Fecal Incontinence (Bowl Incontinence)

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What is Fecal Incontinence?

Fecal incontinence, or bowel incontinence, is the inability to control bowel movements causing unexpected leaks from an individual’s rectum. This loss of control can range from an occasional leakage before being able to reach a restroom, to complete loss of bowl movements all together. Or, a person may not feel the urge to go to the toilet at all.

What most people suffering from this condition fail to realize is there are many new effective treatment options available for fecal incontinence. Nearly 18 million Americans deal with this embarrassing condition, so don’t be ashamed to talk about it! Treatment is available that can drastically improve your quality of life.

Why Does Fecal Incontinence Occur?

When a person loses the ability to hold in their stool (continence), it is mainly due to damage of the rectal nerves or muscles that control your bowel movements. In order to maintain continence, the anus, rectum and nervous system all have to be working together. If the muscles on the wall of the anus and rectum are at all compromised, a person’s ability to hold in stool will in turn be affected. Continence also relies on the body’s ability to notice the presence of stool in the rectum, as well as the body’s ability to relax and store stool while using the bathroom. If any of these dexterities become weak or none compliant, incontinence is what ensues.

What causes fecal incontinence?

  • Age: As we grow older its natural for sphincter muscles to become weaker. In turn, older people often find themselves unable to contract the sphincter muscles tightly enough to hold in stool until they are able to reach a bathroom.
  • Constant diarrhea: Conditions such as diarrhea can cause the muscles in the anus and in the intestines to stretch and become weak. Diarrhea can lead to bowel incontinence by overwhelming the rectum and anal sphincters with the volume of stool being passed, ultimately leading to leakage or complete incontinence.
  • Crohn's disease: Patients who suffer from Colitis or Crohn’s disease most often than not aslo suffer from bowel incontinence. Because both conditions can cause severe and chronic diarrhea, the anal muscles often become weak and control eventual becomes compromised.
  • Excessive staining or constipation: Constipation is one of the more common causes of fecal incontinence. The type of constipation that is most likely to lead to fecal incontinence occurs when people are unable to relax their sphincter and pelvic floor muscles when trying to push out a bowel movement. Unknowingly while straining, the individual can mistakenly squeezing these muscles instead of relaxing them making it difficult for stool to pass. When stool becomes hardened in the rectum the looser, watery stool must move around the drier mass and often leaks from the anus.
  • Neurological Conditions: Many neurological diseases, such as Alzheimer's, that affect the nervous system may also cause fecal incontinence. Because bowel control relies so heavily on the bodies nervous system to notice the presence of stool, patients who suffer from these (and other) neurological disorders are often unable to hold in their stool.
  • Radiation treatment: The anal sphincter muscles won’t open and close properly if the nerves that control them are damaged. Likewise, if the nerves that sense stool in the rectum are damaged, a person may not feel the urge to go. Both types of nerve damage can lead to fecal incontinence, and both these types of nerve damage can occur while undergoing radiation therapy.
  • Trauma or damage done during pervious anal surgery - Injury to one or both of the sphincter muscles can cause fecal incontinence. If these muscles, called the external and internal anal sphincter muscles, are damaged or weakened, they may not be strong enough to keep the anus closed and prevent stool from leaking.
  • Vaginal delivery – Obstetrical injuries are the number one cause of fecal incontinence and result in about 60 percent of all cases. During childbirth or anal surgery injury to one or both of the sphincter muscles can often occur. The risk becomes greater if forceps are used during the birthing process or if an episiotomy (a cut made to the vagina to help deliver the baby) is performed. Some woman experience incontinence directly following child birth, while others aren’t affected until years later.

What are the symptoms of fecal incontinence?

Symptoms of fecal incontinence can vary to include:

  • Staining or completely soiling your underwear
  • Not being able to reach the bathroom in time
  • Not feeling the urge to use the bathroom
  • Complete loss of bowel control

Diagnosis of Fecal Incontinence

Diagnoses of fecal incontinence is most often based off of a health care providers evaluation of a patient’s medical history, an in office physical exam, and other related blood or imaging test results.

Patients are often asked to log their bowel movements as well. How frequent is your incontinence? Was it liquid or solid stool? Were you able to sense the need to go? How heavy of an impact does is it having on your day to day life? Do you need to wear a pad? In doing all of that, your physician will be able to better evaluate the severity of your condition, as well as implement the proper course of treatment.

A physical examination can also assist in confirming the severity as well as the cause(s) of a patient’s incontinence. This may include a visual exam of the anus, a physical finger exam of the anus, and or an anoscopy, or a look at the anal canal with a small scope.

Further diagnostic testing may also be required to confirm the exact cause of a patient’s incontinence. One of the most common examinations performed is anal ultrasound. During this test, the ultrasound machine takes multiple pictures which can uncover damaged or abnormal function of the anal muscles.

Diagnostic tests may include:

  • Blood tests
  • Colonoscopy
  • Electromyography (EMG) - Tests the nerve function in the muscles around the anus by using tiny needle electrodes.
  • Rectal or pelvic ultrasound
  • Stool culture
  • Test of anal sphincter tone (anal manometry) – This is used to evaluate the rectal sensation, strength and response by utilizing a catheter and a balloon to study the nerves and muscles of the anus and rectum.
  • X-ray procedure using a special dye to evaluate how well the sphincter contracts (balloon sphincterogram)

Treatment & Prevention Options

Treatment for fecal incontinence can vary. Sometimes, for less severe cases, a simple change in diet and nutrition is all that is needed. For patients suffering from more severe incontinence, treatment can include biofeedback, surgery, or the latest and most favorable procedure, electoral nerve stimulation or InterStim Therapy.

  • Injection treatment - This procedure entails injections of a thick gel, called Solesta, into the anal sphincter to bulk up the lining of the rectum. By added density, fecal matter is less likely to slip out due to muscle weakness.
  • Artificial bowel sphincter – During this surgical procedure an artificial sphincter is placed around the rectal sphincter. Consisting of three parts (a cuff, a pressure-regulating balloon, and a pump) the cuff stays inflated to maintain continence. Once you have a bowel movement the cuff will deflate the balloon which will automatically re-inflate in 10 minutes.
  • Biofeedback: Biofeedback is an effective non-surgical treatment option that helps the body learn through reinforcement. Bio-feedback training is usually done in conjunction with at home bowel training exercise (such as Kegel’s) and works to increase the body’s awareness of a biological response, like having to go to the bathroom, so a person and relearn and improve their voluntary control.
  • Medication: For less severe cases a physician may recommend medication to treat fecal incontinence. Medications may include: Anti-diarrheal medication that helps bulk up stool, such as Imodium® and Pepto-Bismol®. Or for those suffering from constipation they may recommend laxatives such as milk of magnesia, or stool softeners such as Colace and Dulcolax.
  • Sacral nerve stimulation or Interstim Implantation is a surgical procedure that is FDA approved for the treatment of fecal incontinence. The treatment form is highly affective and is most often used when conservative therapy doesn’t relieve a patient’s incontinence. This treatment targets the 3rd sacral nerve root, which controls bowel and bladder continence. Done in two stages by a colorectal surgeon, this procedure is normally performed in an out-patient setting. During the first stage, your surgeon will place a thin, flexible wire, called a test lead, near your tailbone, which will send mild electrical pulses to the nerves that control your bowel continence. Your ability to control your bowels with the “test lead” will be tracked over the next two weeks, and adjustments are made to the electrical pulses if needed. If Interstim has proved effective during the trial state, then the flexible wire or lead will be implanted under your skin permanently. Interstim therapy has been shown to improve quality of life, and reduce the frequency and severity of fecal incontinence episodes in the majority of patients who receive the permanent implant.
At the Surgery Group of Los Angeles, our surgeons pride themselves on staying at the forefront of innovative, personalized care. By utilizing the latest technology our physicians are able to provide patients with a wide-verity cutting edge treatment options specifically tailored to every individual’s needs and personal preferences.

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