Fecal Incontinence

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Fecal Incontinence

What Is It?

When stool (feces) is released from the bowel accidentally, it is known as fecal incontinence. Under normal circumstances, stool enters the end portion of the large intestine, called the rectum, where it is stored. As the rectum fills with stool, the anal sphincter muscle (a circular muscle surrounding the anal canal) prevents feces from leaving the rectum until it is time to have a deliberate (controlled) bowel movement.

Various conditions can cause stool to escape. The rectum may start to lose its ability to store the stool, the person may be unable to feel that the rectum is full, or the anal sphincter may be too weak to hold the pressure of the stool in the rectum. A person also must be alert to the need to empty the bowels, and be mobile enough to reach the bathroom in time. Diarrhea from any cause makes incontinence worse (since it is more difficult to control liquid stool than solid stool).

The problem can be caused by several conditions. Muscle or nerve damage usually is involved in chronic (long-term) cases of fecal incontinence.

Damage to muscles can be caused by:

• Childbirth

• Rectal surgery

• Inflammatory bowel disease

• Trauma

Damage to nerves can be caused by:

• Diabetes

• Spinal cord injury

• Multiple sclerosis

• Unknown factors

Symptoms

Symptoms of fecal incontinence can range from mild soiling when passing gas to complete inability to contain solid stool.

Diagnosis

Several tests are used to determine the cause of fecal incontinence. The first step is a digital rectal exam in which the doctor inserts a gloved finger into the rectum. The doctor feels for abnormal anatomy or impacted stool. Impacted stool is a mass of hard, dry feces that becomes lodged in the bowel. Liquid material can leak out around it.

Nerve damage that could affect rectal reflexes can be identified with the "wink" test, in which the doctor touches the anus to see if it contracts normally. The next test is often a sigmoidoscopy. A doctor inserts a thin, flexible tube (fitted with a light and video camera) into the rectum to look for inflammation, tumors, fissures or other problems. Your doctor may also suggest a barium enema x-ray or colonoscopy to look for problems in the intestine. Sometimes, abdominal X-rays are needed to spot fecal impaction higher up in the intestine. Another diagnostic test, anorectal manometry, measures the sensation and elasticity of the rectum and strength of the anal sphincter muscle.

Expected Duration

Fecal incontinence, when due to a temporary problem such as severe diarrhea or fecal impaction, disappears when that problem is treated. However, in some cases, especially in people who are weak or immobile, fecal incontinence can be so severe that it cannot be controlled.

Prevention

Fecal incontinence sometimes can be prevented by managing your diet. For certain people, avoiding foods that contain sugars such as lactose (from milk), fructose (from fruit) and sorbitol (from berries and other fruits) can prevent diarrhea and lower the risk of fecal incontinence. It can also be prevented in certain cases by avoiding constipation.

Treatment

Treatment for fecal incontinence depends on the cause of the problem. If fecal incontinence is the result of diarrhea, fiber supplements that contain psyllium may help you to have firmer stools, which increase the sensation of rectal fullness. Anti-diarrhea medications such as "Kaopectate," loperamide ("Imodium"), or "Lomotil" are another options for treating diarrhea. If the condition is the result of impaction, the hardened stool can be removed by hand or with enemas. Emptying the rectum completely each morning (sometimes with the aid of a glycerin suppository or an enema) may help, since there will be less stool to remaining, to leak out during the day. Pelvic muscle exercises (Kegel exercises) are sometimes useful.

One effective way to treat chronic fecal incontinence is with biofeedback. People who are able to feel stool in their rectum and contract their sphincter muscles can learn, with the help of a monitor, to coordinate sphincter contractions with the fullness that occurs when stool is in the rectum. Learning the technique requires patience and practice. You need to practice contracting your sphincter at least three times a day. It is also crucial that you contract your anal muscles whenever you feel fullness in the rectum.

When conservative treatments fail, the final option is surgery. Some people benefit from operations to repair the anal sphincter muscle. Another option is to implant electrical stimulation electrodes over the tailbone to help contract the sphincter muscle. . However, these procedures do not have a high success rate. Artificial anal sphincter devices are available, but have substantial complication rates. Finally, if all else fails, surgery to create a colostomy can improve the situation for some patients with severe incontinence.

When To Call A Professional

Because of the embarrassment surrounding fecal incontinence, many people wait longer than necessary before seeking medical help. If the inability to control your bowel movements is an ongoing problem, consult your doctor.

Prognosis

Although some causes of fecal incontinence are harder to treat than others, most people with this problem can overcome it. Between 70% and 80% of people with this problem get at least some relief with treatment.

Additional Info

American Academy of Family Physicians (AAFP) 11400 Tomahawk Creek Parkway Leawood, KS 66211-2672 Phone: (913) 906-6000 Toll-Free: (800) 274-2237 E-Mail: email@familydoctor.orghttp://www.familydoctor.org/

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Last updated:	May 15, 2007