Fecal incontinence

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

Fecal incontinence, or also called bowel incontinence, is the inability to control bowel movements. The rectum leaks stool (feces, waste, or excrement) when least expected, even if it is not during bathroom breaks. This condition could also leak stool even if just releasing gas until uncontrollable bowel movements.

As the muscle or nerve injury may be related to aging or giving birth, it is common in elderly. Fecal incontinence is frequently brought on by muscle or nerve injury, constipation, and diarrhea.

The following are two types of fecal incontinence:

Urge incontinence: refers to the condition that cannot control the urge to defecate.
Passive incontinence: refers to the condition that the person does not realize that they need to defecate.

Fecal incontinence typically does not cause major health issues, but it can significantly interfere day-to-day living. Fecal incontinence can be challenging to talk about, regardless of the cause. It is recommended to discuss the condition to the healthcare provider. Treatments can enhance the quality of life and reduce fecal incontinence.

Symptoms

Bowel incontinence may be a temporary issue or a recurring one. Occasionally having diarrhea might lead to fecal incontinence. But fecal incontinence occurs frequently for some persons. Other bowel issues, such as:

Diarrhea, loose watery stool.
Constipation, problem passing stool.
Gas and bloating.

If the patient or the baby have fecal incontinence and had been severe that resulted to mental discomfort, it is recommended to seek medical help. People may feel too ashamed to disclose fecal incontinence to healthcare provider. However, the sooner they are assessed, the sooner they might see some symptom to be treated.

Causes

Fecal incontinence can have more than one probable cause. These are some of the potential causes:

Diarrhea: Loose stools from diarrhea might aggravate or cause fecal incontinence because they are harder to keep in the rectum than solid stools.
Constipation: A dry, hard lump of stool that has become too big to pass may form in the rectum as a result of chronic constipation. Constipation for an extended period of time might harm nerves, which can result in fecal incontinence.
Muscle damage: When healthcare provider uses forceps or make a little cut (an episiotomy) to create a bigger opening during a challenging vaginal delivery, muscle injury may result. Anal or rectal surgery can also potentially cause muscle injury. This resulted in difficulty to hold stools if the muscle at the end of the rectum are injured.
Nerve damage. Incontinence may occur if the nerves that controls the rectum and anus muscles are damaged. Incontinence can also result from impaired “rectal sensory” nerves. Constipation (which causes episodes of frequent and intense straining) can cause nerve injury, as can the presence of certain medical disorders, difficult vaginal deliveries, anal surgery, and certain health issues (such as diabetes, multiple sclerosis, stroke or a spinal tumor).
Reduced rectum storage capacity: The rectum typically expands to make room for the stool. Excess feces can leak out if the rectum cannot extend as much as it needs which could due to scarring or stiffness. The rectum may become tight and scarred as a result of surgery, radiation therapy, or inflammatory bowel disease.
Surgery: Fecal incontinence can be brought on by rectal and anal surgeries, such as those performed for hemorrhoids, which can harm muscles and nerves.
Other health conditions:
- Rectal prolapse: Fecal incontinence may develop as a result of rectal prolapse, a disorder in which the rectum descends into the anus. The nerves that control the rectal sphincter are damaged as a result of the rectal sphincter being stretched by prolapse.
- Rectocele: Fecal incontinence in females can happen if the rectum pokes through the vagina.
- Hemorrhoids: Stool may seep out of the anus as a result of these enlarged veins, preventing it from shutting entirely.

Risk factors

The chances of developing fecal incontinence may be affected by a number of factors, including:

Age: Fecal incontinence is more common in individuals over the age of 65, but it can occur at any age.
Gender: Women are more prone to develop fecal incontinence because a small increase has been discovered in recent research among women who use menopausal hormone replacement treatment. Childbirth complications including fecal incontinence are possible.
Nerve damage: Fecal incontinence may occur in people with long-term diabetes, multiple sclerosis, or spinal damage after injury or surgery. The nerves that help regulate defecation may be harmed by certain disorders.
Physical disability: Fecal incontinence can result from a traumatic injury that damages the rectal nerves. Being physically disabled could be challenging to get to the bathroom in time.
Dementia: Dementia and late-stage Alzheimer’s disease, fecal incontinence is frequently observed.

Diagnosis

The healthcare provider will conduct physical examination and history taking about the condition. A visual examination of the anus is frequently recommended. To evaluate for nerve injury in this location, a device may be utilized. There are several tests available to properly determine the cause of fecal incontinence:

Digital rectal examination: The purpose of this technique is to assess the strength of the sphincter muscle and look for any abnormalities in the rectal region. Patient is advice to bear down while the exam is being performed. Rectal prolapse will also be examined during this operation.
Magnetic resonance imaging (MRI): To evaluate whether the muscles are still intact, an MRI can produce detailed images of the sphincter. Additionally, defecography can deliver visuals while defecating.
Anorectal ultrasonography: Healthcare provider will examine the structure of the sphincter using this test. The device will be inserted to evaluate the rectum and anus and give out detailed imaging.
Anal manometry. Using a narrow and flexible tube, it will be inserted to the rectum and anus. The tip of the tube has a small balloon that can be inflated. This test helps to determine the anal sphincter’s degree of tightness as well as the rectum’s sensitivity and functionality.
Colonoscopy: This procedure uses a flexible tube attached to a small camera and inserted into the rectum to visualize the entire colon.
Balloon expulsion test: A water-filled small balloon is inserted into the rectum. Patient will be advice to go to the restroom and push out the balloon. Patients who have defecation disorder will take more than one to three minutes.
Proctography: The patient will use a specially designed toilet for defecation while an x-ray video image are taken. The test measures the rectum’s capacity to hold stool. It also assesses the body’s capacity to eliminate stool.
Nerve test: The responsiveness of the nerves regulating the sphincter muscles is assessed. The tests could be able to identify nerve injury that may result in bowel incontinence.

Treatment

Surgery

Surgery may be necessary to address an underlying problem, such as rectal prolapse or sphincter injury brought on by delivery, in order to treat fecal incontinence. The choices consist of:

Sphincteroplasty:  During childbirth, the anal sphincter may have been weakened or injured, which is fixed by this operation. By doing so, the sphincter will become tighter and the muscle will be strengthened. When a muscle is injured, healthcare provider will locate it and cut the edges free of the surrounding tissue. The muscles are reattached, and then edges are sewn in an overlapping pattern. For those attempting to avoid colostomy, sphincteroplasty can be an alternative.
Colostomy: Through an abdominal incision, stool is diverted during this procedure. The stool is collected through the abdomen by attaching a special bag. Usually, a colostomy is only considered when other therapies have failed. This procedure is also known as bowel diversion.
Sphincter cuff device: An air-filled cuff that encloses the anal sphincter can be implanted. To avoid bowel incontinence, the cuff is deflated during bowel motions and inflated again afterward.
Surgical correction: Surgery to treat hemorrhoids, a rectocele, or rectal prolapse will probably lessen or resolve fecal incontinence.

Medications

The type of medication will depend on the underlying cause of fecal incontinence.

Anti-diarrheal medication: Loperamide and those with atropine and diphenoxylate.
Laxatives: If your incontinence is being brought on by chronic constipation, try methylcellulose and psyllium.

Other type of therapies

Healthcare provider might suggest an exercise regimen and other treatments to rebuild muscle strength if muscle injury is the cause of fecal incontinence. Anal sphincter control and awareness of the urge to defecate can both be improved by these treatments.

Kegel exercises: Increase the pelvic floor muscles’ strength. These muscles provide support for the uterus, colon, and bladder in females. Contract the muscles and hold for 3 seconds then relax for another 3 seconds. Repeat the procedure for 10 times. Hold the contraction for a longer period of time as your muscles get stronger. Work your way up to three sets of 10 contractions per day. Increasing the strength of these muscles might lessen incontinence.
Radiofrequency therapy: The anal canal wall will receive a radiofrequency to help with muscle tone improvements. The minimally invasive radiofrequency therapy is typically carried out while the patient is sedated and under local anesthetic. This procedure is also known as Secca procedure.
Biofeedback: Simple exercises that can strengthen the anal muscles are taught by physical therapists. The procedure could be done with anal manometry and rectal balloon. These workouts can improve the pelvic floor muscles, contract the muscles for bowel movement, and improve the senses for defecation.
Vaginal balloon (Eclipse System): An intravaginal pump-style device. The pressure from the inflated balloon on the rectal area reduces the frequency of fecal incontinence.
Bowel training: Patient is encouraged to have a routine bowel movement every day. Patient can exert more control by determining when they need to seek for the restroom.
Bulking agents: The walls of the anus can be thickened by injections of non-absorbable bulking agents that could lessen the chances of leaks.
Sacral Nerve Stimulator: The procedure uses a small device that stimulates the pelvic nerves. People with bowel incontinence caused by nerve injury may benefit from this procedure.
Posterior tibial nerve stimulation: The ankle’s posterior tibial nerve is stimulated by this minimally invasive procedure.

Diseases & Conditions Fecal incontinence