A condition known as fecal incontinence occurs when bowel movements are not controlled, resulting in involuntary leaks of stool and gas. Incontinence may cause physical, emotional, and social distress, affecting the quality of life of those who suffer from it. It can range from a minor leak to complete bowel control.
Fecal incontinence can have many possible causes, such as:
It is possible to damage or weaken the muscles and nerves that control the anus or rectum as a result of injury, surgery, childbirth, aging, or chronic constipation or diarrhea. In this case, it is difficult to sense and hold stool in the rectum, or to contract the anal sphincter to prevent leakage.
Diseases that affect the brain, spinal cord, or nerves, such as stroke, multiple sclerosis, Parkinson's disease, diabetes, or spinal cord injury, can interfere with the brain-bowel communication, causing bowel incontinence.
Defects in the anatomy of the anus or rectum, such as hemorrhoids, rectal prolapse, rectocele, or fistulas, can allow stool to leak out or prevent the anal sphincter from closing.
Fecal impaction can stretch and damage the rectal wall as well as the anal sphincter if there is a large mass of hard stool in the rectum. In addition to blocking normal bowel movements, impacting stool can cause overflow incontinence, where liquid stool leaks around the hard stool.
Diarrhea: Loose or watery stool is more difficult to hold in the rectum than solid stool, especially if the rectal muscles are weak. Diarrhea can also irritate the rectum lining, causing it to leak.
Antibiotics, laxatives, antacids, or opioids may affect the consistency of stool or bowel function, causing diarrhea or constipation, which contributes to fecal incontinence.
The main symptom of fecal incontinence is the inability to control bowel movements, resulting in leakage of stool or gas. The severity and frequency of fecal incontinence can vary from person to person, depending on the underlying cause and other factors. Some people may experience only occasional minor leaks, while others may have frequent or Others may not feel any urge to defecate, and leak stool without warning. Some people leak only when they cough, sneeze, laugh, or exercise, while others h, or exercise, while others may leak at any time.
Fecal incontinence can also cause other symptoms, such as:
Skin irritation or infection: The leakage of stool or gas can irritate the skin around the anus, causing itching, burning, redness, or soreness. The skin can also become infected by bacteria or fungi, causing rash, blisters, or ulcers.
Odor: The leakage of stool or gas can cause an unpleasant odor, which can be embarrassing and affect the self-esteem and social life of those who suffer from it.
Emotional distress: Fecal incontinence can cause feelings of shame, guilt, anxiety, depression, or isolation, as well as affect the sexual and intimate relationships of those who suffer from it.
To diagnose fecal incontinence, a doctor will ask about the medical history, symptoms, medications, and lifestyle habits of the patient, and perform a physical examination, which may include:
Digital rectal exam: The doctor will insert a gloved finger into the anus to check for any abnormalities, such as hemorrhoids, rectal prolapse, rectocele, or fistula, and to assess the strength and tone of the anal sphincter.
Anoscopy: The doctor will insert a thin, lighted tube into the anus to examine the lining of the anus and the lower part of the rectum for any signs of inflammation, infection, or injury.
Sigmoidoscopy or colonoscopy: The doctor will insert a flexible, lighted tube into the anus and up into the colon to examine the entire or a part of the large intestine for any signs of disease, such as ulcerative colitis, Crohn’s disease, or colon cancer.
Stool tests: The doctor may collect a sample of stool to test for any signs of infection, inflammation, or blood.
The doctor may also order some tests to evaluate the function and structure of the anus, rectum, and colon, such as:
Anorectal manometry: The doctor will insert a thin, flexible tube with a balloon at the end into the anus and rectum, and inflate the balloon to measure the pressure and sensation of the rectal muscles and the anal sphincter.
Anorectal ultrasound: The doctor will insert a thin, flexible tube with a small device that emits sound waves into the anus and rectum, and use a computer to create images of the muscles and tissues of the anal canal and the surrounding area.
Defecography: The doctor will inject a contrast material into the rectum, and then ask the patient to defecate while taking X-rays or MRI scans of the pelvic area, to see how the rectum and anus change shape and position during a bowel movement.
Pudendal nerve test: The doctor will insert a thin, flexible tube with electrodes into the anus, and stimulate the pudendal nerve, which controls the anal sphincter, to measure the nerve’s function and response.
The treatment of fecal incontinence depends on the cause, severity, and impact of the condition on the patient’s quality of life. The treatment options may include:
Diet changes: The doctor may advise the patient to modify their diet to improve the consistency and frequency of stool, as well as to avoid foods or drinks that trigger diarrhea or constipation, including spicy, fatty, or greasy foods, dairy products, caffeine, alcohol, and artificial sweeteners. For regular bowel movements and to prevent impaction, the doctor may also recommend eating more fiber and fluids.
A doctor may prescribe antibiotics, anti-inflammatory drugs, antidiarrheals, laxatives, or stool softeners to treat the underlying cause or symptoms of fecal incontinence. Anticholinergics, alpha-adrenergic agonists, and calcium channel blockers may also be prescribed to relax or strengthen the anal sphincter.
An improvement in bowel habits and control can be achieved by teaching the patient some techniques, such as setting a regular schedule for bowel movements, using biofeedback to monitor and control the anus and rectum muscles, or using suppository, enema, or irrigation devices to empty the bowels before leaving the house or engaging in activities that may lead to leakage.
Performing pelvic floor exercises, such as Kegel exercises, which involve contracting and relaxing the pelvic floor muscles repeatedly, may help strengthen the muscles and nerves that support the anus and rectum.
Anal plugs, which are inserted into the anus to block the passage of stool or gas, or disposable pads, liners, or underwear, which absorb and contain leaks while protecting skin and clothing, are some devices that can be used to prevent or reduce leakage.
If other treatments fail to improve the condition or cause unacceptable side effects, the doctor may recommend surgery. The type of surgery depends on the cause and extent of fecal incontinence.
Sphincter repair: The doctor will stitch together the torn or weakened parts of the anal sphincter to restore its strength and function.
Sphincter replacement: The doctor will implant an artificial device that mimics the action of the anal sphincter, and can be controlled by a remote or a switch.
Sphincter augmentation: The doctor will inject a bulking agent, such as collagen or silicone, into the anal canal to increase its size and resistance, and reduce leakage.
Neuromodulation: The doctor will implant a device that delivers electrical impulses to the nerves that control the bowel, and can be adjusted by a remote or a switch.
Colostomy: The doctor will create an opening in the abdomen, and divert the end of the colon to it, where a bag is attached to collect the stool. This procedure bypasses the anus and rectum, and eliminates fecal incontinence.
It is not always possible to prevent fecal incontinence, especially if it is caused by congenital or acquired conditions that affect the anus, colon, or rectum. There are, however, some measures that can reduce the severity or risk of fecal incontinence, such as:
Diet and lifestyle: Eating a balanced diet that includes enough fiber and fluids, avoiding foods or drinks that may cause diarrhea, exercising regularly, managing stress, and quitting smoking can help prevent or relieve bowel problems that can lead to fecal incontinence.
When experiencing symptoms or signs of fecal incontinence, consult your doctor right away. A doctor can ask about the patient's medical history, symptoms, medications, and lifestyle habits, and perform a physical examination and some tests to evaluate the function and structure of the anus, rectum, and colon. Depending on the cause, severity, and impact of the condition on the patient's quality of life, a doctor can also suggest some treatment options, such as dietary changes, medications, bowel training, pelvic floor exercises, devices, or surgery.
Treatment or management of other medical conditions that may cause or worsen fecal incontinence, including diabetes, thyroid disorders, inflammatory bowel disease, irritable bowel syndrome, and pelvic floor disorders, can prevent or reduce the symptoms and complications of fecal incontinence.
There are many causes of fecal incontinence, including muscle damage, neurological disorders, structural defects, impacted stool, diarrhea, and medications. It is a common and distressing condition that affects the ability to control bowel movements. Aside from irritation or infection of the skin, it can also cause odors, emotional distress, and structural defects. A doctor can diagnose fecal incontinence by asking about the patient's medical history, symptoms, medications, and lifestyle habits, as well as performing tests to evaluate the function and structure of the anus, rectum, and colon. Incontinence can be treated by a doctor, who may recommend dietary changes, medications, bowel training, pelvic floor exercises, devices, or surgery, depending on the cause, severity, and impact of the condition on the patient's quality of life. Fecal incontinence cannot be prevented, but certain measures may help reduce its risk or severity, including maintaining a healthy diet and lifestyle, seeking medical attention, and treating or managing any other bowel disorders. If properly diagnosed and treated, fecal incontinence can be improved or cured. It is not an inevitable part of aging, but it can be improved or cured. If you suffer from fecal incontinence, you should not feel ashamed or alone, and you should seek help from your doctor, as well as support from friends and family. Fecal incontinence is a challenging condition, but you can overcome it if you are patient, persistent, and positive.
