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Fecal Incontinence - Causes, Diagnosis, and Treatment

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Fecal incontinence is the inability to control bowel movements. This article discusses the causes, diagnosis, and treatment of fecal incontinence.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Jagdish Singh

Published At October 13, 2022
Reviewed AtDecember 1, 2023

Introduction

Fecal incontinence, also called anal incontinence, is where bowel movements cannot be controlled, causing leaking of stools from the rectum, interfering with day-to-day activities, and causing discomfort and distress to the patient.

Who Is at Risk of Fecal Incontinence?

The risk factors for fecal incontinence are as follows:

  • Adults over 65 years have a high risk for fecal incontinence.

  • Any damage to the nerves caused due to long-standing diabetics, back injury or surgery, and multiple sclerosis.

  • Complications during childbirth.

  • In the late stages of dementia and Alzheimer's disease.

  • Chronic constipation.

  • Physically disabled.

What Are the Causes of Fecal Incontinence?

  • Nerve Damage - If any damage occurs to the nerve that controls the ability of the anus and rectal muscles to contract, any injury to the nerves that control the sensitivity of the rectum can also cause fecal incontinence. Nerve damage can happen during childbirth, spinal cord injury, stroke, and chronic constipation. Diseases like diabetes and multiple sclerosis can also cause damage to the nerve.

  • Muscle Damage - Trauma to the anal sphincter muscle (muscle at the end of the rectum) makes it hard to hold the stool properly. Injury to the anal sphincter occurs during childbirth, anal or rectal surgery.

  • Old Age - As people grow old, there will be a natural loosening of the anal and rectal muscles. The structure nearby the pelvis also gets loosened. This can lead to fecal incontinence.

  • Constipation or Diarrhea - Frequent constipation and diarrhea make the rectal muscles weak and weaken the ability to hold the stools.

  • Hemorrhoids - Hemorrhoids are a condition that causes the rectal veins to swell, which does not allow the anus to close completely, leading to stool leakage.

  • The Inability of the Rectum to Stretch - If the elasticity of the rectal muscle is weak, there will be stool leaking. It happens in inflammatory bowel disease, which affects the stretching ability of the rectum. Scar tissue formation after the surgery or radiation therapy to the rectum can stiffen the muscles and make the muscles less elastic.

  • Rectal Prolapse - When the rectum slips outside the anus, it is called rectal prolapse. This damages the nerve that controls the rectal sphincter causing fecal incontinence.

  • Other Causes - Overuse of laxatives, radiation therapy, certain nervous system and congenital defects, infection, and inflammatory bowel disease may affect the ability to control stool.

How Is Fecal Incontinence Diagnosed?

There are many tests for the diagnosis of fecal incontinence.

They are as follows:

  • Anal Manometry - A thin, flexible tube is inserted into the anus, and a small balloon at the tip of the tube will be expanded. This test measures the anal sphincter muscle strength, sensitivity, and rectal functioning.

  • Endoluminal Ultrasound or Anal Ultrasound - A small probe is inserted into the rectum and anus to take images of the sphincters. This test helps find the shape and structure of the anal sphincter and surrounding tissue.

  • Anal Electromyography - This test is used to determine whether nerve damage is the reason for the anal sphincter not working correctly.

  • Proctography - This test takes the x-ray video of the rectum functioning. A small amount of liquid barium is released into the rectum and colon to make the X-ray video. The video shows how well the rectum holds the stool, how much stool the rectum can hold, and how well the rectal releases the stool.

  • Balloon Expulsion Test - A small balloon filled with water is inserted into the rectum. The patient is asked to go to the bathroom and push out the balloon. If a patient takes more than 3 minutes to push the balloon out, the patient has defecation disorder (the inability to evacuate contents from the rectum).

  • Proctosigmoidoscopy - This test checks for abnormalities at the end of the large bowel or colon, such as inflammation, scar tissue, or tumor, which may lead to fecal incontinence. A delicate tube with a camera attached at the end is inserted into the rectum up to the sigmoid colon to view the bowel's lining.

  • Magnetic Resonance Imaging (MRI) - This gives a clear image of the muscles and supporting structures in the anus, rectum, and pelvis.

What Is the Treatment for Fecal Incontinence?

The treatment includes:

Dietary Changes -

  • Identify the problem caused by specific food and stop eating them. Track your diet; the consistency of the stool depends on the food you eat. Dairy products, spicy foods, and oily foods cause bloating, diarrhea, and fecal incontinence. Leafy greens, bananas, caffeine-containing beverages, and alcohol can act as laxatives and cause fecal incontinence.

  • Eating Fiber-Rich Foods - If constipation is the cause of fecal incontinence, eating fiber-rich food can be helpful by softening the stool. If fecal incontinence is caused due to diarrhea, eating fiber-rich foods adds bulk to the stools and makes the stool hard.

  • Hydrating - Drinking eight glasses of water makes the body hydrated and relieves constipation.

Medications -

Medications depend on the cause of fecal incontinence:

  • If diarrhea is the cause of fecal incontinence, medicines like Loperamide and Bismuth subsalicylate are prescribed.

  • Stool softeners, laxatives, or fiber supplements are recommended if fecal incontinence is caused due to constipation.

Exercise and Other Therapies -

  • Kegels Exercise - It strengthens the pelvic floor muscles supporting the bowel and the bladder. This is done by contracting and relaxing the muscles of the pelvic region.

  • Bowel Training - There are two types of bowel training. In the first type, the doctor advises setting up a bowel training routine so the patient can gain greater control over the bowel movements. In the second type, the trained therapist teaches exercises to strengthen the muscles around the anus.

  • Biofeedback - In this method, people learn to use their minds to control bodily functions. Trained physical therapists teach simple exercises that can increase anal muscle strength.

Surgical Management -

  • Sphincteroplasty - This surgery repairs the weakened or damaged anal sphincter during childbirth. The anal sphincter muscle is overlapped and stitched to secure the muscle on both sides, resulting in a tighter anal opening.

  • Artificial Sphincter - An artificial sphincter made of a silicone ring is placed around the anus. The patient can deflate the artificial sphincter to pass out the stools and inflate it to close the anus, preventing leakage.

  • Colostomy - An opening is made in the abdomen, through which the colon is brought to the surface of the skin. The stool is collected into a bag from the opening. This surgery is always considered the last option.

Conclusion:

Fecal incontinence can cause great distress and emotional breakdown because the patients may be isolated from social gatherings. Proper diet and treatment can bring the patient back to normal life. It is advisable to reach out to a medical professional if the symptoms are worse to aid in early diagnosis and treatment plan.

Frequently Asked Questions

1.

Who Is at Risk for Fecal Incontinence?

Individuals who are at risk of developing fecal incontinence are-  
-People over 65 years of age.
-Individuals who suffer from nerve damage due to chronic diabetics, back injury or surgery, and multiple sclerosis.
-Pregnancy and childbirth complications.
-Advanced stages of diseases like dementia (a condition affecting memory and thinking) and Alzheimer’s (shrinkage of the brain due to progressive neurological disorder).
-Long-standing constipation.
-Physical disabilities.

2.

Why Does Fecal Incontinence Happen?

Fecal incontinence can occur due to various causes, including-  
-Damage to the nerves that control the contraction of the anus and rectum.
-Muscle damage or damaged anal sphincter.
-Old age.
-Chronic constipation.
-Diarrhea.-Hemorrhoids.
-The rectum's inability to stretch
-Rectal prolapse.

3.

How Is Fecal Incontinence Diagnosed?

Fecal incontinence can be diagnosed with the help of the following tests:  
-Anal manometry.
-Anal ultrasound.
-Anal electromyography.
-Proctography.
-Balloon expulsion test.
-Proctosigmoidoscopy.
-MRI (magnetic resonance imaging).

4.

What Is the Treatment for Bowel Incontinence?

 
Treating bowel incontinence or fecal incontinence depends primarily on the condition's cause. If the condition occurs due to diarrhea or constipation, medication and dietary changes can be helpful. Moreover, exercises (like the Kegel exercise) and bowel training are also used for treating bowel incontinence. Surgical management is considered in cases of nerve or muscle damage in the anal and rectum regions.

5.

What Foods Should I Avoid With Bowel Incontinence?

The following food should be avoided in case of bowel incontinence:  
-Alcohol.
-Caffeinated drinks.
-Dairy products.
-Oily and fatty food.
-Spicy food.
-Excess sugar.
-Avoid eating leafy vegetables and roughage because they can act as a laxative.

6.

How Common Is Fecal Incontinence?

 
According to medical professionals, fecal incontinence is a frequent issue that affects one in three persons. Fecal incontinence is prevalent among older adults.

7.

Can Fecal Incontinence Be Cured?

Yes, fecal incontinence is a curable condition with proper treatment. Incontinence of the bowel is not a typical aspect of aging. Most people with the condition need treatment; it typically will not resolve independently. Dietary changes, exercising, bowel training, medication, surgery, etc., are the common treatment approach depending on the cause of fecal incontinence.

8.

How Is Bowel Incontinence Treated in the Elderly?

Bowel incontinence, although very common, is not a normal part of aging or getting old. Bowel incontinence can be treated in the elderly by treating the underlying cause of the condition. Th common treatment modalities include  
-Dietary changes.
-Bowel training and exercises.
-Medication.
-Surgery.

9.

Is There Medication for Bowel Incontinence?

 
Yes, there are several types of medication available to treat bowel incontinence. Fecal incontinence can also be addressed with over-the-counter medications. Medication like Loperamide and Bismuth subsalicylate is administered if diarrhea is the underlying cause of fecal incontinence. Laxatives and stool softeners may be given to treat chronic constipation, which is another common cause of fecal incontinence.

10.

Does Diverticulitis Cause Fecal Incontinence?

 
Diverticulosis is a medical condition that is associated with the development of tiny, bulging pouches in the digestive tract. Diverticulitis is the term for an infection or inflammation of one or more of these pouches. Diverticulitis is frequently associated with diarrhea and constipation, both of which are common causes of fecal incontinence.
Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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fecal incontinence
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