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Fecal Incontinence
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Fecal incontinence

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DIGESTIVE SYSTEM
Diseases & Conditions  

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence can range from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Treatment

Fortunately, effective treatments are available for fecal incontinence. Your primary care physician may be able to assist you, or you may need to see a doctor who specializes in treating conditions that affect the colon, rectum and anus, such as a gastroenterologist, proctologist or colorectal surgeon. Treatment for fecal incontinence is usually able to help restore bowel control or at least substantially reduce the severity of the condition.

Treatment depends on the cause of your incontinence and may include changes to your diet, medication, exercises to help you regain control of your bowels, surgery or a combination of treatments.

Dietary changes
What you eat and drink affects stool consistency. Your doctor may recommend changes to your diet, to help improve your bowel movements.

For example, if chronic constipation is to blame for fecal incontinence, your doctor may recommend that you drink plenty of fluids (about 8 to 10 glasses of water, preferably, daily) and eat fiber-rich foods that aren't constipating. If diarrhea is contributing to the problem, your doctor may recommend that you increase your intake of high-fiber foods to add bulk to your stools, making them less watery. In general, your doctor will recommend a diet that helps you gain good stool consistency for increased control of your bowels.

Medications
Sometimes, doctors recommend medications to treat fecal incontinence, such as:

  • Antidiarrheal drugs. Your doctor may recommend medications to reduce diarrhea and help you avoid accidents. A drug called loperamide (Imodium) may be used because it helps prevent diarrhea.

  • Laxatives. If chronic constipation is to blame for your incontinence, your doctor may recommend the temporary use of mild laxatives, such as milk of magnesia, that help restore normal bowel movements.

  • Stool softeners. To prevent stool impaction, your doctor may recommend a stool-softening medication.

  • Other medications. Drugs used to treat inflammatory bowel diseases are among the other medications that may be used to control fecal incontinence.

Bowel training
If fecal incontinence is due to a lack of anal sphincter control or decreased awareness of the urge to defecate, you may benefit from a bowel retraining program and exercise therapies aimed at helping you restore muscle strength.

In some cases, bowel retraining means learning to go to the toilet at a specific time of day. For example, your doctor may recommend that you make a conscious effort to have a bowel movement after every meal. This helps you gain greater control by establishing with some predictability when you need to use the toilet. This technique can work well for children who have constipation and fecal incontinence because they forget to use the toilet. Children can learn to use the toilet at scheduled times.

In other cases, bowel retraining involves an exercise therapy called biofeedback to help you strengthen and coordinate the muscles involved in holding in stool.

Biofeedback involves inserting a pressure-sensitive probe into your anal canal. This probe registers muscle strength and activity of your anal sphincter as it contracts around the probe. You can practice sphincter contractions and learn to strengthen your own muscles by viewing the scale's readout as a visual aid. A typical program comprises two visits to your doctor's office, for 3 to 4 days. Sometimes, one session is all you need.

Treatment for stool impaction
Your doctor may have to remove an impacted stool if taking laxatives or using enemas don't help you pass the hardened mass. To remove an impacted stool, a doctor inserts one or two fingers into the rectum and breaks the impacted stool into fragments that you can later expel.

Surgical options for fecal incontinence
For some people, treatment of fecal incontinence requires surgery to correct an underlying problem. Surgical options include:

  • Sphincteroplasty. This is surgery to repair a damaged or weakened anal sphincter. It's the most common procedure to repair a damaged sphincter muscle in younger women. It's effective for people who have a single site of anal sphincter injury. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.

  • Operations to treat rectal prolapse, a rectocele or hemorrhoids. Rectal prolapse, a condition in which a portion of your rectum protrudes through your anus, weakens the anal sphincter. In certain circumstances, such as chronic constipation and straining, the ligaments in the rectum can become stretched and lose the ability to hold stool in place. Surgical correction of the rectal prolapse may be needed along with sphincter muscle repair. In women, a protrusion of the rectum through the vagina (rectocele) may need to be treated surgically to correct fecal incontinence. Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence. Hemorrhoids may be near the upper part or beginning of the anal canal (internal hemorrhoids) or at the lower portion or anal opening (external hemorrhoids). Hemorrhoids can be treated by conventional hemorrhoidectomy, a surgical procedure to remove the hemorrhoidal tissue.

  • Sphincter replacement. The Food and Drug Administration has approved an artificial anal sphincter to treat severe fecal incontinence. The small device replaces a damaged anal sphincter. The device is essentially an inflatable cuff, which is implanted around your anal canal. When inflated, the device keeps your anal sphincter shut tight until you're ready to defecate. To go to the bathroom, you use a small external pump to deflate the device and allow stool to be released.

  • Colostomy. As a last resort, a colostomy may be the most definitive way to correct fecal incontinence, particularly in older adults. A colostomy is an operation that diverts stool through an opening in the abdomen instead of through the rectum. A special bag is attached to this opening to collect the stool.

Sacral nerve stimulation
Another treatment for fecal incontinence is sacral nerve stimulation.

The sacral nerves run from your spinal cord to muscles in your pelvis. These nerves regulate the sensation and strength of your rectal and anal sphincter muscles. Direct electrical stimulation of these nerves is a promising treatment option for fecal incontinence caused by nerve damage.

Sacral nerve stimulation is carried out in stages. First, four to six small needles are positioned in the muscles of your lower bowel, and these muscles are stimulated by an external pulse generator. The muscle response to the stimulation generally isn't uncomfortable.

Following a successful response, a temporary stimulation wire is introduced into the stimulation needle and fixed to the skin. The results of stimulation are then recorded over a period of 10 to 21 days. If your incontinence is improved for up to 14 days, you may have a pulse generator permanently implanted.

The permanent pulse generator is implanted in your abdomen. A wire from the small, battery-driven device is connected to the sacral nerves. Through the wire, the device generates electrical impulses that stimulate the nerves, helping you regain continence.

Prognosis
Surgical procedures to treat fecal incontinence aren't necessarily easy or free of complications. But certain causes of fecal incontinence — anal sphincter damage caused by childbirth or rectal prolapse, for example — can often be effectively treated with surgery.

Prevention

Can fecal incontinence be prevented? It depends on the cause of the problem.

Fecal incontinence due to chronic constipation can be improved or eliminated by treating the constipation. Getting more exercise, eating high-fiber foods and drinking plenty of fluids are generally advised to avoid constipation.

If diarrhea is to blame, treating or eliminating the cause of the diarrhea, such as an intestinal infection, may help you avoid accidents.

Straining during bowel movements eventually may weaken anal sphincter muscles and, at times, lead to fecal incontinence, so avoid straining when possible.

Fecal incontinence > 1 > 2 > 3 > 4

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Last Modified : 03/15/08 12:38 AM