• Fecal Incontinence

    (Incontinence, Fecal; Bowel Incontinence; Incontinence, Bowel)

    Definition

    Fecal incontinence is the loss of control over the bowels. Some people may have uncontrolled release of just gas and liquid stool. Others have no control over the release of solid waste. Many people with this condition also have trouble controlling the release of urine.
    This condition can lead to issues, such as depression or isolation. If you think you have this condition, contact your doctor right away.

    Causes

    Women are more likely to suffer from this condition than men are. Many cases are a result of an injury to the pelvic floor. The pelvic floor is a group of muscles that support pelvic organs. Injury can happen through pregnancy or delivery . Other causes include:
    Rectal Prolapse
    Rectal prolapse
    The rectum falls through the anal opening.
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Risk factors include:
    • Gender: female
    • History of episiotomy
    • Older age
    • Diseases of the nervous system (eg, stroke )
    • Damage to the spinal cord (eg, cauda equina syndrome )
    • Other risk factors thought to contribute to fecal incontinence include:
      • Diabetes
      • Depression
      • Lack of physical activity
      • Being overweight

    Symptoms

    The main symptom is the inability to control bowel movements, which leads to stool leakage.

    When Should I Call My Doctor?

    Call your doctor if you have fecal incontinence. Your doctor can help find the underlying cause.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may send you to a specialist, such as:
    • Gastroenterologist
    • Colorectal surgeon
    • Proctologist
    Tests may include the following:
    • Anorectal manometry—test that uses a catheter to check pressure in the anal canal while resting and squeezing
    • Pudendal nerve terminal motor latency (PNTML) testing—test that uses an electrode in the anal canal to evaluate how well the nerves are working
    • Endoanal ultrasound—test that uses sound waves to make a picture; used to detect any injury to anal sphincter muscles
    • Proctosigmoidoscopy—test that uses a thin, lighted tube inside the rectum; used to examine the rectum and lower colon for injury or disease
    • Defecography—test that uses x-rays and dye to look at the bowel and how it functions

    Treatment

    Talk with your doctor about the best plan for you. Options include:

    Diet

    Your doctor may suggest changes to your diet. You may be referred to a nutritionist for diet ideas. Examples of dietary changes include:
    • Eating smaller meals more frequently
    • Avoiding foods that may trigger diarrhea (Spicy food or foods with caffeine are common culprits.)
    • Eating more fiber and drinking more fluids (if incontinence is due to constipation)

    Devices

    Absorbent diapers are often used with fecal incontinence. Another option is an anal plug. These plugs, which are available in a variety sizes and shapes, may be helpful for some people to control symptoms.

    Bowel Training

    Your doctor may suggest using biofeedback . This method can retrain your body’s responses.
    A bowel movement schedule can also train your bowels. For example, you can pick four times throughout the day to try to go to the bathroom.

    Exercise

    Learn how to do Kegel exercises . These exercises help strengthen the pelvic floor muscles.

    Surgery

    Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:
    • An overlapping sphincteroplasty to rebuild the anal sphincter
    • Injecting bulking agents, radiofrequency therapy, and/or nerve stimulation
    • Inserting an artificial bowel sphincter (which you can open and close as needed)
    • Colostomy (done in severe cases)—disconnects the colon and brings the end through an opening in the abdomen

    Prevention

    To help reduce your chance of getting fecal incontinence, take the following steps:
    • Prevent constipation by eating a high-fiber diet and drinking plenty of fluids.
    • Pay attention to your diet and avoid foods that trigger diarrhea.
    • Try to maintain a regular bowel movement schedule.
    • Talk to your doctor if you are having trouble with diarrhea or constipation.

    RESOURCES

    International Foundation for Functional Gastrointestinal Disorders http://www.iffgd.org/

    National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Digestive Health Foundation http://www.cdhf.ca/

    Canadian Society of Intestinal Research http://www.badgut.org/

    References

    Diarrhea. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/ . Accessed January 9, 2012.

    Fecal incontinence. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/index.htm . Accessed January 9, 2012.

    Fecal incontinence: lifestyle and home remedies. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/fecal-incontinence/DS00477/DSECTION=lifestyle-and-home-remedies . Accessed January 9, 2012.

    Fecal incontinence: treatment. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/fecal-incontinence/treatment.html . Updated January 2011. Accessed January 9, 2012.

    Fauci A, Harrison TR. Harrison's Principles of Internal Medicine . 17th ed. New York, NY: McGraw-Hill; 2008.

    Garg, P, Song J, Bhatia A, Kalia H, Menon G. The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Diseases . 2010;12:965-970.

    Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes of Health State-of-the-Science Conference Statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med . 2008;148:449-458.

    Rectal prolapse. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/rectal%5Fprolapse/ . Accessed January 9, 2012.

    12/4/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Deutekom M, Dobben A. Plugs for containing fecal incontinence. Cochrane Database Syst Rev. 2009;(4):CD005086.

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