Fecal Incontinence: Causes, Symptoms, Diagnosis, Treatments and Prevention
Fecal incontinence (a.k.a: Bowel incontinence) is the inability to control bowel movements that causes leakage of feces. Fecal incontinence is commonly observed in older people; with higher incidence in women.
Individuals with fecal incontinence may have fecal leakage before they reach the toilet. This causes severe embarrassment and has a huge impact on the quality of life.
Diarrhea, constipation, nerve damage or bowel muscle inactivity are the common causes of fecal incontinence.
- What is Fecal Incontinence?
- Types of Fecal Incontinence:
- What Causes Fecal Incontinence?
- What are the Symptoms of Fecal Incontinence?
- What are the Risk factors of Fecal Incontinence?
- What are the Complications of Fecal Incontinence?
- How is Fecal Incontinence Diagnosed?
- How is Fecal Incontinence Treated?
- How is Fecal Incontinence Managed?
What is Fecal Incontinence?
Fecal incontinence is a serious medical condition that needs prompt treatment. In this condition, an individual has uncontrolled discharge of feces from the rectum that causes severe discomfort and embarrassment.
Fecal discharge is regulated by the anal sphincter – a muscle that opens to allow discharge of feces. Fecal incontinence occurs due to nerve damage or loss of muscle activity of the anal sphincter.
Types of Fecal Incontinence:
There are two types of fecal incontinence, namely:
- Urge incontinence: It is the inability to resist bowel movements. Individuals suffering with severe diarrhea find it difficult to control bowel movements until they reach the bathroom.
- Passive incontinence: This occurs when the individual isn’t aware of the need to visit the toilet. Passive incontinence occurs due to the nerve damage in the rectum
What Causes Fecal Incontinence?
Normal bowel movements are regulated by coordinated function of the pelvic muscles, movements in the colon and rectum, anal sphincter and the nervous system. Injury or damage to any of the above systems can cause of fecal incontinence.
While, women generally experience fecal incontinence due to accidental bowel leakage during childbirth.
The causes of fecal incontinence are:
- Nerve damage: An injury or damage of the nerves regulating bowel movements is a major cause of anal sphincter damage. This damage may occur during child birth, stroke, frequent constipation, multiple sclerosis or diabetes.
- Muscle damage: Damage to the muscles of the anal sphincter prevents the complete closure of the anal sphincter. This may occur due to haemorrhoids, severe constipation, surgery, or trauma.
- Diarrhea: Sometimes, the excess urge of bowel movements in diarrhea makes it difficult to reach the bathroom.
- Fecal impaction: In individuals with chronic constipation, the hardened stool may get stuck in the colon or the rectum. The hardened stool stretches the walls of the rectum and damage the anal sphincter.
- Reduced storage capacity of the rectum: The inability of the rectum to hold stools results from reduced storage capacity in the rectum. This may occur due to surgery, radiation therapy or gastrointestinal disorders such as inflammatory bowel disease.
- Surgery: A surgery to treat hemorrhoids (enlarged blood vessels in the rectum or anus) or other bowel disorders may result in muscle and nerve damage in the bowel.
- Rectal prolapse: The condition occurs when part of the rectum slips outside the anus.
- Rectocele: The condition is observed in women due to weakening of the walls between the vagina and the rectum. This results in protruding of the rectum outside the vagina.
What are the Symptoms of Fecal Incontinence?
Fecal incontinence is characterized by leakage of stools. The other symptoms that may accompany leakage of feces may include:
- Severe constipation
- Abdominal discomfort
What are the Risk factors of Fecal Incontinence?
The factors that increase the risk of developing fecal incontinence include:
- Age: Although prevalent among all age group, middle-aged and older people are at a greater risk of developing the condition.
- Gender: Women are at a greater risk of developing fecal incontinence. This may be due to increased risk of complications during childbirth. Women with fecal incontinence have symptoms at the age of 40. However, the exact cause of fecal incontinence in women isn’t clear.
- Physical disability: Individuals suffering from physical disability may find it difficult to reach the toilet during bowel urgency. This may be a cause of fecal leakage.
- Nerve damage: Long-term disorders such as diabetes or multiple sclerosis may cause damage to the nerves controlling bowel movements. A damage to the nerves controlling bowel movements results in fecal discharge.
- Neurological disorders: Individuals suffering from stage-IV Alzheimer’s disease and dementia usually experience fecal incontinence.
What are the Complications of Fecal Incontinence?
The complications associated with fecal incontinence include:
- Emotional distress: The inability to control bowel movements leading to fecal discharge cause embarrassment and loss of dignity. Generally, individuals find it challenging to involve in social engagements.
- Skin irritation: The skin surrounding the anus and the buttocks are usually delicate and sensitive. The continuous discharge of the feces causes pain and itching and sores over the skin. This requires immediate medical care.
How is Fecal Incontinence Diagnosed?
The test to diagnose fecal incontinence include:
- Stool testing: In case of diarrhea, culture test of the stools are performed to check for any infection.
- Anorectal manometry: The test is performed by inserting a flexible long tube fixed with a small balloon into the anus and rectum. The balloon is then inflated check the tightness and flexibility of the anal sphincter.
- Anorectal ultrasonography: A narrow instrument is inserted into the anus to produce images that helps in monitoring the structure of the rectum and anus.
- Nerve test: The test helps detect nerve damage that may have caused bowel incontinence. The test measures the responsiveness of nerve activity to bowel movement.
- Electromyography: The test is performed to check the muscle activity of the rectum and the anus.
How is Fecal Incontinence Treated?
Anti-diarrheal and laxative drugs are used to treat diarrhea and constipation respectively. Medications are also used to treat certain underlying factors causing fecal incontinence
- Sphincteroplasty: The surgery is performed to treat the weakened sphincter. The anal sphincter is stitched together in an overlapping fashion. This tightens and strengthens the sphincter. This procedure is commonly performed in children who suffer from fecal incontinence since childbirth.
- Sacral nerve stimulator: This procedure is performed in individuals suffering from nerve damage. Implant devices are used to stimulate the nerves of the anal sphincter and the rectum.
- Colostomy: The surgery is performed to divert the bowel contents into a special bag through an opening. The bowel contents bypasses the rectum into a pouch. The surgery is performed when the individual does not respond to other treatment methods.
- Sphincter repair: The surgery is performed by replacing the damaged sphincter with a muscle flap of the inner thigh and restoring the normal function of the sphincter.
How is Fecal Incontinence Managed?
Fecal incontinence can be effectively managed by following certain lifestyle changes such as:
- Pelvic floor strengthening exercises: The doctor recommends certain exercises that helps strengthen the pelvic floor vessels. The exercises also help to support bladder and bowel, thus lowering the risk of incontinence.
- Dietary changes: Taking a diet rich in fiber helps regulate bowel movements and prevents constipation. It is also recommended to drink plenty of water and avoid caffeinated products during the course of treatment.
- Skin care: Keeping the skin clean and dry around the anus helps relieve a feeling of discomfort and irritation. Wash the skin with water and dry thoroughly. Apply the prescribed cream or medicated powder to ease pain and discomfort.