Treatment of Fecal Incontinence and Defecatory Disorders

What Is Fecal Incontinence and Defecatory Disorder?

Fecal incontinence is the uncontrolled release of stool from the rectum. The occurrence ranges from an occasional leakage of stool while passing gas to a complete loss in the ability to control bowel movements.

Defecatory disorders refer to an inability to empty the rectum efficiently when necessary.

What Are the Causes of This Condition?

The causes include:

1. Damage to the Anal Muscle: Injury to the ring of muscle at the end of the rectum can make it difficult to hold the stool. These rings are called the anal sphincter, which can occur during childbirth. This most commonly happens while using forceps during delivery.

2. Nerve Damage: Injury to the nerves that supply the anal sphincter can cause fecal incontinence. Many factors can lead to nerve damage which includes:

• Childbirth.

• Constipation for a long time.

• Repeated straining during bowel movements.

• Spinal cord injury.

• Stroke.

• Diabetes.

• Multiple sclerosis (a disease of the immune system that causes nerve coverings destruction).

3. Constipation: Impaction of stool occurs when the stool becomes dry, hard, and large, making it difficult to pass. As a result, the rectal and intestinal muscles extend and weaken eventually, which sometimes allows watery stools to pass around the impacted stool and cause leakage.

4. Diarrhea: Loose stools can lead to fecal incontinence.

5. Hemorrhoids: These are swollen veins in the rectum and can keep the anus from closing completely, leading to leakage of stool.

6. Surgery: Surgery done in the rectum and anus can sometimes cause muscle or nerve damage, leading to fecal incontinence.

7. Loss of Rectal Storage: Usually, the rectum stretches to accommodate stool. If the rectum gets scarred or stiffened, there will not be enough space for more stool, and this can cause excess stool to leak out. Some of the conditions which can cause scarring or inflammation in the rectum include:

• Surgery.

• Radiation treatment.

• Inflammatory bowel disease.

8. Rectal Prolapse: In this condition, the rectum drops into the anus, causing stretching of the rectal sphincter and damaging the nerves controlling the rectal sphincter. The muscles would not recover as long as this condition lasts.

9. Rectocele: Fecal incontinence can occur in women if the rectum projects through the vagina.

What Can Be the Possible Risk Factors for This Condition?

Many factors can increase the risk of developing fecal incontinence, which includes:

• Age: Although this condition can occur at any age, it is more common in older people over 65.

• Gender: Females giving childbirth can cause fecal incontinence. In addition, recent research has found that women who undergo hormonal replacement for menopause can cause this condition.

• Nerve Damage: People with long-standing diabetes, multiple sclerosis, and trauma in the back because of an injury or surgery can be risk factors for this condition.

• Physical Disability: Being physically disabled can make it difficult to even go to the toilet on time. In addition, an injury that causes a physical disability can also damage the rectal nerve, which leads to fecal incontinence.

How Can Fecal Incontinence and Defecatory Disorders Be Treated?

1. Medications:

• Antidiarrheal Drugs: Loperamide, Diphenoxylate, and Atropine.

• Bulk Laxatives: Methylcellulose and Psyllium if constipation is caused by fecal incontinence that is present for a prolonged period.

2. Exercise and Other Therapies:

If the primary cause of fecal incontinence is muscle damage, the doctor may recommend a set of exercises and therapies to restore muscle strength. In addition, these exercises can improve the function of the anal sphincter and awareness of the urge to defecate. The exercises include:

a) Kegel Exercise: The pelvic floor muscles hold up the bladder, bowel, and uterus in women. Strengthening these muscles will help to reduce incontinence. To perform this exercise, the individual should contract the muscle used to control the urine flow. Contract and hold for 3 seconds and then relax for 3 seconds. Repeat this pattern ten times. As the muscles strengthen, hold the contraction for a longer period. Increase the count gradually and perform three sets of ten contractions every day.

b) Biofeedback: Trained physical therapists will teach simple exercises that would increase the strength of anal muscles. The following exercises can help in different ways which include:

• Strengthen the pelvic floor muscles.

• It will help in alertness when stool is ready to get released.

• Control of muscles which will help to control bowel movements whenever necessary.

3. Radiofrequency Therapy:

This technique involves giving radiofrequency energy to the muscle wall to help improve the tone of the muscles, which is called the Secca procedure. This therapy is minimally invasive and is performed under local anesthesia and sedation. Unfortunately, this procedure is not covered under insurance.

4. Sacral Nerve Stimulation:

The sacral nerve runs from the spinal cord to the pelvic muscles. These nerves regulate the strength of the rectal and anal muscles. Implanting a device that sends tiny electrical impulses to the nerves can help strengthen the bowel muscles.

5. Bowel Training:

The doctor will recommend making an effort to maintain a consistent time for passing the stool. Example: after eating, which will help the patient to gain control over the defecation.

6. Bulking Agents:

Injection of non-absorbable bulking agents will help to thicken the walls of the anus, which helps in preventing leakage.

7. Posterior Tibial Nerve Stimulation:

This minimally invasive treatment stimulates the posterior tibial nerve at the ankle.

8. Vaginal Balloon:

This is a pump-like device inserted inside the vagina. The inflated balloon results in pressure on the rectal area, decreasing the frequency of rectal incontinence.

What Are the Different Surgical Procedures That Can Be Used for Fecal Incontinence?

The different surgical procedures that can be used for rectal incontinence are as follows:

• Sphincteroplasty: This procedure helps repair a damaged or weakened anal sphincter caused during childbirth. First, doctors will identify the injured muscle area and free its edges from the surrounding tissue. Then they will bring the muscle edges together and sew them in an overlapping fashion, which will help strengthen the muscle and tighten the sphincter.

• Treatment of Hemorrhoids: Surgical correction of these problems will reduce or eliminate fecal incontinence. However, the longer the condition goes untreated, the higher the risk of fecal incontinence not resolving after surgery.

• Bowel Diversion: This procedure is otherwise called a colostomy. This surgery is done by diverting the stool through an opening in the abdomen. Doctors will attach a special bag to this opening to collect the stool. Colostomy will be considered the last option for treatment.

What Lifestyle Changes Can Be Made to Reduce the Symptoms of This Condition?

Keeping track of foods eaten can help identify foods that increase the symptoms of fecal incontinence. Once the specific type of food is identified, the individual can stop eating them and observe whether the incontinence improves.

Foods that commonly cause fecal incontinence are spicy foods, fat-rich foods, and dairy products. In addition, caffeine-containing beverages and alcohol can also act as laxatives.

If constipation is the problem, the doctor will recommend the patient have fiber-rich foods. Fiber helps in making the stool soft. If diarrhea is the problem, foods rich in high fiber can add bulk to the stool and make them less watery. Fiber is present in some fruits, vegetables, whole grain bread, and cereals. It is good to aim for 25 grams of fiber per day.

Drink an adequate amount of water, at least eight glasses a day, to keep the stool soft and smooth. Irritation to the skin of the anus can sometimes occur if the skin is in contact with the stool frequently.

The following steps can help in reducing the symptoms which include:

• Washing the area around the anus properly after defecation.

• Change the underwear as soon as possible.

• Keep the anal area dry.

• Use non-medicated powders.

• Use disposable underwear.

• Wear clothes and underwear that let air pass through easily.

Conclusion

Many people think it is something embarrassing to say out loud. There is nothing to feel embarrassed about. It is our body and our responsibility to take care of this. Individuals suffering from fecal incontinence should visit the doctor soon to reduce complications like emotional distress and skin irritation. If the skin around the anus comes in contact with the stool frequently, it may cause ulcers and sores, which would also require medical attention.