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FECAL INCONTINENCE

Fecal incontinence, also called as bowel incontinence is the inability to control bowel movements, causing leakage of feces or stools. It is a common condition, especially in older adults. This condition ranges from an inability to hold a bowel movement until reaching the toilet to passing stool without being aware of it. It is mainly due to damage of muscle around the anus. Patients with this condition feel ashamed to go in public and hence avoid social activities. Various treatment options such as medications and surgery are available which can effectively treat fecal incontinence.

Symptoms

Diarrhea is the main symptom of fecal incontinence. Few people experience it occasionally, whereas few people have recurring or chronic fecal incontinence. The patients may not be able to resist the urge to defecate, a condition called as urge incontinence. Few people experience passive incontinence, a condition in which they may not be aware of the stool to pass, it happens unknowingly.

Other symptoms include anal itching, a buttock skin infection, constipation, gas, and bloating.

The person with these symptoms should not feel shy to discuss the problem and consult the doctor immediately. The mothers should frequently check if the child develops fecal incontinence and notify the doctor immediately.

Causes

The most common cause of fecal incontinence is damage to the anal sphincters (muscles around the anus). This condition usually occurs during vaginal birth which damages the anal sphincters and nerves. Therefore, women are at higher risk of fecal incontinence than men. Anal surgery may also damage the anal sphincters and nerves, resulting in fecal incontinence. Other causes include:

  • Diarrhea, caused by infections and irritable bowel syndrome
  • Diseases or injury that damages the nervous system
  • Bowel or intestinal diseases such as Crohn’s disease and ulcerative colitis
  • Chronic constipation in older adults cause impacted stool, leading to fecal incontinence
  • After radiation treatment, for any cancers, especially prostate cancer may damage the rectum
  • Rectum prolapse, drop down of rectum into the anus may cause fecal incontinence
  • Rectocele, a condition in which rectum protrudes through vagina in females also cause fecal incontinence

Risk factors

The following factors may increase the risk of fecal incontinence:

  • Age- middle-aged and older adults
  • Gender- females
  • Nerve damage- Patients with long-standing diabetes and multiple sclerosis damage the nerves that help control defecation
  • Nervous disorders- in patients with late-stage Alzheimer’s disease and dementia

Complications

Fecal incontinence should be treated soon after the condition is noticed or diagnosed because if it is not treated in early stages, it may result in complications like emotional distress, skin irritation, and chronic diseases like Chron’s disease and cancer.

Diagnosis

The physician performs physical examination to check the strength of the anal sphincter muscle by inserting a gloved finger into the rectum.  Other tests which help in diagnosing the condition include:

  • Balloon expulsion test- in this test, a small balloon is inserted into the rectum and fills with water and then the patient will be asked to record the time taken to expel the balloon.  A defecation disorder is confirmed if the patient takes one minute or more to expel the balloon.
  • Anal manometry- the tightness and functioning of the anal sphincter and rectum are assessed by inserting a narrow flexible tube (with small balloon at the tip) into the rectum and anus.
  • Anorectal ultrasonography- Video images of the anus and rectum are taken using a wand-like instrument to assess the abnormalities
  • Endosonography- An ultrasound probe is sent into the rectum and anus to produce images to identify the problems
  • Magnetic resonance imaging-  MRI scan of the pelvis helps in taking clear images of the sphincter

Treatment

Based on the cause and severity of the disease, the following treatment options are available:

Medications

  • Anti-diarrheal drugs- loperamide hydrochloride, diphenoxylate, and atropine sulfate
  • Bulk laxatives- given for chronic constipation, examples include methylcellulosepsy, psyllium
  • Injectable bulking agents- dextranomer microspheres or hyaluronate Sodium in 0.9 % Nacl are injected directly into the anal canal

Exercise and other therapies

Fecal incontinence caused by muscle damage can be managed by performing pelvic floor exercises. Other treatment options include:

  • Bowel training- undergoing bowel training which helps to establish greater control on bowel
  • Sacral nerve stimulation-a device is implanted that sends small electrical impulses continuously to the nerves to strengthen the muscles.
  • Vaginal balloon- an inflated balloon is inserted into the vagina that increases pressure on the rectal area, resulting in decreased episodes of fecal incontinence.

Surgery

Surgery may be required for correcting the problems that occur during birth such as rectal prolapse or sphincter damage. The various surgical techniques include:

  • Sphincteroplasty- repairs damaged or weakened anal sphincter
  • Sphincter replacement- replacement of damaged anal sphincter with artificial sphincter
  • Sphincter rapair- also called as dynamic graciloplasty in which a muscle from inner thigh is taken and wrapped around the sphincter to restore the muscle tone of the sphincter
  • Colostomy- this surgery involves diverting the stool to an opening in the abdomen, where a special bag is placed to collect the stool

Prevention and lifestyle changes

Making certain lifestyle changes can be very helpful in preventing or managing fecal incontinence. Some of them include:

  • Drinking plenty of water to avoid constipation
  • Performing pelvic floor exercises regularly to improve the muscle strength
  • Avoiding intake of coffee to prevent diarrhea
  • Eating fiber-rich food, take nearly 20 to 30 grams of fiber per day
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