What Is Fecal Incontinence?
Fecal incontinence is a condition where one lacks the ability to control bowel movements. In some cases, even the sensation associated with the need to move one’s bowels is not felt. In these cases, stool or mucus may be impossible to hold back and can oftentimes result in mortifying accidents.
Normally, strong healthy muscles and nerves in the anus and rectum cooperate with each other, working together to keep stool in the rectum where it belongs until it’s time to have a bowel movement.
This works much the same way as a garden hose with a fitting attached to a spray nozzle. When the tap is turned on, the water remains contained in the hose until the trigger of the nozzle is squeezed, releasing water spray. If the nozzle or fitting is faulty, depending on the extent of the damage, water will either dribble out slowly or gush uncontrollably. Fecal incontinence is similar. There is either some uncontrolled leakage or full incontinence.
Fecal incontinence can be occasional or chronic. Most of us suffer from gastric issues from time to time and can experience some loss of bowel control. But sometimes, what we presume will be simple flatulence may result in an unwelcome surprise of anal leakage.
Urge bowel incontinence is the need to defecate without warning. Those who have it know they need to get to a toilet, but usually cannot get there in time. Passive incontinence is being completely unaware of the need to defecate. The sensation is simply not there, and stool is passed with no warning.
Because of humiliating factors such as sound, odor and visible staining associated with this condition, it can often draw unwanted attention. In time, psychological issues like humiliation, depression, shame and even self-disgust may arise, causing those afflicted to withdraw and isolate themselves from society.
Who is Affected?
Fecal incontinence affects one in 12 adults in the United States alone. There is no age limit, however it affects older adults more often, and slightly more women than men. To put this ratio into perspective, at least one person at every family reunion or five people at any moderate church gathering may be suffering from fecal incontinence. It’s not uncommon.
What Causes Fecal Incontinence?
• Inactivity: Bed or wheelchair bound individuals, the elderly who lead a less vigorous lifestyle and those who spend most of their day in a sitting or prone position are more susceptible. A sedate lifestyle is more likely to cause stool retention in the rectum. Softer or more liquid fecal matter can leak past the harder stool causing fecal incontinence.
• Constipation: Hard, thick stool can develop with constipation, stretching the rectum and relaxing sphincter muscles. More watery fecal matter forms behind this stool and may leak out. Subsequent straining to relieve constipation may weaken pelvic floor muscles.
• Diarrhea: We’ve all had it at one time or another and know how hard it is to get to a bathroom in time. Accidents often result because watery fecal matter is harder to hold in than firmer stool and fills the rectum faster.
• Loss of rectal elasticity: The rectum stretches to allow room for fecal waste, however scarring, sores and irritation caused by such things as radiation, inflammatory bowel disease and rectal surgery may cause the rectum to stiffen and no longer expand.
• Childbirth via vaginal delivery: Giving birth vaginally, especially if forceps are used, can cause damage to nerves and muscles in the pelvic floor. So can surgically cutting (episiotomy) in an effort to minimize vaginal tearing during birth. Fecal incontinence may occur years later or immediately after giving birth.
• Hemorrhoids: Hemorrhoids that develop around the anus may prevent sphincter muscles from closing completely. Since this muscle keeps feces in the rectum, any small portal can allow leakage to escape.
• Rectal prolapse: Sometimes the rectum can descend through the anus, causing the sphincter to not do its job properly.
• Rectocele: The rectum and vagina are separated by a thin layer of muscle. If that layer weakens, the rectum may jut down into the vagina forming bulges. In more severe cases, it can visibly hang outside the vagina, resulting in possible retention of stool in the rectum. It is speculated, though not certain, that this may cause fecal incontinence.
• Diet: Certain drinks such as dairy products or caffeine beverages may have a laxative effect, aggravating fecal incontinence symptoms, as can spicy, greasy foods.
• Overuse of laxatives: Sometimes mother nature may need a little medicinal nudge, but chronic use of laxatives poses a higher risk for developing fecal incontinence.
• Muscle weakness or damage: Circular muscles called sphincters located in the rectum contract tightly to prevent feces from passing through the anus (similar to the concept of aperture on a camera). These muscles can be damaged or weaken with age, losing strength and tautness.
• Nerve damage: Impairment of the nerves in the sphincter muscles, and those that sense the need to pass stool can also result in leakage.
Damage to both the sphincters and nerves can be caused by childbirth, cancer or hemorrhoid surgery. Additionally, nerves may be damaged due to stroke, constant forcing of stool, head trauma, injury to the spinal cord and diseases that affect nerve function such as multiple sclerosis and diabetes.
How is Fecal Incontinence Diagnosed?
After questions are asked, symptoms charted and a physical examination is completed, your doctor may order a series of tests to correctly diagnose fecal incontinence. These tests may include:
• Anal Ultrasound: This test specifically pinpoints the anus and rectum. Sound waves form an image of the sphincter muscles.
• Anal Manometry: An inflated balloon and pressure sensors check rectal sensitivity and function, along with sphincter muscle tightness.
• Magnetic Resonance Imaging (MRI): Magnets and radio waves produce images of soft internal issues and organs.
• Anal Electromyography (Anal EMG): This checks the health and electrical activity of the pelvic floor nerves and muscles, translating those into images and sounds.
• Defecography: An x-ray of the area surrounding the anus and rectum indicates the patient’s ability to hold and void stool. It also shows any structural damage in the rectum, pelvic floor and anus.
• Flexible Sigmoidoscopy or Colonoscopy: Similar to a regular colonoscopy, this test concentrates only on the lower colon and rectum to check for fecal incontinence. In some cases, if necessary, a small piece of tissue is harvested for a biopsy.
• Diet: About 20 to 25 grams of fiber, along with plenty of water should slowly be introduced into the diet to counteract diarrhea and constipation. It’s always best to get fiber from natural sources, but there are plenty of flavored and unflavored fiber supplements on the market. We’ve come a long way from the phlegmy, thick, pasty drinks. Keeping a diary of foods that can aggravate incontinence is always a good idea too.
• Bowel Training: It can take a few weeks to several months, but training your body to obey you by having bowel movements at certain times of the day can help minimize fecal incontinence.
• Medication: If chronic diarrhea is a problem, bulk laxatives can help for more controllable and solid bowel movements. Antidiarrheal medications may also be prescribed.
• Pelvic floor exercise and biofeedback: Exercises targeted to strengthen the muscles on the pelvic floor by squeezing and relaxing can help with bowel function and control. Biofeedback, using sensors can make sure the correct muscles are pinpointed.
Surgery is usually reserved as a final option, but when all other forms of treatment prove ineffective, it may be necessary. If so, you’ll receive a detailed description of all you need to know about the procedure and any possible risks associated with it.
You don’t have to suffer with fecal incontinence. It can almost always be corrected with non-invasive methods. Sometimes, a more aggressive approach may be needed, but in almost all cases, the problem CAN be fixed.
Our doctors are here to help. Call today to schedule an appointment so you can get your life back on track.