Fecal incontinence: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

The term "fecal incontinence" refers to the inability to control bowel movements. The stool unexpectedly flows out of the rectum. Fecal incontinence can take several forms, from a complete loss of control over one's bowel movements to occasional stools leaking when passing gas. Fecal incontinence is also known as bowel incontinence.

Fecal incontinence is frequently caused by diarrhea, constipation, and injuries to the muscles or nerves. The harm to the nerves or muscles may result from childbirth or aging.

Whatever the reason, discussing fecal incontinence can be difficult. But feel free to speak to your doctor about this recurring problem. Treatments can improve your fecal incontinence as well as your quality of life.

Causes Of Fecal incontinence

Many people experience a variety of factors for their fecal incontinence.

Among the potential reasons are:

• Damage to the muscles: If you have an injury to the rings of muscle near the end of your rectum, it may be difficult to hold in stool. These rings are known as the anal sphincter. This kind of damage could occur during childbirth. Forceps births or episiotomies are the most common causes of this.
• Damage to the nerves: Damage to the nerves that regulate the anal sphincter or that sense feces in the rectum might cause fecal incontinence. These nerves can be harmed by several things, including
  • Childbirth.
  • Prolonged straining during bowel movements.
  • Prolonged constipation.
  • Spinal cord injury.
  • Stroke
  • Multiple sclerosis
  • Diabetes.

• Loose stool: Constant constipation can cause a solid, dry lump of stool to build up in the rectum that is too large to pass. This is known as stool impaction. The muscles of the intestines and the rectum lengthen and eventually weaken. Because of this, watery stools from farther up the digestive tract can get past the feces that are impacted and escape. In addition to harming nerve endings, prolonged constipation can cause fecal incontinence.
• A situation of diarrhea. Since loose stools from diarrhea are more difficult to retain in the rectum, they can either cause or worsen fecal incontinence.
• Bleeding disorders. Hemorrhoids are the swollen veins in the rectum.
• Decrease in the rectum's storage capacity. Usually, the rectum enlarges to make space for stools. If the rectum is rigid or scarred, it may not be able to stretch to its maximum capacity and excess feces may leak out. The conditions that might cause the rectum to stiffen and scar include radiation therapy, surgery, and inflammatory bowel disease
• Surgery- Surgery on the anus and rectum, such as hemorrhoid excision, can cause damage to muscles and nerves, leading to fecal incontinence.
• Prolapse of the rectal wall. Fecal incontinence may arise from this disease, in which the rectum falls into the anus. When prolapse causes the sphincter to stretch, it damages the nerves that control the rectal sphincter. There is less chance that the muscles and nerves will repair.
• Rectocele. Women may experience fecal incontinence if the rectum protrudes through the vagina. This condition is known as rectocele.

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Symptoms Of Fecal incontinence

Fecal incontinence can occasionally be brought on by periodic diarrhea. However, some people experience frequent fecal incontinence. Those who have this medical condition might not be able to control their urge to urinate. It can come on so fast you can't even go to the toilet in time. This is known as urge incontinence.

A distinct type of incontinence related to the bowels affects those who are unaware that they need to pass feces. This is known as passive incontinence.

The following digestive problems could coexist with fecal incontinence:

• Diarrhea.
• Gas and bloating.

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Risk Factors Of Fecal incontinence

There are various factors that may increase your likelihood of developing fecal incontinence, including:

• Age: While fecal incontinence can affect anyone at any age, it is more common in those over 65.
• Sex: Fecal incontinence is one of the postpartum problems. Furthermore, current research indicates that women undergoing menopausal hormone replacement therapy have a slightly higher incidence of fecal incontinence.
• Damage to the nerves: People with multiple sclerosis, long-term diabetes, or spinal damage from surgery or injury can develop fecal incontinence. These conditions may damage the nerves that help regulate feces.
• Dementia: Fecal incontinence is often seen in the later stages of dementia and Alzheimer's disease.
• Physical incapacity: If you have a physical limitation, you can find it difficult to go to the bathroom on time. Damage to the rectal nerve caused by an injury resulting in a physical handicap might cause fecal incontinence.

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Diagnosis Of Fecal incontinence

A physical examination may be performed by your doctor in addition to asking you questions concerning your health. This usually means taking a visual look at your anus. A probe could be used to look for nerve damage in this area. This touching causes the anus to open up and the anal sphincter to contract.

Medical assessments

There are various tests available to help identify the cause of fecal incontinence:

• Digital rectal examination: A healthcare provider inserts a gloved and lubricated finger into the rectum to measure the strength of the sphincter muscles and check for any anomalies in the rectal region. During the examination, your doctor can advise you to stay motionless. Use this to check for rectal prolapse.
• Test for balloon expulsion: Within the rectum is inserted a little balloon filled with water. Then, you'll have to use the bathroom to get the balloon out. If it takes more than one or three minutes, you probably have a defecation disorder.
• Anal manometry: The rectum and anus are made to accommodate a small, flexible tube. The small balloon at the tube's end can be inflated. This test helps to evaluate the rectum's sensitivity and functionality in addition to the tightness of the anal sphincter.
• Anorectal ultrasound imaging: The rectum and anus are penetrated with a device that looks like a thin stick. The video images from the device allow your doctor to inspect the anatomy of your sphincter.
• Proctology: On a specifically built toilet, X-ray video images are created as you defecate. The test quantifies the capacity of the rectum to contain stool. It also assesses how effectively your body eliminates feces.
• Colonoscopy: To examine the entire colon, a flexible tube is put into the rectum.
• MRI stands for magnetic resonance imaging: If the muscles are still intact, an MRI can provide you with a clear image of the sphincter. It can also display graphics when a person is defecating. We refer to this as defecography.

Treatment Of Fecal incontinence

Medication prescribed for treatment

The following options vary based on the etiology of fecal incontinence:

• Medications that prevent diarrhea, such as atropine and diphenoxylate-containing medications (Lomotil) and loperamide (Imodium A-D).
• Bulk laxatives, such as psyllium (Metamucil) and methylcellulose (Citrucel), if your incontinence is being caused by prolonged constipation.
• Physical activity and additional treatments
• Your doctor may advise an exercise regimen and other therapies to rebuild muscular strength if fecal incontinence is the result of muscle injury. The awareness of the urge to urinate and the control of the anal sphincter can both be enhanced by these treatments. Choices consist of:

Kegel exercises

Kegel exercises improve the muscles of the pelvic floor. These muscles assist the intestines, bladder, and uterus in women. Increasing the strength of these muscles might lessen incontinence. Kegel exercises involve contracting the muscles used to stop the flow of urine.

Hold the contraction for three seconds, then let go. Repeat this sequence ten times. As your muscles strengthen, increase the force you apply to the contraction. Gradually increase to three sets of ten contractions every day.

Physical Training

Physical therapists with specialist training can teach basic exercises that strengthen the anal muscles. These pursuits could be advantageous:

• Develop the muscles of your pelvic floor.
• When the stool is ready to be expelled, sense it.
• Constrict the muscles if you find that a particular time is uncomfortable for you to have a bowel movement.
• Anal manometry and a rectal balloon may be employed during the training procedure.
• Bowel training: You may be advised by your doctor to try to timing your bowel movements to occur at a specific time of day, such as just after you eat. By knowing when to use the loo. agents in quantity, you can increase your control. Nonabsorbable bulking agents can be injected into the anus to thicken its walls. Leaks are less likely as a result.
• A sacral nerve stimulation: The sacral nerves connect your spinal cord to the muscles in your pelvis. The sensitivity and strength of your anal and rectal sphincter muscles are regulated by them. By implanting a device that stimulates the nerves with tiny electrical impulses, the muscles of the gut can be strengthened.
• Stimulation of the tibial posterior nerve: This minimally invasive treatment stimulates the posterior tibial nerve near the ankle. In a large study, however, this treatment did not provide a statistically significant improvement over a placebo.
• Inflatable vaginal (Eclipse System): This implanted vaginally looks like a pump. Because the inflated balloon puts pressure on the rectal region, there is a decrease in the frequency of episodes of fecal incontinence.
• Radiofrequency treatment: Radiofrequency energy is delivered to the anal canal wall to help increase muscular tone. Sometimes, this is referred to as the Secca procedure. Due to its less intrusive nature, radiofrequency therapy is frequently administered under local anesthesia and while the patient is sedated. However, insurance does not typically pay for this kind of care.

Surgery

Treatment for fecal incontinence may need surgery to address an underlying problem, such as rectal prolapse or sphincter damage during delivery. Among the options are:

• Sphincteroplasty: The anal sphincter may weaken or sustain damage after childbirth; this procedure restores it. Doctors identify a damaged muscle area and divide the surrounding tissue from the injured area. After that, they put the muscle edges back together and sew them together in an overlapping pattern. The muscle gains strength and the sphincter becomes tighter as a result. An alternative to colostomy surgery is sphincteroplasty for those who wish to forego the procedure.
• Treating a rectocele, rectal prolapse, or hemorrhoids. Following surgical resolution of these problems, fecal incontinence will likely be reduced or completely eradicated. The longer the prolapse is untreated, the more likely it is that postoperative fecal incontinence will continue.
• Colostomy, commonly known as "bowel diversion" following this operation, stool is redirected through an abdominal incision. Medical practitioners attach a special bag to this opening in order to collect the stool. A colostomy is frequently considered a final option if all other forms of treatment have failed.

Prevention Of Fecal incontinence

The underlying cause of fecal incontinence may be addressed to avoid or ameliorate the condition. These actions might be advantageous:

• Decrease the bowel movement: Get more exercise, eat more foods high in fiber, and drink plenty of water.
• Take care of diarrhea: By treating the underlying cause of your diarrhea, such as an intestinal infection, you may be able to avoid developing fecal incontinence.
• Stay away from straining: Restricting oneself while bowel movements can potentially damage nerves or weaken the muscles that control the anal sphincter.

Complications Of Fecal incontinence

Complications from fecal incontinence can include:

• Suffering on an emotional level: Losing control over one's body might lead to discomfort when in public. Those who suffer from incontinence may try to hide the problem or avoid social situations.
• Inflammation of the skin: The skin around the anus is thin and sensitive. Frequent contact with the stools can be uncomfortable and itchy. It can also lead to ulcers, or sores as they are most widely called. Ulcers frequently require medical attention.

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