What is Fecal Incontinence?

BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Fecal Incontinence?
The inability in controlling bowel movements leading to the unexpected leaking of stool (feces) from the rectum (the last several inches of the large intestine) is known as fecal incontinence. Fecal incontinence is also known as bowel incontinence can range from an occasional leakage of stool on passing gas to a complete loss in bowel control.
Fecal incontinence can lead to embarrassment. Treatment of fecal incontinence can help in improving the quality of life of an individual. In this article, we will be discussing in detail about fecal incontinence.
- What are the causes of Fecal Incontinence?
- What are the risk factors of Fecal Incontinence?
- What are the symptoms of Fecal Incontinence?
- How to diagnose Fecal Incontinence?
- What is the treatment of Fecal Incontinence?
- What are the complications of Fecal Incontinence?
- How to prevent Fecal Incontinence?
What are the causes of Fecal Incontinence?
The causes of fecal incontinence could include:
- Damage to the ring of muscles at the end of the rectum (also known as anal sphincter muscles)
- Damage to the nerve that senses stool in the rectum
- Chronic (long-term) constipation
- Diarrhea
- Hemorrhoids, in which the anus (the opening at the lower end of the intestine) does not close properly due to the swelling of the veins in the rectum
- Surgery to treat the enlarged veins in the anus or rectum (hemorrhoids)
- Stiffness or scarring of the rectum due to inflammatory bowel disease, surgery, or radiation therapy (treatment for cancer)
- Rectocele (protrusion of the rectum through the vagina)
- Rectal prolapse (the rectum drops down into the anus)
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What are the risk factors of Fecal Incontinence?
Certain factors increase the chances of developing fecal incontinence. These factors include:
- Age above 65 years
- More common in female
- Physical disability
- Late-stage Alzheimer’s disease (a progressive disease affecting memory and mental abilities)
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- Dementia (loss of memory, language, and thinking ability)
- Trauma from an injury, surgery, multiple sclerosis, long-standing diabetes may lead to nerve damage, which is a risk factor for fecal incontinence
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What are the symptoms of Fecal Incontinence?
There are two types of fecal incontinence, which include:
- Urge bowel Incontinence: It is a condition in which the person has a sudden urge to pass stools, but is unable to reach there on time.
- Passive soiling: It is a condition that indicates that a bowel movement is about to happen.
- Accidental fecal leakage occurs in cases of severe diarrhea.
- Chronic fecal incontinence can occur when there is a frequent or occasional accidental stool leakage, silent leakage of feces during exertion or other daily activities, inability to hold in gas, or not being able to reach the washroom in time.
- The type of stools passed during fecal incontinence can vary. The stools can be solid or liquid in nature, or an individual may break wind and pass a small portion of stool.
- The fecal incontinence episodes may occur on a daily, weekly, or monthly basis.
- The severity of fecal incontinence can be mild which may include soiling of underwear, to severe which may include a total lack of bowel control.
- Other symptoms of fecal incontinence may include:
- Diarrhea or constipation
- Urinary incontinence (accidental urine leakage)
- Cramping
- Abdominal pain
- Bloating
- Flatulence (passing gas)
- Itching or irritation of the anus
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How to diagnose Fecal Incontinence?
- Physical examination: The doctor will physically examine the patient and note down the symptoms of the patient.
- Rectal exam: The doctor inserts his/her gloved finger to check for problems in the bottom (rectum).
- Anal manometry: This is a test to study the strength of the anal sphincter muscles. A thin, short tube is inserted up into the anus and rectum to take images of the sphincter muscles.
- Pudendal nerve terminal motor latency test: This test helps in measuring the function of the pudendal nerves that are involved in controlling the bowel.
- Endoluminal ultrasound or anal ultrasound: This test helps in evaluating the shape and structure of the anal sphincter muscles and the surrounding tissue. A small probe is inserted up into the anus and rectum by the doctor to obtain images of the sphincters.
- Anal electromyography (EMG): This test helps in checking the coordination between the anal and rectum muscles, and if nerve damage is causing fecal incontinence.
- Proctosigmoidoscopy or flexible sigmoidoscopy: This test helps in checking the end of the large intestine (sigmoid colon) for any abnormalities like a tumor, inflammation, or scar tissue, that may be causing fecal incontinence. The doctor inserts a thin tube with a camera on one end into the rectum up to the sigmoid colon to perform this test.
- Proctography or defecography: This is a test done to obtain an x-ray video to see how well the rectum is functioning, that is, how well the rectum holds and releases the stools.
- Magnetic resonance imaging (MRI) scan: This is an imaging test done to obtain clear images of the pelvic organs (organs below the stomach region).
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What is the treatment of Fecal Incontinence?
The treatment of fecal incontinence depends on the cause of the condition. The various treatment options include:
Medications:
- Anti-diarrheal drugs: Drugs like atropine sulfate, diphenoxylate, and loperamide hydrochloride are used to treat diarrhea.
- Bulk laxatives: Laxatives like psyllium and methylcellulose are used to treat chronic constipation.
Exercise and other treatments: Exercises can help in curing muscle damage that may be causing fecal incontinence. Examples include:
Kegel exercises:
- These exercises help in strengthening the pelvic floor muscles, that support the bowel and bladder, and in the case of women, the uterus, to help in reducing fecal incontinence.
- For performing Kegel exercises, contract the muscles used for stopping the urine flow, hold the contractions for three seconds, and then relax for three seconds. This should be repeated 10 times.
- You can gradually increase this to three sets of ten contractions every day.
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Bowel training:
- The doctor recommends having a bowel movement at a specific time of the day.
Biofeedback:
- A physiotherapist can teach you simple exercises to increase the strength of the anal muscles.
- This helps in strengthening the pelvic floor muscles, sensing when the stool is ready to be released, and contracting the muscles when having a bowel movement.
Bulking agents:
- The injections of non-absorbable bulking agents can help in the thickening of the walls of the anus.
- This helps in the prevention of stool leakage.
Sacral nerve stimulation (SNS):
- The sacral nerves run from the spinal cord (backbone) to the pelvic muscles and help in regulating the strength and sensation of the rectal and anal sphincter muscles.
- A device sending small electrical impulses continuously to the nerves can help in strengthening the muscles in the bowel.
Posterior tibial nerve stimulation (PTNS/TENS):
- This is a minimally invasive treatment that stimulates the posterior tibial nerve present at the ankle region.
Vaginal balloon:
- This is a type of pump device that is inserted into the vagina.
- An inflated balloon causes pressure on the rectal area, leading to less frequency of fecal incontinence.
Radiofrequency therapy:
- Temperature-controlled radiofrequency energy is applied to the anal canal wall to improve the muscle tone.
- It is also called the Secca procedure.
Surgery: A surgery may be needed to correct an underlying medical problem that may be causing fecal incontinence. Surgical options include:
Sphincteroplasty:
- This is a procedure done to repair a weakened or damaged anal sphincter that may have occurred during childbirth.
- The doctors identify the injured area of muscle and then free its edges from the surrounding tissue.
- The edges are then bought together and sutured (stitched) in an overlapping manner to strengthen the muscle and tighten the sphincter.
Treatment of rectal prolapse, hemorrhoids, or rectocele:
- The surgical correction of these disorders helps in treating fecal incontinence.
Colostomy:
- This surgery helps in diverting the stool through an opening in the abdomen.
- A special bag is attached to the opening for the collection of the stool.
- Colostomy is the last preferred treatment modality, only after other treatments have failed.
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What are the complications of Fecal Incontinence?
The complications of fecal incontinence are:
- Skin irritation around the anus area
- Pain in the anus
- Itching in the anus area
- Ulcer (sore) formation in the anus region
- Embarrassment, frustration, and depression
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How to prevent Fecal Incontinence?
Fecal incontinence can be prevented or improved by the following means:
- Avoiding constipation, by eating a fiber-rich diet, drinking lots of fluids, exercising.
- Getting diarrhea treated by addressing any infection in the digestive system.
- Avoid straining while defecating, as this can cause weakening of the anal sphincter muscles.
- Performing pelvic floor exercises like kegel exercises.
- Avoid alcohol, caffeine, fatty foods, dairy products, spicy foods, smoked or cured meats, and artificial sweeteners.
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We hope we could answer all your questions about Fecal Incontinence through this article.
If you experience the problem of excessive fecal incontinence, then you can contact a Gastroenterologist.
We only aim to provide you with information through the article. We do not recommend any medicine or treatment to anyone. Only a doctor can give you the best advice and correct treatment plan.