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Fecal incontinence - bowel incontinence
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Fecal incontinence - bowel incontinence

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DIGESTIVE SYSTEM
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Causes

Your body's digestive tract begins at your mouth and nears its end at your rectum, the lower portion of the large intestine. Your digestive tract contains a complex system of organs that convey the food you eat, convert it into energy and remove waste that your body can't digest.

As food waste passes through the upper portion of your large intestine (colon), your body absorbs nearly all of the water from the waste. The remaining residue, called stool, is usually soft but formed and comprises undigested foods, unabsorbed water, bacteria, mucus and dead cells.

Sphincter muscles, external and internal, in your anus — a short canal that's the outlet for your rectum — serve as the final valve. As your rectal walls stretch, they signal the need to release stool. As your sphincter muscles relax, your rectal walls contract to increase pressure. Sometimes, you have to exert pressure from your abdominal muscles, which put pressure on the outside of your colon and rectum. With this coordination of muscles and also nerves, stool is expelled through the anus.

Your digestive tract contains a complex system of organs that convey the food you eat, convert it into energy and remove waste that your body can't digest. Sphincter muscles, external and internal, ...

Critical to normal bowel function are:

  • Anal sphincter muscles. External and internal anal muscles contract to prevent stool from leaving your rectum.

  • Rectal sensation. This feeling warns you to go to the bathroom.

  • Rectal accommodation. Rectal stretching allows you to hold stool for some time until you can get to a toilet.

The ability to hold stool requires the normal function of your rectum, anus and nervous system. In addition, you have to have the physical and psychological capabilities to recognize and appropriately respond to the urge to defecate. If something is wrong with any of these factors, fecal incontinence can occur.

A broad range of conditions and disorders can cause fecal incontinence, including:

  • Constipation. The most common cause of bowel incontinence, ironically, is constipation. Chronic constipation may lead to impacted stool — a large mass of dry, hard stool within your rectum. The mass may be too large for you to pass. The impacted stool causes the muscles of your anus to stretch and weaken. Watery stool from higher in the bowel may move around the mass and leak out, causing fecal incontinence. Chronic constipation not only may cause the muscles of your anus to stretch and weaken but also may make the nerves of the anus and rectum less responsive to the presence of stool in the rectum.

  • Diarrhea. Because loose stool is more difficult to control than more solid stool, diarrhea can cause or worsen fecal incontinence.

  • Muscle damage. Often, the cause of fecal incontinence is injury to the anal sphincters — the rings of muscle at the end of the rectum that help you hold in stool. When damaged, the muscles aren't strong enough to do their job, and stool can leak out. In women, the damage often happens when giving birth. The risk of injury is greatest if you tear a muscle in your anus during vaginal delivery. Some women develop fecal incontinence within weeks of giving birth. For others, incontinence due to childbirth doesn't show up until the mid-40s or later.

  • Nerve damage. Fecal incontinence can also be caused by damage to the nerves that control the anal sphincter or that sense stool in the rectum. If the nerves that control anal sphincter muscles are injured, the muscle doesn't work properly, and incontinence can occur. If the sensory nerves are damaged, they don't sense that stool is in the rectum. You then won't feel the need to defecate until stool has leaked out. Causes of nerve damage can be childbirth, a long-term habit of straining to pass stool, stroke, injury to the spinal cord and diseases that affect these nerves, such as diabetes and multiple sclerosis.

  • Loss of storage capacity (accommodation) in the rectum. Normally, the rectum stretches to hold stool until you can get to a toilet. But surgery to your rectum, radiation treatment and inflammatory bowel disease can scar and stiffen the walls of the rectum. The rectum then can't stretch as much and can't hold stool, and fecal incontinence results.

  • Surgery. Surgery to treat hemorrhoids — enlarged veins in the rectum or anus — also can cause damage to the anus and fecal incontinence, as can more complex operations involving your rectum and anus.

  • Infection. Anal and rectal infections — as well as bowel diseases, such as Crohn's disease — can lead to incontinence by damaging the muscles that help you control defecation.

  • Other conditions. A dropping down of the rectum into the anus (rectal prolapse) or, in women, a protrusion of the rectum through the vagina (rectocele) can be a cause of fecal incontinence. Hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence.

  • Loss of muscle strength with age. Over time, muscles and ligaments that support your pelvis, as well as your anal sphincter muscles, can weaken, leading to incontinence.

  • Stress. Sudden, extreme stress or emotional disturbance can cause fecal incontinence.

Fecal incontinence in children

Fecal incontinence can occur at any age — even in children. Newly toilet-trained children simply may not make it to the toilet in time to defecate, soiling their pants. But the most common medical cause of fecal incontinence in the young is constipation, although the problem — known medically as encopresis — can also be due to an underlying condition, including mental retardation or other birth defects.

Constipation and impacted stools aren't uncommon in children. Toilet-trained children often get constipated simply because they refuse to go to the toilet — they're too busy playing, or they're too embarrassed to use a public toilet. The child holds in the stool, the stool hardens, and then the fear of passing the hardened stool keeps him or her from trying to pass it.

A child who is constipated may soil his or her underpants — and try to hide it from others. Soiling happens when liquid stool from farther up in the bowel seeps past the hard stool in the rectum and leaks out.

Risk factors

Fecal incontinence can occur at any age. But it's most common among people older than 65, who sometimes have to cope with a lack of bladder control (urinary incontinence) as well.

Fecal incontinence is more common in women than in men because the condition can be a complication of childbirth. Urinary incontinence also can be a complication of giving birth.

People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence. Fecal incontinence is also often an aspect of late-stage Alzheimer's disease, in which both dementia and nerve damage play a role. In addition, being physically disabled for any number of reasons makes it difficult to reach a toilet in time.

 

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