Fecal Incontinence

April 10th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Fecal incontinence, or the loss of bowel control, is a very unsettling problem. It causes a loss of self-esteem and self-confidence. It even leads to social isolation, and it is much more common than people think.

Over $400 million dollars are spent per year on adult diapers in the USA alone. Fecal incontinence is also the second leading cause of nursing home placement. Unfortunately, many who suffer from this disorder do not seek help due to embarrassment. Many times the problem is treatable or even curable.

What is it? What are the risk factors?

Fecal incontinence falls under two major categories:

  1. Minor incontinence: Inadvertent escape of flatus or stool leaving stains on the undergarments.
  2. Major incontinence: Involuntary excretion of feces.

The major risk factors associated with developing fecal incontinence are:

  • Advanced age
  • Poor general health and limited physical activity
  • Emphysema (COPD/lung disease)
  • Irritable bowel syndrome
  • Urinary incontinence
  • History of colectomy/colon surgery
  • Chronic diarrhea
  • Depression
  • Diabetes

What are the causes of fecal incontinence?

Our bodies naturally digest the food we eat, and the waste products are eliminated. The fecal matter is stored in the rectum until our body sends us signals that it is time to defecate. This mechanism is actually quite complex and requires adequate function in the following areas:

  • Mental/nervous system health
  • Stool volume and consistency
  • Colon transit time
  • Rectal sensation and muscle control

When something goes wrong in one or more of these areas, then problems can develop.

For example, nerve damage, as seen in diabetics, can lead to problems with sphincter control. Also, women who have given birth vaginally are at increased risk for anorectal trauma. These women can suffer from incontinence right after giving birth or even years later.

How is it diagnosed?

Your physician will first do a thorough interview. This is to find out if you have any symptoms or history of diseases that might cause fecal incontinence. One part of the exam is a simple test where the doctor gently touches the skin near the anus. If the anal sphincter fails to pucker or “wink” then there could be nerve damage. The doctor will also do an exam of the rectum by placing a finger inside and asking you to bear down. This is a way to check if your muscle tone is strong.

There are other tests that might be ordered such as:

  • Blood and stool testing
  • Sigmoidoscopy or colonoscopy: to look inside the rectum and large intestine
  • Anal manometry: measures anal and rectal pressure and function
  • Pudendal nerve testing and electromyography: tests for nerve damage
  • Endorectal ultrasound, MRI scans: these look for structural abnormalities or tumors

How is fecal incontinence treated?

First of all, if any underlying disease is detected, then this will be a cornerstone of treatment. Otherwise, treatment is aimed at decreasing stool frequency and improving stool consistency. For example, formed stool is easier to control than liquid diarrhea. In this case, your doctor might try using methylcellulose to add bulk and solidify the stool.

Antidiarrheal drugs, like loperamide, might also provide relief. In persons who have problems after meals, the anticholinergic agent hyoscyamine can be beneficial.

If a person has stool impaction, this can also cause incontinence as liquid stool seeps around the blockage. In this case the person must be disimpacted.

Finally, in some persons biofeedback works. In this treatment, you are guided in improving control of your pelvic and abdominal muscles. This is done with a special device that detects muscle contraction and lets you know when your muscles are doing the right thing.

Surgery might be needed sometimes to repair a sphincter defect. Also, newer therapies exists such as Solesta and Sacral Nerve Stimulator.

Summary

Fecal incontinence is extremely troubling, for patients and their families. It is important to have a complete evaluation by a physician in order to establish the cause of the disorder. In many cases, the problem can be reduced or even eliminated.

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