FECAL INCONTINENCE
Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. The condition ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth. Although fecal incontinence can occur at any age, it's more common in adults over 65.
Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments can improve fecal incontinence and your quality of life.
Fecal incontinence may occur temporarily during an occasional bout of diarrhea.
People cannot stop the urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. This is called urge incontinence.
People who are not aware of the need to pass stool. This is called passive incontinence.
Causes
Muscle damage. Injury to the rings of muscle at the end of the rectum (anal sphincter) may make it difficult to hold stool back properly. This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery.
Nerve damage. Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to fecal incontinence. The nerve damage can be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke. Some diseases, such as diabetes and multiple sclerosis, also can affect these nerves and cause damage that leads to fecal incontinence.
Constipation. Chronic constipation may cause a dry, hard mass of stool (impacted stool) to form in the rectum and become too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool from farther up the digestive tract to move around the impacted stool and leak out. Chronic constipation may also cause nerve damage that leads to fecal incontinence.
Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose stools of diarrhea can cause or worsen fecal incontinence.
Hemorrhoids. When the veins in your rectum swell, causing hemorrhoids, this keeps your anus from closing completely, which can allow stool to leak out.
Loss of storage capacity in the rectum. Normally, the rectum stretches to accommodate stool. If your rectum is scarred or your rectal walls have stiffened from surgery, radiation treatment or inflammatory bowel disease, the rectum can't stretch as much as it needs to, and excess stool can leak out.
Surgery. Surgery to treat enlarged veins in the rectum or anus (hemorrhoids), as well as more-complex operations involving the rectum and anus, can cause muscle and nerve damage that leads to fecal incontinence.
Rectal prolapse. Fecal incontinence can be a result of this condition, in which the rectum drops down into the anus.
Rectocele. In women, fecal incontinence can occur if the rectum protrudes through the vagina.
Recent research has also found that women who take menopausal hormone replacement therapy are more likely to have fecal incontinence.
Dementia. Fecal incontinence is often present in late-stage Alzheimer's disease and dementia.
Physical disability. Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence.
Prevention
Reduce constipation. Increase your exercise, eat more high-fiber foods and drink plenty of fluids.
Control diarrhea. Treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid fecal incontinence.
Avoid straining. Straining during bowel movements can eventually weaken anal sphincter muscles or damage nerves, possibly leading to fecal incontinence.
Treatment
Medications
Anti-diarrheal drugs such as loperamide hydrochloride (ImodiumA-D), diphenoxylate and atropine sulfate (Lomotil), cholestyramine and colestipol.
Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil).
Biofeedback.
Specially trained physical therapists teach simple exercises that can increase anal muscle strength. People learn how to strengthen pelvic floor muscles, sense when stool is ready to be released and contract the muscles if having a bowel movement at a certain time is inconvenient. Sometimes the training is done with the help of anal manometry and a rectal balloon.
Bowel training.
Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating. Establishing when you need to use the toilet can help you gain greater control.
Bulking agents.
Injections of nonabsorbable bulking agents can thicken the walls of your anus. This helps prevent leakage.
Sacral nerve stimulation (SNS).
The sacral nerves run from your spinal cord to muscles in your pelvis, and regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses continuously to the nerves can strengthen muscles in the bowel.
Posterior tibial nerve stimulation (PTNS/TENS).
This minimally invasive treatment stimulates the posterior tibial nerve at the ankle. It may be helpful for some people with fecal incontinence when done weekly for several months.
Vaginal balloon (Eclipse System).
This is a pump-type device inserted in the vagina. The inflated balloon results in pressure on the rectal area, leading to a decrease in the number of episodes of fecal incontinence.
Surgery
Sphincteroplasty.
This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. Doctors identify an injured area of muscle and free its edges from the surrounding tissue. They then bring the muscle edges back together and sew them in an overlapping fashion, strengthening the muscle and tightening the sphincter.
Treating rectal prolapse, a rectocele or hemorrhoids.
Surgical correction of these problems will likely reduce or eliminate fecal incontinence.
Sphincter replacement.
A damaged anal sphincter can be replaced with an artificial anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the toilet, you use a small external pump to deflate the device and allow stool to be released. The device then reinflates itself.
Sphincter repair (dynamic graciloplasty).
In this surgery doctors take a muscle from the inner thigh and wrap it around the sphincter, restoring muscle tone to the sphincter.
Colostomy (bowel diversion).
This surgery diverts stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy is generally considered only after other treatments haven't been successful.
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