Fecal Incontinence

Basic Facts

Fecal incontinence is the decreased ability to control stool or gas.

It ranges in severity from mild difficulty with gas control to severe loss of control over liquid and formed stool.

It is a common but embarrassing problem that increases with age. Up to twenty percent of people who live at home and fifty percent of individuals living in nursing homes have this problem.

People who have this condition rarely discuss it with their health care provider.

CAUSES AND RISK FACTORS

The many potential causes and risk factors for fecal incontinence are often difficult to diagnose. Some causes for fecal incontinence are thought to be injury during childbirth, anal operations or injury to surrounding tissue, infections around the anal area, aging, diarrhea, a tumor of the rectum, rectal prolapse, or disease.

Injury during childbirth may cause a separation in the anal muscles and decrease in muscle strength. Nerves supplying the anal muscles may also be injured. These injuries often go unnoticed and do not become a problem until later in life.

Anal operations or injury to surrounding tissue can damage the anal muscles and decrease control of bowels. Infections around the anal area may destroy muscle tissue and lead to incontinence. Aging often causes a loss of strength of the anal muscles resulting in a minor problem becoming more significant. Disease such as multiple sclerosis and diabetes can affect the nerves that go to the anal sphincter and therefore cause incontinence.

Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent liquid stools passing through the anal opening. Bleeding and diarrhea may indicate inflammation within the colon (colitis), a tumor of the rectum, rectal prolapse. All of these conditions require prompt evaluation by your health care provider.

DIAGNOSIS

When making a diagnosis, your health care provider will take a health history, especially of events that may traumatize the pelvic floor such as multiple pregnancies, large weight babies, uncontrolled births, forceps deliveries, or episiotomies. Current medical illnesses and medications will be part of your health history because they also can contribute to poor control. Your health care provider will do a physical examination of the anal region.

Further testing may done such as manometry, pudendal nerve terminal motor latency studies, anal ultrasound, and defecography. Manometry is a test where a small catheter is placed into to anus to record pressure as the anal muscles are relaxed and tightened. This demonstrates anal muscle strength and weaknesses. Pudendal nerve terminal motor latency studies help determine if nerves going to the anal muscles are functioning. Ultrasound can provide a picture of the muscles and show areas where the anal muscle have been injured. Defecography evaluates the function of the anal rectal unit during defecation. After diagnosis, your health care provider will develop a treatment plan.

TREATMENT APPROACH

Treatment of underlying disorders contributing to anal incontinence is started. Mild problems can be handled with dietary changes and with the use of medications to increase the firmness of the stool. Exercises called Kegel exercises or pelvic floor muscle exercises are started to increase the strength of the anal muscles and decrease fecal incontinence Use of biofeedback assist in teaching individuals how to do these exercises. Treatment can also include surgery to repair anal muscles and use of artificial devices to help maintain continence.

LIFESTYLE

Managing fecal incontinence also means making life style changes. These can include: limiting consumption of alcohol and caffeine, exercising regularly, consuming an adequate amount of fluids, avoiding smoking, increasing fiber to an adequate amount, and planned daily bowel movements.

References

American Society of Colon and Rectal Surgeons. (2002). Bowel incontinence [Brochure].

Bickley, L.S. & Szilagyi, P.G. (2003). Bates' guide to physical examination and history taking (8th ed., p. 428). Philadelphia: Lippincott Williams & Wilkins.

Heitkkemper, M.M. (2000). Physiology of defecation. In D.B. Doughty, Urinary & fecal incontinence (2nd ed., pp. 313-323). St. Louis: Mosby.

Waldrop, J. & Doughty, D.B. (2000). Pathophysiology of bowel dysfunction and fecal incontinence. In D.B. Doughty, Urinary & fecal incontinence (2nd ed., pp. 313-323). St. Louis: Mosby.

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