Fecal (Bowel) Incontinence (Symptoms,Causes and Treatment)
Fecal incontinence, also known as bowel incontinence, is a condition characterized by the inability to control bowel movements, resulting in the involuntary passage of feces or stool. It can range from occasional leakage to a complete loss of bowel control. Here is some brief information about fecal incontinence:
Causes: Fecal incontinence can be caused by various factors, including:
1-Weak or Damaged Sphincter Muscles: The sphincter muscles, which help control bowel movements, may become weak or damaged due to factors such as childbirth, aging, injury, or certain medical conditions.
2-Nerve Damage: Nerve damage or dysfunction can disrupt the normal signals between the rectum and the brain that regulate bowel control. This can occur due to conditions such as diabetes, multiple sclerosis, stroke, spinal cord injury, or nerve-related conditions.
3-Diarrhea or Constipation: Chronic diarrhea or severe constipation can contribute to fecal incontinence. Diarrhea can overwhelm the rectum’s ability to hold stool, while chronic constipation can cause the rectal muscles to become stretched and less responsive.
4-Pelvic Floor Dysfunction: Dysfunction of the pelvic floor muscles, which support the rectum and help control bowel movements, can contribute to fecal incontinence.
Symptoms: The primary symptom of fecal incontinence is the involuntary passage of stool. Other associated symptoms may include:
*Urgency: A strong and sudden urge to have a bowel movement.
*Incomplete Emptying: The feeling of not being able to completely empty the bowel during a bowel movement.
*Accidental Gas Leakage: In addition to stool leakage, some individuals may experience the unintentional release of gas.
*Emotional Distress: Fecal incontinence can lead to embarrassment, anxiety, social withdrawal, and a diminished quality of life.
Treatment: Treatment options for fecal incontinence depend on the underlying cause and severity of the condition. They may include:
*Dietary Modifications: Adjusting the diet to manage diarrhea or constipation, including increasing fiber intake, avoiding trigger foods, and staying hydrated.
*Medications: Medications may be prescribed to regulate bowel movements, manage diarrhea or constipation, or treat underlying conditions.
*Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises known as Kegel exercises can help improve bowel control.
*Biofeedback: This technique uses sensors to provide feedback and guidance on how to properly contract and relax the pelvic floor muscles.
*Bowel Training: Establishing a regular bowel routine and using techniques to improve control, such as scheduled toilet visits and relaxation techniques.
*Surgical Interventions: In severe cases, surgical options, such as sphincter repair or artificial sphincter implantation, may be considered.
It’s important to consult with a healthcare professional, such as a gastroenterologist or colorectal surgeon, for an accurate diagnosis and appropriate treatment plan based on individual circumstances. They can provide further evaluation, discuss treatment options, and provide guidance on managing fecal incontinence.
This article covers the following topics :
Why does fecal incontinence happen?
Fecal incontinence can occur due to various factors that disrupt the normal mechanisms involved in bowel control. Here are some common causes and contributing factors of fecal incontinence:
1-Weak or Damaged Sphincter Muscles: The anal sphincter muscles, which surround the rectum and help control the release of stool, may become weak or damaged. This can happen due to childbirth trauma, rectal surgery, injury to the pelvic area, or aging.
2-Nerve Damage or Dysfunction: Nerves play a crucial role in coordinating the muscles involved in bowel control. Damage or dysfunction of the nerves that control the rectum and anal sphincter muscles can impair their ability to function properly. Nerve damage can occur due to conditions such as diabetes, multiple sclerosis, stroke, spinal cord injury, or nerve-related conditions.
3-Chronic Diarrhea or Constipation: Chronic diarrhea can overwhelm the rectum’s capacity to hold stool, leading to leakage or fecal incontinence. On the other hand, chronic constipation can cause the rectal muscles to stretch and weaken, reducing their ability to retain stool and increasing the risk of leakage.
4-Pelvic Floor Dysfunction: The pelvic floor muscles provide support to the rectum and play a role in maintaining bowel control. Dysfunction of these muscles, often due to weakened or damaged pelvic floor muscles, can contribute to fecal incontinence.
5-Rectal Surgery or Radiation Therapy: Surgical procedures involving the rectum or radiation therapy to the pelvic area can lead to damage or scarring that affects bowel control.
6-Certain Medical Conditions: Some medical conditions can increase the risk of fecal incontinence. These include inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), rectal prolapse, rectocele (a bulging of the rectum into the vagina), and tumors or growths in the rectum.
7-Medications: Certain medications, such as laxatives, can contribute to fecal incontinence if used excessively or improperly.
It’s important to note that fecal incontinence can have a multifactorial cause, and often, multiple factors contribute to its development in an individual. The specific cause or causes of fecal incontinence may vary from person to person.
If you are experiencing fecal incontinence or have concerns about it, it is recommended to consult with a healthcare professional, such as a gastroenterologist or colorectal surgeon. They can assess your symptoms, evaluate the underlying causes, and provide appropriate diagnosis and treatment options based on your specific situation.
What causes changes in body functions that lead to fecal incontinence?
Changes in body functions that can contribute to fecal incontinence include disruptions in the normal mechanisms involved in bowel control. Here are some factors that can cause these changes:
1-Weak or Damaged Sphincter Muscles: The anal sphincter muscles, which surround the rectum, are responsible for maintaining continence by closing off the anus and preventing stool from leaking out. Weakness or damage to these muscles can result from factors such as childbirth trauma, rectal surgery, injury to the pelvic area, or the natural aging process.
2-Nerve Damage or Dysfunction: Nerves play a vital role in coordinating the muscles involved in bowel control. Any damage or dysfunction of the nerves that control the rectum and anal sphincter muscles can disrupt the normal signaling process between the rectum and the brain. Nerve damage can occur due to conditions such as diabetes, multiple sclerosis, stroke, spinal cord injury, or nerve-related conditions.
3-Altered Rectal Sensation: The rectum normally senses the presence of stool and sends signals to the brain to initiate the process of defecation. Changes in rectal sensation can occur due to nerve damage, rectal surgery, or other conditions, affecting the timing and control of bowel movements.
4-Pelvic Floor Dysfunction: The pelvic floor muscles provide support to the rectum and play a role in maintaining bowel control. Dysfunction of these muscles, such as weakness or damage, can impair their ability to properly support the rectum and contribute to fecal incontinence.
5-Altered Bowel Habits: Chronic diarrhea or severe constipation can affect bowel control. Diarrhea can overwhelm the rectum’s ability to hold stool, while chronic constipation can cause the rectal muscles to become stretched and less responsive, leading to difficulty in controlling bowel movements.
6-Impaired Rectal Storage Capacity: Conditions that reduce the rectum’s ability to adequately store stool, such as rectal prolapse or rectocele, can contribute to fecal incontinence.
7-Medications and Medical Treatments: Certain medications, such as laxatives, can lead to changes in bowel function and contribute to fecal incontinence if used excessively or improperly. Additionally, medical treatments involving the rectum or pelvic area, such as radiation therapy or rectal surgery, can cause changes in bowel function and affect continence.
It’s important to note that changes in body functions leading to fecal incontinence can vary from person to person, and multiple factors may contribute to an individual’s condition. A thorough evaluation by a healthcare professional, such as a gastroenterologist or colorectal surgeon, is necessary to identify the underlying causes and determine the most appropriate treatment approach.
What tests are used to diagnose fecal incontinence?
To diagnose the underlying causes of fecal incontinence, healthcare professionals may employ various tests and evaluations. These diagnostic approaches help identify the specific factors contributing to fecal incontinence. Here are some common tests used in the diagnosis of fecal incontinence:
1-Medical History and Physical Examination: The healthcare provider will conduct a comprehensive medical history assessment, including questions about symptoms, bowel habits, previous surgeries or medical conditions, and lifestyle factors. A physical examination may be performed to assess the anal sphincter muscles, rectal tone, and signs of nerve damage.
2-Anal Manometry: Anal manometry measures the pressures and muscle function within the anus and rectum. It helps evaluate the strength and coordination of the anal sphincter muscles and assess rectal sensation and compliance.
3-Endoanal Ultrasound: Endoanal ultrasound involves inserting a small ultrasound probe into the anus to obtain detailed images of the anal sphincter muscles and surrounding structures. It helps assess the integrity, thickness, and structure of the muscles and identify any defects or damage.
4-Anorectal Physiology Testing: Anorectal physiology testing is a set of tests that evaluate the function and coordination of the rectum, anal sphincter muscles, and pelvic floor. These tests include balloon expulsion test, rectal sensation test, and electromyography (EMG), among others.
5-Proctography or Defecography: Proctography or defecography is a specialized imaging test that uses X-rays or fluoroscopy to evaluate the anatomy and function of the rectum during defecation. It helps assess rectal emptying, rectal prolapse, or structural abnormalities that may contribute to fecal incontinence.
6-Stool Studies: Stool studies, including stool cultures and examination for parasites, may be performed to rule out infectious causes of diarrhea or other bowel abnormalities.
7-Anal Electromyography (EMG): Anal EMG measures the electrical activity of the anal sphincter muscles and helps evaluate their function and coordination.
8-Imaging Tests: In some cases, additional imaging tests such as MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans may be ordered to assess the pelvic anatomy and identify any structural abnormalities or conditions contributing to fecal incontinence.
The specific tests performed may vary depending on the individual’s symptoms, medical history, and the suspected underlying causes of fecal incontinence. A healthcare professional, such as a gastroenterologist or colorectal surgeon, will determine the most appropriate tests based on the individual case.
It’s important to discuss your symptoms and concerns with a healthcare professional, who can guide you through the diagnostic process and provide appropriate treatment options based on the underlying causes identified.
How is fecal incontinence treated?
The treatment for fecal incontinence depends on the underlying causes and severity of the condition. It often involves a combination of conservative measures, lifestyle modifications, and, in some cases, medical interventions. Here are some common treatment approaches:
1-Dietary Modifications: Adjusting the diet can help regulate bowel movements and manage symptoms of fecal incontinence. This may include increasing fiber intake to promote regular bowel movements, avoiding foods that can cause diarrhea or constipation, and maintaining proper hydration.
2-Bowel Training: Establishing a regular bowel routine can help improve bowel control. This involves setting specific times for bowel movements, sitting on the toilet for a sufficient duration, and using relaxation techniques to facilitate emptying.
3-Pelvic Floor Exercises: Pelvic floor exercises, also known as Kegel exercises, aim to strengthen the pelvic floor muscles. These exercises involve repeatedly contracting and relaxing the muscles that control bowel and bladder function. Strengthening the pelvic floor can improve muscle tone and enhance bowel control.
4-Medications: Medications may be prescribed to address specific underlying causes or symptoms of fecal incontinence. For example, anti-diarrheal medications can help manage diarrhea, while medications that regulate bowel movements, such as fiber supplements or stool softeners, may be used to address constipation.
5-Biofeedback Therapy: Biofeedback therapy helps individuals learn to control and strengthen their pelvic floor muscles. It involves the use of sensors to provide visual or auditory feedback on muscle activity. This feedback helps individuals learn proper muscle coordination and control.
6-Sacral Nerve Stimulation: In some cases, sacral nerve stimulation may be recommended. This involves implanting a small device that delivers electrical stimulation to the sacral nerves, which can help improve bowel function and control.
7-Surgical Interventions: In severe cases of fecal incontinence that do not respond to other treatments, surgical options may be considered. Surgical procedures aim to repair or strengthen the anal sphincter muscles, create an artificial sphincter, or address specific anatomical issues contributing to fecal incontinence.
8-Bowel Management Techniques: For individuals with more complex cases, bowel management techniques may be recommended. This involves methods such as scheduled toileting, use of enemas or suppositories, or manual evacuation under the guidance of a healthcare professional.
The treatment approach for fecal incontinence is highly individualized, and the most appropriate treatment options depend on the underlying causes, severity of symptoms, and the individual’s overall health. It’s important to consult with a healthcare professional, such as a gastroenterologist or colorectal surgeon, to receive a proper evaluation, discuss treatment options, and develop a tailored treatment plan based on your specific situation.
What are medical treatment options for treating fecal incontinence?
In addition to conservative measures and lifestyle modifications, there are several medical treatment options available for managing fecal incontinence. These medical interventions are typically recommended when conservative measures do not provide sufficient relief or when there are underlying conditions that require specific treatment. Here are some medical treatment options for fecal incontinence:
1-Medications:
*Antidiarrheal Medications: These medications, such as loperamide (Imodium), can help control loose stools and reduce episodes of fecal incontinence.
*Bulk-forming Agents: Fiber supplements or stool softeners may be prescribed to regulate bowel movements and prevent constipation or diarrhea.
*Antispasmodic Medications: Medications like dicyclomine (Bentyl) can help relax the muscles in the gastrointestinal tract, reducing bowel spasms and improving control.
2-Injectable Bulking Agents: Bulking agents, such as synthetic substances or biocompatible materials, can be injected into the anal sphincter or rectal tissue to thicken and reinforce the area. This can help improve sphincter function and reduce fecal incontinence episodes.
3-Sacral Nerve Stimulation (SNS): Sacral nerve stimulation involves the placement of a small device, similar to a pacemaker, that delivers electrical impulses to the sacral nerves, which control the bowel and pelvic floor muscles. SNS helps modulate nerve signals and can improve bowel control in selected cases.
4-Bowel Irrigation Systems: Bowel irrigation involves the use of water or a specialized solution to flush out the rectum and colon, typically via a catheter or enema system. This technique can help regulate bowel movements and promote better control.
5-Fecal Incontinence Devices: Various devices are available to manage fecal incontinence, such as anal plugs, rectal balloons, or rectal valves. These devices can help provide temporary support to the anal sphincter and improve control.
It’s important to note that the suitability of these medical treatment options depends on the underlying causes and individual circumstances. The healthcare professional managing your care, such as a gastroenterologist or colorectal surgeon, will evaluate your specific condition and recommend the most appropriate treatment approach.
It’s essential to have a thorough discussion with your healthcare provider to understand the benefits, potential risks, and expected outcomes of each medical treatment option. They will guide you in selecting the most suitable treatment based on your individual needs and goals.
What surgical options treat fecal incontinence?
In cases of severe fecal incontinence that do not respond to conservative treatments or medical interventions, surgical options may be considered. Surgical interventions for fecal incontinence aim to repair or improve the function of the anal sphincter muscles, address anatomical abnormalities, or provide support to the rectum and anal canal. Here are some surgical options used to treat fecal incontinence:
1-Sphincteroplasty: Sphincteroplasty is a surgical procedure to repair a weakened or damaged anal sphincter muscle. The procedure involves suturing the muscle to strengthen it and restore its function. Sphincteroplasty may be considered for individuals with a specific defect or injury to the sphincter muscles.
2-Artificial Anal Sphincter: An artificial anal sphincter is a device implanted around the anus to provide mechanical support and improve sphincter function. The device consists of a cuff that encircles the anal canal, a pressure-regulating balloon, and a control pump. The cuff inflates and deflates to maintain continence. The artificial anal sphincter is typically reserved for individuals with severe sphincter muscle dysfunction.
3-Sacral Nerve Stimulation (SNS): Sacral nerve stimulation, mentioned earlier as a medical treatment option, can also be performed as a surgical procedure. It involves the implantation of a small device that delivers electrical impulses to the sacral nerves, which control the bowel and pelvic floor muscles. SNS helps modulate nerve signals and can improve bowel control in select cases.
4-Gracilis Muscle Transposition: In this procedure, a portion of the gracilis muscle, located in the inner thigh, is harvested and used to create a new anal sphincter. The muscle is surgically attached to the anus to provide improved control over bowel movements.
5-Colostomy or Ileostomy: In some cases of severe fecal incontinence that are resistant to other treatments, a surgical procedure called colostomy or ileostomy may be considered. This involves diverting the stool away from the rectum and creating an opening (stoma) on the abdominal wall through which stool is collected in an external bag. This option is typically reserved for individuals with significant impairment of bowel control and can have a significant impact on quality of life.
The choice of surgical intervention depends on the underlying cause, severity of fecal incontinence, individual circumstances, and response to conservative and medical treatments. These surgical procedures carry risks and potential complications, and the decision to undergo surgery should be made in consultation with a qualified healthcare professional, such as a colorectal surgeon or gastroenterologist, who can assess your specific condition and discuss the most appropriate surgical options for you.