What Is Fecal Incontinence?

Fecal, or bowel, incontinence is the inability to regulate bowel movements. It can be common among the elderly. Accidental bowel leakage is typically not an indication of something serious. However, it can affect daily life and a person’s self-confidence. Effective treatments used at the office can include:

• medication

• surgery

• minimally-invasive procedures

What Causes Bowel Incontinence?

The most frequent cause of bowel incontinence is an injury to the muscles surrounding the anus. Vaginal childbirth and anal surgery can damage the anal sphincters, or their nerves, which can cause the condition. Other causes can include:

• Diarrhea- frequently due to an infection or irritable bowel syndrome (IBS)

• Impacted stool- due to serious constipation

• Inflammatory bowel disease- such as Crohn's disease and ulcerative colitis

• Nerve damage- this may be caused by spinal cord injury, multiple sclerosis, and diabetes

• Radiation damage to the rectum- such as that following prostate cancer treatment

• Cognitive impairment- seen following a stroke or progressed Alzheimer's disease

Multiple causes often affect the person and occasionally there may not be a clear cause.

How Is Bowel Incontinence Diagnosed?

Discussing the problem can be a little strange but it will be helpful to remember that the doctor is there to help. To make sure that the right treatments are used, the doctor may perform a physical examination of the strength of the anal sphincter. Other tests can include:

• Stool testing- stool testing can identify an infection

• Endoscopy- A tube with a camera is inserted into the anus to identify any potential issues in the anal canal or colon.

• Anorectal manometry- A pressure monitor is directed into the anus and rectum to measure the strength of the sphincter muscles.

• Endosonography- An ultrasound probe is inserted into the anus which generates images which can identify issues in the anal and rectal walls.

• Nerve tests- This can test the reaction of the nerves which control the sphincter muscles to diagnose nerve damage.

• MRI defecography- Magnetic resonance imaging can be done on the pelvis, possibly when the patient is moving the bowels on a special commode. This offers information about the muscles and supporting structures of the pelvis, anus, and rectum.

How Severity Of Fecal Incontinence Measure?

Many scroring systems are used to measure the severity like Jorge-

Wexner incontinence score.

What Are The Treatment Options For Bowel Incontinence?

Medications

Depending on the cause of fecal incontinence, options include:

• Anti-diarrheal medications like loperamide (Imodium) and those containing diphenoxylate and atropine (Lomotil).

• Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil)

• Exercise and physical therapies

Like:

Kegel exercises

Kegel exercises help to strengthen the pelvic floor muscles. These muscles support the bladder and bowel and in women, the uterus. Strengthening these muscles may help reduce incontinence of stools.

Biofeedback

Specially pelvic floor trained physical therapists teach simple exercises that can increase anal muscle strength to

-Strengthen pelvic floor muscles.

-Sense when stool is ready to be released.

-Contract the muscles if having a bowel movement at a certain time is

Bowel training

Your doctor may recommend making a conscious effort to have a bowel movement at a specific time of day: for example, after eating.

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Surgical Treatment Options:

Sacral nerve stimulation

The sacral nerves run from your spinal cord to muscles in the pelvis. They regulate the sensation and strength of your rectal and anal sphincter muscles. Implanting a device that sends small electrical impulses to the nerves can strengthen muscles in the bowel.

Surgery

Treating fecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth. The options include:

Sphincteroplasty: This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. Doctors identify an injured area of muscle and free its edges from the surrounding tissue and bring the muscle edges back together and sew them in an overlapping fashion. This helps strengthen the muscle and tighten the sphincter. Sphincteroplasty may be an option for people trying to avoid colostomy.

Treating rectal prolapse, a rectocele or hemorrhoids: Surgical correction of these problems will likely reduce or eliminate fecal incontinence. The longer the prolapse goes untreated, the higher will be the risk of fecal incontinence not resolving after surgery.

Colostomy, also called bowel diversion. This surgery diverts stool through an opening in the abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy is generally considered only after other treatments haven't been successful.