Causes of Fecal Incontinence
Fecal incontinence can occur briefly during bouts of diarrhea Diarrhea in Adults Diarrhea is an increase in the volume, wateriness, or frequency of bowel movements. (See also Diarrhea in Children.) The frequency of bowel movements alone is not the defining feature of diarrhea... read more or when hard stool becomes lodged in the rectum ( fecal impaction Fecal impaction Constipation is difficult or infrequent bowel movements, hard stool, or a feeling that the rectum is not totally empty after a bowel movement (incomplete evacuation). (See also Constipation... read more ). Persistent fecal incontinence can develop in people who have birth defects, injuries to the anus or spinal cord, rectal prolapse Rectal Prolapse Rectal prolapse is a painless protrusion of the rectum through the anus. A rectal prolapse is often caused while straining, such as during a bowel movement. The diagnosis is based on an examination... read more (protrusion of the rectal lining through the anus), dementia Dementia Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn. Typically, symptoms include memory loss, problems using language and... read more , neurologic injury Nerve damage in diabetes People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys. (See also Diabetes Mellitus... read more resulting from diabetes, tumors of the anus Anal Cancer Risk factors for anal cancer include certain sexually transmitted infections. Bleeding with bowel movements, pain, and sometimes itching around the anus are typical symptoms. A manual examination... read more , or injuries to the pelvis during childbirth.
Diagnosis of Fecal Incontinence
A doctor's examination
A doctor examines the person for any structural or neurologic abnormality. This examination involves examining the anus and rectum, checking the extent of sensation around the anus, and usually doing a sigmoidoscopy.
Other tests, including an ultrasound of the anal sphincter, magnetic resonance imaging (MRI) of the pelvis and perineal area, an examination of the function of nerves and muscles lining the pelvis, and pressure readings of the rectum and anus ( anorectal manometry Manometry Manometry is measurement of pressure within various parts of the digestive tract. People must not eat or drink anything after midnight before the test. In this test, a flexible tube with pressure... read more ) may be needed.
Treatment of Fecal Incontinence
Measures to regulate bowel movements
Sphincter exercises and sometimes biofeedback
Sometimes a surgical procedure
The first step in correcting fecal incontinence is to try to establish a regular pattern of bowel movements that produces well-formed stool. Dietary changes, including adequate fluid intake and the addition of a small amount of fiber, often help. A suppository or enema may also be used to help establish a regular pattern of bowel movements. If such changes do not help, a drug that slows bowel movements, such as loperamide, and a low-fiber diet may reduce the frequency of defecation.
Exercising the anal muscles (sphincters) by squeezing and releasing them increases their tone and strength. Using a technique called biofeedback Biofeedback Biofeedback, a type of mind-body medicine, is a method of bringing unconscious biologic processes under conscious control. In biofeedback, electronic devices are used to measure and report information... read more , a person can retrain the sphincters and increase the sensitivity of the rectum to the presence of stool. About 70% of well-motivated people benefit from biofeedback.
If fecal incontinence persists, surgery may help—for instance, when the cause is an injury to the anus or an anatomic defect in the anus. As a last resort, a colostomy (the surgical creation of an opening between the large intestine and the abdominal wall—see figure Understanding Colostomy Understanding Colostomy ) may be done. The anus is sewn shut, and stool is diverted into a removable plastic bag attached to the opening in the abdominal wall.