Fecal Incontinence

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What is fecal incontinence?

Fecal incontinence is the loss of normal control of the bowels. This leads to stool leaking from the rectum (the last part of the large intestine) at unexpected times.  It is more common in women and in the elderly of both sexes.

Many people with fecal incontinence are ashamed to talk about this problem with their doctor. They think that nothing can help them. However, many effective treatments for fecal incontinence are available.

What causes fecal incontinence?

Bowel function is controlled by 3 things:

  • anal sphincter pressure,

  • rectal storage capacity and

  • rectal sensation.

The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence.

The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there. This is the rectal storage capacity.

Rectal sensation tells a person that stool is in the rectum. Then the person knows that it is time to go to the bathroom.

A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth.

It's especially likely to happen in a difficult delivery that uses forceps and/or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina for delivery of a baby.

Young women can often compensate for muscle weakness. Typically, they only develop incontinence in later life when their muscles are growing weaker and the supporting structures in the pelvis are becoming loose.

Muscle damage can also occur during rectal surgery (especially surgery for hemorrhoids). It may also occur in people with inflammatory bowel disease or an abscess in the perirectal area.

Damage to the nerves that control the anal muscle or that are responsible for rectal sensation is also a common cause of fecal incontinence.

Nerve injury can occur in the following situations:

  • During childbirth.

  • With severe and prolonged straining for stool.

  • With diseases such as diabetes, spinal cord tumors and multiple sclerosis.

  • Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because loose stool (diarrhea) is more difficult to control than formed stool, diarrhea is an added stress that can lead to fecal incontinence.

A change in stool consistency to a looser form often causes the problem of incontinence to show up.

If I have fecal incontinence, what can be done?

It is important that you have a careful medical evaluation. Attempts at self-treatment are usually unsuccessful.

Anorectal manometry, which tests anal pressures, rectal elasticity and rectal sensation, as well as other tests, can pinpoint the cause of your incontinence.

The treatment of fecal incontinence varies and depends on the cause of your problem.

Preventing diarrhea and forming a regular bowel movement pattern are usually very helpful.

For sphincter weakness or injury, anorectal biofeedback strengthens the muscle. This improves continence in most persons. Biofeedback training can even end the problem of fecal incontinence.

The above opinionated views and information serves to educated and informed consumer .  The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation.  A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions 

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