WHAT IS FECAL INCONTINENCE?
Fecal incontinence (also called anal or bowel incontinence) is the impaired ability to control the passage of gas or stool. This is a common problem, but often not discussed due to embarrassment. In fact, it is estimated that as many as 1 out of 12 adults suffer from fecal incontinence Failure to seek treatment can result in social isolation and a negative impact on quality of life.
There are many causes of fecal incontinence such as injury, disease and age.
- Childbirth-related injury: This is the most common cause, resulting from a tear in the anal muscles. The nerves controlling the anal muscles may also be injured, which can lead to incontinence. Some injuries may be detected right after childbirth; however, many go unnoticed until they cause problems later in life. Since it may be years after giving birth, childbirth is often not recognized as the cause of the problem.
- Trauma to anal muscles: Anal operations or traumatic injury to the tissues near the anal region can damage the anal muscles and lessen bowel control.
- Age-related loss of anal muscle strength: Some people gradually lose anal muscle strength as they age. A mild control problem may have existed when they were younger, but this gets worse later in life.
- Neurological diseases: Severe stroke, advanced dementia or spinal cord injury can cause lack of control of the anal muscles, resulting in incontinence.
Symptoms can range from mild to severe. Mild cases may only involve difficulty controlling gas. Severe cases can lead to an inability to control liquid and formed stools. A patient may have a feeling of urgency or experience stool leakage due to frequent liquid stools or diarrhea.
If there is bleeding with lack of bowel control, consult your physician as soon as possible. This may indicate inflammation within the colon and rectum, such as ulcerative colitis, Crohn’s disease, a rectal tumor or rectal prolapse. All of these conditions require prompt evaluation by a physician.
An initial discussion of symptoms with your physician will help determine the degree of incontinence and the effect on your life. Possible underlying factors are often found during a review of your medical history, such as:
- Multiple pregnancies, large weight babies, forceps deliveries or episiotomies (surgical incisions to aid childbirth).
- History of prior anal or rectal surgeries.
- Medical illnesses or conditions.
- Medication side effects.
A physical examination of the anal region should be performed. An exam may easily identify an obvious injury to the anal muscles. Your physician will decide if tests are needed to confirm the diagnosis. An ultrasound probe may be used in the anal area, which provides photographs of potentially injured anal muscles. Other tests may be required to assess the function of muscles and nerves that help control bowel movements.
There are nonsurgical and surgical treatment options that vary based on the cause and severity of the problem. Your surgeon will discuss different treatment methods and help you decide what approach is best for you.
Dietary changes: Mild problems may be treated simply by changing one’s diet.
Constipating medications: Specific medications can result in firmer stools, enabling more bowel control.
Medications: Inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease) can cause diarrhea and contribute to bowel control problems. Treating these underlying diseases may eliminate or improve incontinence symptoms.
Muscle strengthening exercises: Simple home exercises to strengthen the anal muscles can help in mild cases.
Biofeedback: A type of physical therapy to help patients strengthen anal muscles and sense when stool is ready to be evacuated.
There are several surgical options for the treatment of fecal incontinence. Keep in mind that surgery is not the right choice for every patient.
Surgical muscle repair: Injuries to the anal muscles may be surgically repaired.
Stimulation of the nerves (InterStim): The providers of Oxford Urology Associates offer InterStim as a preferred option to treat patients that are suffering from fecal incontinence. InterStim therapy works by gently stimulating the nerves that control your bowels. The stimulation restores function to your bowels by improving the communication between your brain and pelvic floor. This therapy can significantly reduce the number of bowel accidents. Recent studies have shown that 89% of patients have a 50% improvement in their symptoms and 36% of patients are completely continent or cured of their symptoms at the 5 year mark of the therapy.
Bulking agent injections: Injecting a substance into the anal canal can bulk it up and strengthen the “squeeze” mechanism of the anal muscles used during bowel movements.
Surgical colostomy: In severe cases, a colostomy may be the best option for improving quality of life. During this procedure, part of the colon (large intestine) is brought out through the abdominal wall to drain into a bag.