve the rectum and anus could also cause fecal incontinence.

Loss of muscle strength with age:

Fecal incontinence could be caused over time when the muscles and ligaments that support the pelvis as well as the anal sphincter muscles start to weaken.

Chronic laxative abuse:

Fecal incontinence could be due to reliance on laxatives in order to maintain regularity.

Other conditions:

Fecal incontinence could result in case the rectum drops down into the anus, a condition called rectal prolapse, or in women, in case the rectum protrudes through the vagina (rectocele). Fecal incontinence could also be due to hemorrhoids, a condition that prevents complete closure of the anal sphincter.
 

Complications

Complications:

Skin irritation:

The skin could be irritated due to fecal incontinence. Pain, itching and potentially, sores or ulcers that require medical treatment could be caused due to repeated contact with stool because the skin around the anus is delicate and sensitive.

Emotional distress:

Usually, people with fecal incontinence try to hide their problem and avoid social engagements because this condition could be a source of embarrassment and shame. Frustration, anger and depression could result due to the loss of dignity associated with losing control over one’s bodily functions.
 

Treatments:

There are some effective treatments available for fecal incontinence. Someone could either see a primary care doctor or a doctor who specializes in treating conditions that affect the colon, rectum and anus, such as a proctologist, colorectal surgeon or a gastroenterologist. Usually, treatment for this condition helps reduce the severity of the condition substantially or even restore bowel control.

 

Treatment of fecal incontinence depends on its cause. Some of the available options include dietary changes, medications, special exercises that help better control the bowels or surgery.

 

MEDICATIONS:

In some cases, in order to treat fecal incontinence, medications are recommended, including:

Stool softeners:

A person may be recommended a stool-softening medication in order to prevent stool impaction.

Laxatives:

Someone may be recommended using mild laxatives temporarily, such as milk of magnesia, in case the incontinence is caused by chronic constipation.

Anti-diarrheal drugs:

In order to reduce diarrhea and help avoid accidents, a person may be recommended medications such as loperamide , which is used to treat diarrhea and could also be used to treat incontinence.

Other medications:

Someone with this condition may be recommended medications that decrease the spontaneous motion of the bowel (bowel motility) or medications that decrease the water content of the stool in case the cause of fecal incontinence is diarrhea.

 

THERAPIES:

Fecal incontinence could be improved by a variety of therapies, such as:

Dietary changes:

Stool consistency is affected by what the person eats and drinks. In order to help improve bowel movements, the person may be recommended changes to their diet. For instance, they may be recommended drinking lots of fluids and eating fiber-rich foods that aren’t constipating in case the fecal incontinence is caused by chronic constipation. They may be recommended increasing their intake of high-fiber foods in order to add bulk to their stools, making them less watery in case the fecal incontinence is caused by diarrhea. However, in general, a person will be recommended a diet that helps them gain good stool consistency for increased control of bowels.

Bowel training:

A person could benefit from a bowel training program and exercise therapies aimed at helping them restore muscle strength in case the fecal incontinence is caused by a lack of anal sphincter control or decreased awareness of the urge to defecate.
Learning to go to the toilet at a specific time of day is what bowel training sometimes means. For instance, someone may be recommended making a conscious effort to have a bowel movement after eating. This will help them gain greater control by establishing with some predictability when they need to use the toilet.

 

There is yet another bowel training treatment for fecal incontinence called biofeedback, which involves inserting a pressure-sensitive probe into the anus. This probe will register muscle strength and activity of the anal sphincter as it contracts around the probe. By viewing the scale’s display, the person could practice sphincter contractions and learn to strengthen his/her muscles. The rectal muscles could get stronger with these exercises.

Treatment for stool impaction:

In case taking laxatives or using enemas doesn’t help in passing the hardened mass, the doctor may have to remove the impacted stool by inserting one or two gloved fingers into the rectum in order to break apart the impacted stool. These smaller pieces are easier to expel.

Sacral nerve stimulation:

This is another treatment for fecal incontinence. The sacral nerves, which run from the spinal cord to muscles in the pelvis, regulate the sensation and strength of the rectal and sphincter muscles. In case fecal incontinence is caused by nerve damage and the anal sphincter muscles are still intact, direct electrical stimulation of these nerves could restore continence in 40 to 75%. Usually, this treatment is done only when other treatments fail.

 

This treatment is done in stages. First, four to six small needles are positioned in the muscles of the lower bowel. These muscles are stimulated by an external pulse generator. Usually, the muscle response to the stimulation isn’t uncomfortable. The person could have a permanent pulse generator implanted after a successful response.

 

SURGERY:

Sometimes, in order to correct an underlying problem, treatment for fecal incontinence could require surgery. The surgical procedures that are used to treat fecal incontinence could be difficult and have complications. However, certain causes of fecal incontinence, such as sphincter damage due to childbirth or rectal prolapse, could be effectively treated with surgery. Some of the surgical options are:

Sphincteroplasty:

In this surgery, a damaged or weakened anal sphincter is repaired, during which an injured area of muscle is identified and its edges are freed from the surrounding tissue. Then, the muscle edges are brought back and sewn together in an overlapping fashion, which strengthens the muscle and tightens the sphincter.

Operations to treat rectal prolapse, a rectocele or hemorrhoids:

Rectal prolapse is a condition that weakens the anal sphincter because a portion of the rectum protrudes through the anus. In chronic constipation and straining, the ligaments to the rectum can become stretched and lose their ability to hold the rectum in place. In this case, surgical correction of the rectal prolapse along with sphincter muscle repair is needed. In women, if the fecal incontinence is caused by a protrusion of the rectum into the vaginal wall (rectocele), it may need to be corrected surgically. Complete closure of the anal sphincter may be prevented due to prolapsed hemorrhoids, which could lead to fecal incontinence. Hemorrhoids could be either near the upper part or beginning of the anal canal (internal hemorrhoids) or it could be at the lower portion or anal opening (external hemorrhoids). This condition could be treated with a surgical procedure called hemorrhoidectomy that removes the hemorrhoidal tissue.

Sphincter repair:

A surgical procedure called a gracilis muscle transplant could restore muscle tone to the sphincter. During this surgery, a muscle is taken from the inner thigh and wrapped around the sphincter.

Sphincter replacement:

In case someone's anal sphincter is damaged, it could be replaced with an artificial anal sphincter implanted around the anal canal. This device is essentially an inflatable cuff, when inflated, it keeps the anal sphincter shut tight until the person is ready to defecate. When the person wants to go to the toilet, they use a small external pump in order to deflate the device and allow stool to be released. After about 10 minutes, the device re-inflates itself.

Colostomy:

Although a colostomy could be the most definitive way to correct fecal incontinence, but this procedure is usually considered a last resort and is only done when other treatments have failed. This procedure diverts stool through an opening in the abdomen and in order to collect stool, a special bag is attached to this opening.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Expert's opinion:

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Clinical Trials:

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