What Is It?
When stool is released from the bowel unintentionally, it is known as fecal incontinence. Under normal circumstances, the stool enters the end portion of the colon, called the rectum, and is stored there until it is released intentionally. The rectum distends as it fills with stool. This triggers receptors in the surrounding muscles to tighten the anal sphincter muscle, which prevents feces from leaving the rectum until it is time to have a bowel movement.
Various conditions can cause stool to escape. The rectum may have a diminished capacity to store the stool, the person may be unable to perceive sensation of fullness in the rectum, or anal sphincter may fail to withstand the pressure of the stool in the rectum. A person also must be alert to the need to empty the bowels, and be mobile enough to reach the bathroom in time.
The problem can be caused by several conditions. Muscle or nerve damage usually is involved in chronic cases of fecal incontinence. Women can experience fecal incontinence after childbirth, especially if tissues in the area between the anus and vaginal opening were injured during delivery. Muscle damage also can occur as a result of rectal surgery or from inflammatory bowel disease. Sources of nerve damage that can lead to fecal incontinence include complications from diabetes, spinal-cord injury and multiple sclerosis.
Symptoms of fecal incontinence can range in severity from mild soiling with the passage of gas to the complete inability to contain solid stool.
Several tests are used to determine the cause of fecal incontinence. The first step is a digital rectal exam in which the doctor inserts a gloved finger into the rectum. The doctor feels for anatomical abnormalities or impacted stool. In the latter condition, a mass of hard, dry feces becomes lodged in the bowel and liquid material can leak out around it.
Nerve damage that could affect rectal reflexes can be identified with the “wink” test, in which the doctor touches the anus to see if it contracts normally. The next test is often a sigmoidoscopy. This test involves inserting a thin, lighted tube fitted with a video camera into the rectum to look for inflammation, tumors, fissures or other problems. Your doctor also may suggest a barium enema or colonoscopy to look for problems in the intestine. Sometimes, abdominal X-rays are needed to spot fecal impaction higher up in the intestine. Another diagnostic test, anorectal manometry, measures the sensation and elasticity of the rectum and anal pressures.
Fecal incontinence, when associated with a temporary problem such as severe diarrhea or fecal impaction, disappears when the underlying situation is treated. However, in some cases, especially in people who are weak or immobile, fecal incontinence can be so severe that it cannot be controlled.
Fecal incontinence sometimes can be prevented by managing your diet. For certain people, avoiding foods that contain sugars such as lactose (found in milk), fructose (found in fruit) and sorbitol (found in berries and other fruits) can prevent diarrhea and lower the risk of fecal incontinence.
Treatment for fecal incontinence depends on the underlying cause of the problem. If fecal incontinence is the result of diarrhea, fiber laxatives that contain psyllium may help you have firmer stools and increase the sensation of rectal fullness. If the condition is the result of impaction, the hardened stool can be cleaned out manually and with enemas. Anti-diarrheal medications such as loperamide (Imodium) are another option for treating diarrhea.
One effective way to treat chronic fecal incontinence is with biofeedback. People who are able to feel stool in their rectum and contract their sphincter muscle can learn, with the help of a monitor, to coordinate sphincter contractions with the distention that occurs when stool is in the rectum. Learning the technique requires patience and practice. You need to practice sphincter-contraction exercises at least three times a day. It is also crucial that you contract your anal muscles at any indication of rectal distention.
When more conservative treatments fail, the final option is surgery. Some people benefit from operations to repair the anal sphincter muscle, tighten the anal canal or improve the angle of the anal muscles. It should be noted, however, that these procedures do not have a high success rate.
When To Call A Professional
Because of the embarrassment surrounding fecal incontinence, many people wait longer than necessary before seeking medical help. If inability to control your bowel movements is an ongoing problem, you should consult your doctor promptly.
Although some causes of fecal incontinence are harder to treat than others, most people with this problem can overcome it. Seventy percent to 80 percent of individuals get some relief from treatment.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.