Fecal incontinence (FI) is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, it can range from an occasional leakage of stool while passing gas to a complete loss of bowel control.
Common causes of may include constipation, diarrhea, and muscle or nerve damage. The condition may be due to a weakened anal sphincter associated with aging. Fecal incontinence can also occur as a result of childbirth. Injury to the nerves and muscles of the rectum and anus while giving birth can cause a woman to lose control of her bowel movements.
Babies, of course, are incontinent until toilet-trained. But beyond babies, some 6.5 million older Americans have fecal incontinence. Although fecal incontinence affects people of all ages, this condition is more common in women and in older adults of both sexes.
Fecal incontinence may be a source of embarrassment. It may cause you to stay at home and withdraw from social events. But don’t shy away from talking to your doctor about it. Many treatments, some of which are very simple — are available that can improve, if not correct, incontinence.
Signs and Symptoms of Fecal incontinence
Most of us take for granted that we can control our bowels. We generally don’t have “accidents” unless we have a short-lived bout of diarrhea.
But that’s not the case for people with recurring, or chronic, fecal incontinence. They can’t control the passage of gas or stools, which may be liquid or solid, from their bowels. And they often don’t make it to the toilet in time to avoid an accident.
For some people including children, fecal incontinence is a relatively minor problem, limited to occasional soiling of their underwear. For others, the condition can be devastating due to a complete lack of bowel control.
Fecal incontinence may be accompanied by other bowel movement troubles, such as:
- Abdominal cramping
Your body’s digestive tract begins at your mouth and nears its end at your rectum, the lower portion of the large intestine. Your digestive tract contains a complex system of organs that convey the food you eat, convert it into energy and remove waste that your body can’t digest.
As food waste passes through the upper portion of your large intestine (colon), your body absorbs nearly all of the water from the waste. The remaining residue, called stool, is usually soft but formed and comprises undigested foods, unabsorbed water, bacteria, mucus and dead cells.
Sphincter muscles, external and internal, in your anus — a short canal that’s the outlet for your rectum — serve as the final valve. As your rectal walls stretch, they signal the need to release stool. As your sphincter muscles relax, your rectal walls contract to increase pressure. Sometimes, you have to exert pressure from your abdominal muscles, which put pressure on the outside of your colon and rectum. With this coordination of muscles and also nerves, stool is expelled through the anus.
Critical to normal bowel function are:
- Anal sphincter muscles.
External and internal anal muscles contract to prevent stool from leaving your rectum.
- Rectal sensation.
This feeling warns you to go to the bathroom.
- Rectal accommodation.
Rectal stretching allows you to hold stool for some time until you can get to a toilet.
The ability to hold stool requires the normal function of your rectum, anus and nervous system. In addition, you have to have the physical and psychological capabilities to recognize and appropriately respond to the urge to defecate. If something is wrong with any of these factors, FI can occur.
A broad range of conditions and disorders can cause fecal incontinence, including:
The most common cause of bowel incontinence, ironically, is constipation. Chronic constipation may lead to impacted stool — a large mass of dry, hard stool within your rectum. The mass may be too large for you to pass. The impacted stool causes the muscles of your anus to stretch and weaken. Watery stool from higher in the bowel may move around the mass and leak out, causing fecal incontinence. Chronic constipation not only may cause the muscles of your anus to stretch and weaken but also may make the nerves of the anus and rectum less responsive to the presence of stool in the rectum.
Because loose stool is more difficult to control than more solid stool, diarrhea can cause or worsen fecal incontinence.
- Muscle damage.
Often, the cause of FI is injury to the anal sphincters — the rings of muscle at the end of the rectum that help you hold in stool. When damaged, the muscles aren’t strong enough to do their job, and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if you tear a muscle in your anus during vaginal delivery. Some women develop FI within weeks of giving birth. For others, incontinence due to childbirth doesn’t show up until the mid-40s or later.
- Nerve damage.
FI can also be caused by damage to the nerves that control the anal sphincter or that sense stool in the rectum. If the nerves that control anal sphincter muscles are injured, the muscle doesn’t work properly, and incontinence can occur. If the sensory nerves are damaged, they don’t sense that stool is in the rectum. You then won’t feel the need to defecate until stool has leaked out. Causes of nerve damage can be childbirth, a long-term habit of straining to pass stool, stroke, injury to the spinal cord and diseases that affect these nerves, such as diabetes and multiple sclerosis.
- Loss of storage capacity (accommodation) in the rectum.
Normally, the rectum stretches to hold stool until you can get to a toilet. But surgery to your rectum, radiation treatment and inflammatory bowel disease can scar and stiffen the walls of the rectum. The rectum then can’t stretch as much and can’t hold stool, and FI results.
Surgery to treat hemorrhoids — enlarged veins in the rectum or anus — also can cause damage to the anus and fecal incontinence, as can more complex operations involving your rectum and anus.
Anal and rectal infections — as well as bowel diseases, such as Crohn’s disease — can lead to incontinence by damaging the muscles that help you control defecation.
- Other conditions.
A dropping down of the rectum into the anus (rectal prolapse) or, in women, a protrusion of the rectum through the vagina (rectocele) can be a cause of fecal incontinence. Hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence.
- Loss of muscle strength with age.
Over time, muscles and ligaments that support your pelvis, as well as your anal sphincter muscles, can weaken, leading to incontinence.
Sudden, extreme stress or emotional disturbance can cause fecal incontinence.
Fecal Incontinence in children
FI can occur at any age — even in children. Newly toilet-trained children simply may not make it to the toilet in time to defecate, soiling their pants. But the most common medical cause of FI in the young is constipation, although the problem — known medically as encopresis — can also be due to an underlying condition, including mental retardation or other birth defects.
Constipation and impacted stools aren’t uncommon in children. Toilet-trained children often get constipated simply because they refuse to go to the toilet — they’re too busy playing, or they’re too embarrassed to use a public toilet. The child holds in the stool, the stool hardens, and then the fear of passing the hardened stool keeps him or her from trying to pass it.
A child who is constipated may soil his or her underpants — and try to hide it from others. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out.
Prevention of Fecal Incontinence
Can FI be prevented? It depends on the cause of the problem.
FI due to chronic constipation can be improved or eliminated by treating the constipation. Getting more exercise, eating high-fiber foods and drinking plenty of fluids are generally advised to avoid constipation.
If diarrhea is to blame, treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid accidents.
Straining during bowel movements eventually may weaken anal sphincter muscles and, at times, lead to fecal incontinence, so avoid straining when possible.
Treatment for Fecal incontinence
Fortunately, effective treatments are available for fecal incontinence. Your primary care physician may be able to assist you, or you may need to see a doctor who specializes in treating conditions that affect the colon, rectum and anus, such as a gastroenterologist, proctologist or colorectal surgeon. Treatment for FI is usually able to help restore bowel control or at least substantially reduce the severity of the condition.
Treatment depends on the cause of your incontinence and may include changes to your diet, medication, exercises to help you regain control of your bowels, surgery or a combination of treatments.
What you eat and drink affects stool consistency. Your doctor may recommend changes to your diet, to help improve your bowel movements.
For example, if chronic constipation is to blame for fecal incontinence, your doctor may recommend that you drink plenty of fluids (about 8 to 10 glasses of water, preferably, daily) and eat fiber-rich foods that aren’t constipating. If diarrhea is contributing to the problem, your doctor may recommend that you increase your intake of high-fiber foods to add bulk to your stools, making them less watery. In general, your doctor will recommend a diet that helps you gain good stool consistency for increased control of your bowels.
Sometimes, doctors recommend medications to treat fecal incontinence, such as:
- Antidiarrheal drugs.
Your doctor may recommend medications to reduce diarrhea and help you avoid accidents. A drug called loperamide (Imodium) may be used because it helps prevent diarrhea.
If chronic constipation is to blame for your incontinence, your doctor may recommend the temporary use of mild laxatives, such as milk of magnesia, that help restore normal bowel movements.
- Stool softeners. To prevent stool impaction, your doctor may recommend a stool-softening medication.
- Other medications.
Drugs used to treat inflammatory bowel diseases are among the other medications that may be used to control fecal incontinence.
If FI is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel retraining program and exercise therapies aimed at helping you restore muscle strength.
In some cases, bowel retraining means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after every meal. This helps you gain greater control by establishing with some predictability when you need to use the toilet. This technique can work well for children who have constipation and FI because they forget to use the toilet. Children can learn to use the toilet at scheduled times.
In other cases, bowel retraining involves an exercise therapy called biofeedback to help you strengthen and coordinate the muscles involved in holding in stool.
Biofeedback involves inserting a pressure-sensitive probe into your anal canal. This probe registers muscle strength and activity of your anal sphincter as it contracts around the probe. You can practice sphincter contractions and learn to strengthen your own muscles by viewing the scale’s readout as a visual aid. A typical program comprises two visits to your doctor’s office, for 3 to 4 days. Sometimes, one session is all you need.
Treatment for stool impaction
Your doctor may have to remove an impacted stool if taking laxatives or using enemas don’t help you pass the hardened mass. To remove an impacted stool, a doctor inserts one or two fingers into the rectum and breaks the impacted stool into fragments that you can later expel.
For some people, treatment of FI requires surgery to correct an underlying problem. Surgical options include:
This is surgery to repair a damaged or weakened anal sphincter. It’s the most common procedure to repair a damaged sphincter muscle in younger women. It’s effective for people who have a single site of anal sphincter injury. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.
- Operations to treat rectal prolapse, a rectocele or hemorrhoids.
Rectal prolapse, a condition in which a portion of your rectum protrudes through your anus, weakens the anal sphincter. In certain circumstances, such as chronic constipation and straining, the ligaments in the rectum can become stretched and lose the ability to hold stool in place. Surgical correction of the rectal prolapse may be needed along with sphincter muscle repair. In women, a protrusion of the rectum through the vagina (rectocele) may need to be treated surgically to correct fecal incontinence. Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence. Hemorrhoids may be near the upper part or beginning of the anal canal (internal hemorrhoids) or at the lower portion or anal opening (external hemorrhoids). Hemorrhoids can be treated by conventional hemorrhoidectomy, a surgical procedure to remove the hemorrhoidal tissue.
- Sphincter replacement.
The Food and Drug Administration has approved an artificial anal sphincter to treat severe fecal incontinence. The small device replaces a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you’re ready to defecate. To go to the bathroom, you use a small external pump to deflate the device and allow stool to be released.
As a last resort, a colostomy may be the most definitive way to correct fecal incontinence, particularly in older adults. A colostomy is an operation that diverts stool through an opening in the abdomen instead of through the rectum. A special bag is attached to this opening to collect the stool.
Sacral nerve stimulation
Another treatment is sacral nerve stimulation.
The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Direct electrical stimulation of these nerves is a promising treatment option for FI caused by nerve damage.
Sacral nerve stimulation is carried out in stages. First, four to six small needles are positioned in the muscles of your lower bowel, and these muscles are stimulated by an external pulse generator. The muscle response to the stimulation generally isn’t uncomfortable.
Following a successful response, a temporary stimulation wire is introduced into the stimulation needle and fixed to the skin. The results of stimulation are then recorded over a period of 10 to 21 days. If your incontinence is improved for up to 14 days, you may have a pulse generator permanently implanted.
The permanent pulse generator is implanted in your abdomen. A wire from the small, battery-driven device is connected to the sacral nerves. Through the wire, the device generates electrical impulses that stimulate the nerves, helping you regain continence.
Surgical procedures aren’t necessarily easy or free of complications. But certain causes of fecal incontinence; anal sphincter damage caused by childbirth or rectal prolapse, for example, can often be effectively treated with surgery.
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Primal Defense, A Natural Alternative
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