Fecal incontinence treatment

Fecal incontinence refers to stool leakage from the rectum without any warning. Fecal incontinence can range from occasional stool leakage while passing gas to complete loss of bowel control.
Fecal incontinence can be treated using non-surgical and surgical treatment methods. Treatment will help in improving the quality of life of a person.

Causes:
The different causes of fecal incontinence include:

1. Damage to the anal sphincter muscles (rings of muscle present at the end of the rectum) during childbirth
2. Chronic constipation
3. Diarrhea
4. Nerve damage due to:
5. Childbirth
6. Stroke
7. Diabetes
8. Spinal cord injury
9. Long-lasting constipation
10. Straining during bowel movements
11. Multiple sclerosis
12. Hemorrhoids (swollen veins in the rectum)
13. Stiffening and scarring of the rectum due to surgery, radiation therapy, or inflammatory bowel disease
14. Rectal prolapse (dropping down of the rectum into the anus)
15. Rectocele (rectum protrudes through the vagina)

Symptoms

The symptoms of fecal incontinence include:

1. Leakage of stools when passing gas
2. Leakage of stools due to physical exertions
3. Stool is seen in underwear after a normal bowel movement
4. Feeling that you need to go, but not being able to reach the bathroom in time
5. Complete loss of bowel regulation
6. Constipation or diarrhea 
7. Cramping
8. Abdominal pain
9. Urinary incontinence (accidental urine leakage)
10. Bloating 
11. Itching or irritation of the anus
12. Flatulence (passing gas)

Risk factors:
The following factors could increase the risk of developing fecal incontinence:

1. Age above 65 years
2. More common in females
3. Nerve damage due to diabetes, back trauma, injury, multiple sclerosis
4. Dementia
5. Late-stage Alzheimer’s disease
6. Physical disability 

Diagnosis

1. Physical examination: The doctor will examine the patient physically, which will include the visual inspection of the anus. A probe may be used to examine this area for nerve damage. Touching the probe to this area may cause anal sphincter contraction and puckering of the anus.
2. Digital rectal exam: The doctor will insert the gloved, lubricated finger into the rectum to check the strength of the sphincter muscles and the presence of any irregularities in the rectal area. The doctor will also check for rectal prolapse.
3. Balloon expulsion test: A small balloon will be inserted into the rectum and filled with water. You will then be asked to go to the bathroom for balloon expulsion. If it takes more than one to three minutes to do so, you most probably have a defecation disorder.
4. Anal manometry: A flexible, narrow tube is inserted into the anus and rectum. A small balloon at the top of the tube could be expanded. This test helps in measuring the tightness of the anal sphincter and the functioning and sensitivity of the rectum.
5. Anorectal ultrasonography: A wand-like, narrow instrument will be inserted into the anus and rectum. This instrument will produce video images that will allow the doctor to check the structure of the sphincter.
6. Proctography: X-ray video images are created when you have a bowel movement on a specially designed toilet. This test helps in measuring how much stool the rectum can hold. It also helps in evaluating how well the body expels stool.
7. Colonoscopy: A flexible tube will be inserted into the rectum for inspecting the entire colon.
8. Magnetic resonance imaging (MRI) scan: An MRI can help in providing clear images of the sphincter to determine if the muscles are intact. It is also useful in providing images during defecation, known as defecography.

Treatment

The treatment for fecal incontinence will vary depending on the cause and severity of the condition. The different treatment options include:

1. Non-surgical treatment: These are non-invasive treatment methods and may be performed in the following ways:

a) Medications: The different medicines that can be used for the treatment of fecal incontinence include:

• Anti-diarrheal medications: Medicines like loperamide and drugs containing atropine and diphenoxylate can help in treating diarrhea.
• Bulk laxatives: Medicines containing methylcellulose and psyllium can help in treating chronic constipation.

b) Exercises and other treatment methods: 

• Kegel exercises: These are pelvic floor muscle exercises that help in regular contraction of the muscles used to control urinary flow, build strength in the pelvic muscles, and reduce bowel incontinence.
• Bowel training: Try to schedule bowel movements at the same time every day to prevent any accidents in between.
• Biofeedback: This procedure involves placing a sensor inside the anus and on the abdominal wall. This will provide feedback as a person will do certain exercises to improve bowel control.
• Radiofrequency and anal sphincter remodeling: A probe is inserted into the anus to directly control the amount of heat energy into the wall of the anus. It may cause a mild injury to the sphincter muscles, which may become thicker as they heal.
• Injectable biomaterials: Materials like collagen, silicone, and hyaluronic acid may be injected into the anal sphincter to boost its function and thickness.

2. Surgical treatment: Surgery is recommended when the non-invasive treatments fail to work. The different types of surgeries include:

a) Sphincter surgery:
This procedure may involve stitching the anal muscles more tightly together, known as sphincteroplasty.
Alternatively, the surgeon may choose to take muscle from the buttock or pelvis to support the weak anal muscles. This procedure is known as muscle transposition.
This procedure is generally performed in patients having bowel incontinence due to the tearing of the anal sphincter muscles.

b) Sacral nerve stimulator:
This procedure involves implanting a device to stimulate the pelvic nerves.
This procedure is generally performed in patients having fecal incontinence due to nerve damage.

c) Sphincter cuff device:
The surgeon may implant a cuff filled with air and surrounding the anal sphincter.
The patient has to deflate the cuff during bowel movements and reinflate it to prevent bowel incontinence.

d) Colostomy:
This type of surgery is performed to redirect the colon through an opening created in the belly skin.
This procedure is recommended in recurrent cases of fecal incontinence when all other treatment methods have failed to work.

Risks

When left untreated, fecal incontinence may lead to the following complications:

1. Skin irritation around the anal area
2. Pain in the anal region
3. Itching in the anal region
4. Ulcer formation in the anal region
5. Frustration, embarrassment, and depression

After Procedure

Home remedies:

The following home remedies can help you in gaining better control of your bowel movements:

• Avoid food items that could cause gas or diarrhea

• Avoid spicy food, fatty food, and dairy products

• Avoid caffeinated drinks and alcohol

• Eat a high-fiber diet

• Drink plenty of liquids throughout the day

• Gently wash your anal area with water after every bowel movement

• Gently pat dry your anal area after washing it following a bowel movement

• Non-medicated talcum powder and moisture-barrier creams may help in relieving anal discomfort

• Wear loose, cotton underwear

Prevention:

Fecal incontinence can be improved or prevented in the following ways:

1. Increase exercise, eat a high-fiber diet, and drink lots of fluids to decrease constipation
2. Treat the cause of diarrhea, such as intestinal infection
3. Avoid straining during bowel movements 
4. Do Kegel exercises (pelvic floor exercises)

Cost of surgical methods for fecal incontinence treatment- 

The cost of non-surgical methods to treat fecal incontinence is between INR 500 to INR 10,000.
The cost of surgical methods to treat fecal incontinence in Mumbai is between INR 60,000 to INR 2,25,000.
The cost of surgical methods to treat fecal incontinence in Delhi is between INR 50,000 to INR 2,00,000.
The cost of surgical methods to treat fecal incontinence in Bangalore is between INR 50,000 to INR 2,00,000.
The cost of surgical methods to treat fecal incontinence in Chennai is between INR 40,000 to INR 1,80,000.