Introduction:
Fecal incontinence is a loss of control over the excretion of stool or gas. Leakage of stool can be observed without giving a signal. This condition may range from occasional leakage of stool with gas to complete loss of control over bowel movements. Hence, it is also sometimes called bowel incontinence.
What Is Fecal Incontinence?
Fecal incontinence (FI) is a condition seen more commonly among the old-aged group. This condition has bad impacts on society and economics; hence, the affected individual faces embarrassing movements and gets isolated from society.
The prevalence of FI is difficult to estimate as cases are not reported due to social stigma. The prevalence of FI ranges from 2 % to 21 %. This varies with age. Overall, cases of FI are on the rise.
What Are the Causes of Fecal Incontinence?
The causes of fecal incontinence may include
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Central nervous system.
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Autonomic nervous system.
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Inflammatory bowel disease.
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Diabetes Mellitus.
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Cerebrovascular accident.
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Anal surgery.
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Spinal cord trauma.
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Vaginal delivery.
What Are the Symptoms of Fecal Incontinence?
FI may occur during diarrhea. It may be occasional for some individuals, but among a few, it may occur a lot.
Some conditions that may show FI are
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Diarrhea.
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Constipation.
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Gas and bloating.
What Are the Risk Factors for Fecal Incontinence?
Factors that may increase the risk of FI include
Age: FI may occur at any age but is more common among individuals over 65.
Female: Among females, FI may be caused as a complication after childbirth. Women of menopausal age who take menopausal hormone replacement therapy have a risk for FI.
Nerve Damage: Individuals with diabetes mellitus for a long time, multiple sclerosis, and back trauma due to injury or surgery may pose a higher risk for FI.
Dementia: FI can be observed at a later stage of Alzheimer's disease or dementia.
Physical Disability: This condition may cause a delay in reaching the toilet in time. An injury responsible for physical disability may cause nerve damage in the rectum. This may lead to FI.
What Are the Complications of Fecal Incontinence?
Complications of FI may include
Emotional Distress: Affected individuals try to avoid going out and feel uneasy engaging in social activities. These things lead to emotional distress.
Skin Irritation: The skin around the anus is very sensitive and delicate. If this skin comes in contact with stool, it may lead to pain and irritation.
How to Evaluate Fecal Incontinence?
Diagnosis or evaluation can be done by using the following methods:
Physical Examination: This involves a visual examination, and a probe is used to know about the nerve damage.
Digital Rectal Exam: A gloved or lubricated finger is inserted into the rectum to check for the sphincter muscle's strength and any irregularities present.
Balloon Expulsion Test: In this method, a small balloon is first inserted into the rectum. Then it is filled with water. Then the individual is asked to go to the toilet to remove the inserted ballon. If the person takes more than 1-3 minutes to remove the balloon, then it is considered that the person has a defecation problem.
Anal Manometry: A narrow, flexible tube is inserted into the rectum, and a small balloon, attached at the tip of the tube, is expanded. This method helps to know about the tightness of the anal sphincter and the rectum's sensitivity and functioning.
Anorectal Ultrasonography: A narrow instrument is inserted into the rectum that takes video images. These images help us learn about the structure of the sphincter.
Proctography: This method takes X-ray images during bowel movements. This can be done on a specialized toilet.
Colonoscopy: A flexible tube is inserted through the rectum to view the colon.
Magnetic Resonance Imaging: This method gives a clear picture of the sphincter and helps to know how well the muscles are intact. This test can help take images during defecation and is called defecography.
How to Treat Fecal Incontinence?
Treatment methods vary depending on the cause and severity of the condition.
Medications: Medications like antidiarrheal are used if the cause of this condition is diarrhea.
Laxatives can be used if the cause is constipation.
Exercise and Other Therapies: If the cause of this condition is muscle damage, then exercise and other therapies are used to strengthen the muscles. This type of treatment helps to improve sphincter control at the anus and raises awareness about the urge to defecate.
Surgery: In some cases, surgery may be needed to correct problems like rectal prolapse or sphincter damage caused by childbirth.
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Sphincteroplasty: This procedure is used to correct damaged or weakened anal sphincter. This helps to strengthen the muscle and tighten the sphincter. This is an option for those who want to avoid colostomy.
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Treatment of Rectal Prolapse, Rectocele, or Hemorrhoids: Surgical treatment of these problems helps reduce or eliminate fecal incontinence. If the prolapse treatment is not done for long, the risk of fecal incontinence is high and may not be resolved even after being surgically treated.
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Colostomy or Bowel Diversion: In this surgical procedure, the stool is diverted through an opening into the abdomen. A special bag is attached to collect stool at the opening. This procedure is considered only if other methods fail.
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Lifestyle Modifications: These include dietary changes like keeping track of what is to be eaten. Avoiding spicy, fatty, greasy, and dairy foods may help. If fecal incontinence is due to constipation, eating more fiber-rich foods helps. Drinking sufficient water throughout the day helps soften the stool.
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Skincare: Keeping the skin around the anus clean and dry may help reduce the discomfort caused during fecal incontinence.
Conclusion:
Fecal incontinence is a condition that causes embarrassing situations for the individual affected and hampers their quality of life. Hence, knowing about fecal incontinence, its causes, symptoms, and management becomes important. Knowing about it helps with early diagnosis and effective treatment. This, in turn, helps improve the quality of life of an affected individual.
