Fecal Incontinence

What is fecal incontinence?

Fecal incontinence, also known as bowel incontinence, is the inability to control bowel movements. Nearly 18 million Americans suffer from fecal incontinence. It’s not always a part of aging, but is more common in older adults. It is also more common in women. Accidental leakage of solid or liquid stool when passing gas is also known as FI (fecal incontinence). Most people are embarrassed to discuss FI, and even limit their social activities for fear of embarrassment. Generally, FI is not a serious problem, but it can restrict daily life. It could be caused by a medical problem, so it’s important to get a proper diagnosis from your health care provider. There are treatments available for FI. The first step is to talk to your doctor or health care provider.

What causes fecal incontinence?

The most common cause of fecal incontinence is damage to the muscle around the anus (rectum). Vaginal child birth can damage the anal sphincters or their nerves, which is why FI is more common in women. Other potential causes include:

• Constipation:  When a person has fewer than 3 bowel movements a week, watery stool can build up behind the hard stool and leak out (overflow, diarrhea). Long-term constipation can weaken the sphincter muscles.
• Diarrhea: loose stools are more difficult to hold than solid stools.
• Nerve damage: Potential causes of nerve damage are child birth, constipation, straining to pass stool, stroke injury, and diseases such as MS and diabetes.
• Loss of stretch in the rectum: The rectum will stretch to hold stool until you have had a bowel movement. The inability of the muscle to stretch can be caused by IBD, ulcerative colitis, rectal surgery, and radiation treatment. These can all cause scarring, leading to loss of stretch.
• Hemorrhoids: External hemorrhoids can affect the ability of the anal sphincter muscles to close completely thus leading to mucous or stool leakage.
• Pelvic floor dysfunction: Abnormalities of the pelvic floor muscles and nerves is sometimes caused by childbirth.
• Muscle damage or weakness: Possible causes of injury to sphincter muscle are trauma, cancer surgery, or hemorrhoid surgery.
• Inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.

What are the symptoms of fecal incontinence?

Most people only experience fecal incontinence during an occasional short-lived bout of diarrhea. If you have fecal incontinence, you may:

• Have trouble getting to the toilet on time
• Are unable to control the passage of stools or gas (which may be solid or liquid)
• Have unusual gas and bloating
• abdomen pain though typically not upper left abdomen pain
• Constipation
• Diarrhea

How is fecal incontinence diagnosed?

A proper diagnosis begins with a complete medical history, physical exam, medical test results, and digital rectal exam. Some questions your health care provider may ask you are:

• When did the FI begin?
• How much stool leaks, and is it solid or liquid?
• Do specific foods make the FI worse?
• Can you control your gas?
• Does FI happen without warning?
• How often does FI happen?
• How has FI affected your life?
• Do you have hemorrhoids, and do they bulge out?

Depending on these findings, your doctor may want to refer you to a specialist, such as a gastroenterologist, proctologist, or colorectal surgeon. He or she may want to suggest more testing which may involve:

• Stool testing: This can show if there is an infection present, especially if diarrhea is present.
• Anorectal manometry: To measure the strength of the sphincter muscles, the doctor may insert a monitor into the anus and rectum.
• Endosonography: This is an ultrasound probe, which is inserted into the anus. It will show the doctor images of the anal and rectal walls.
• Anorectal ultrasonography: This is an ultrasound instrument which is inserted into your anus and rectum. It emits sound waves, which produce video images onto a computer screen.
• Nerve tests: This test detects nerve damage by measuring the responsiveness of the nerves controlling the sphincter muscles.
• MRI defecography: This test is performed on a special commode while the patient moves her bowels. It is an imagining exam and can provide valuable evidence about the muscles and supporting structures in the anus, rectum, and pelvis.
• Proctography: With this test, your doctor coats the walls of your intestines with barium. This allows the stool to be seen on the X-rays and he or she can then see how much stool is there, how well it moves through and how much your rectum can hold.
• Proctosigmoidoscopy: This test involves a long, slender tube with a tiny video camera attached to examine your rectum and sigmoid. This exam will show the doctor any inflammation, scar tissue, or possible tumors. Since this only reaches the lower portion of your colon, your doctor may want to also perform a colonoscopy (link) to evaluate the entire colon.
• Anal electromyography. This test involves the insertion of tiny needle electrodes into muscles around your anus that can reveal signs of nerve damage

How is fecal incontinence treated?

Typically, bowel incontinence is treatable, and in many cases it can be cured completely. The treatment depends on the cause of the FI, and frequently, more than one treatment technique may be essential to control symptoms. Most health care professionals will try nonsurgical treatments first. These can include:

• Medications, such asImodium, Lomotil, and Hyoscyamine which can help reduce the amount of bowel movements and the urge to move the bowels. Also, bulk laxatives such as Metamucil and Citrucel can help regulate bowel movements. Methylcellulose can help make liquid stool more solid and easier to control.
• Diet: If chronic constipation is responsible for your fecal incontinence, your health care provider may suggest that you drink plenty of fluids and eat fiber-rich foods. If diarrhea is causing the problem, he or she may recommend that you increase your intake of high-fiber foods to add bulk to your stools so they are not so watery. Also adding 20-30 grams of fiber a day to your diet can help to make your stool bulkier and easier to control. Avoid:
  • Caffeine
  • Alcohol
  • Milk
  • Carbonated beverages
• Water: Drinking eight, eight-ounce glasses of water each day can help to prevent constipation.
• Pelvic floor exercises: These can help to strengthen the pelvic floor muscles. Biofeedback may also be beneficial.
• Bowel training: This exercise involves trying to have your bowel movement at the same time daily, such as after a meal. In time, your body will adapt to a regular bowel movement pattern. This involves consistency and persistence.
• Vitamin supplements
• Sacral nerve stimulation. The sacral nerves run from your spinal cord to muscles in your pelvis, and they regulate the feeling and strength of your rectal and anal sphincter muscles. The doctor will insert small needles into the muscles of your lower bowel. An external pulse generator is used to identify which muscle stimulates anal contractions the most by stimulating them. This may be uncomfortable, but after a successful response, you may have a permanent pulse generator implanted. This treatment is usually done after all others have failed.

What surgical procedures can be done to treat fecal incontinence?

When all other treatment options have failed, surgery may become an option for FI patients. Surgical options include:

• Sphincter repair: The surgeon takes muscle from the inner thigh and wraps it around the sphincter. This is called a gracilis muscle transplant and will restore the muscle control to your sphincter.
• Injection of biomaterials: This procedure uses an injection of a silicone-based material into the anal sphincter by swelling the size of the anal sphincter.
• Sphincteroplasty: This is the most common FI surgery. The surgeon will connect the ends of the sphincter muscle that were torn in childbirth or injury. This is done at a hospital by a colorectal, gynecological, or general surgeon.

• Colostomy: This procedure is usually the last resort. The operation diverts your stool to an opening in the abdomen called a stoma. A bag is attached and the patient is taught to empty and keep this clean.
• Sphincter replacement: This surgery is rare, but is used by some surgeons, involves placing an inflatable cuff, called an artificial sphincter, around the anus and implanting a small pump beneath the skin. The patient can activate the pump to either inflate or deflate the cuff to allow stool to be released.
• Electrical Stimulation: This surgery involves placing electrodes in the nerves to the anal canal and rectum. Electrical pulses continuously stimulate these nerves. The technique requires a battery-operated stimulator placed beneath the skin.
• Rectal prolapse, a rectocele or hemorrhoids. Some of these problems would require surgical correction (hemorrhoids can be treated with IRC in the office).

Related Articles about fecal incontinence

Finally, there’s a Good Treatment for Fecal Incontinence