Fecal Incontinence

  The concept of fecal incontinence, most published in the literature, since there is no accepted consensus on the matter until now, is “the continuous uncontrollable or recurrent passage of stools (> 10mL) of solid, liquid and gas consistency for periods of at least one month, in patients older than 4 years ” (1)

 From the clinical point of view there are three subtypes of fecal incontinence: Passive incontinence which refers to the involuntary passage of stools or gas without realizing it; urge incontinence, it is the passage of secondary fecal material to an active effort in trying to retain the stools; and finally anal soiling, which is the loss of small amounts of bowel movements without realizing it, followed later by an evacuation of normal consistency. (2)

  The lack of control in the exclusive elimination of gases is not considered within the definition of fecal incontinence, however, this condition also requires proper management and treatment.

  Physiological continence depends on several factors and processes, including mental function, indemnity of the anatomical and functional sphincter apparatus, stool consistency and volume, type and speed of intestinal transit, rectal compliance, anal sphincter function, anorectal sensation and anorectal reflexes. (3)

  Fecal incontinence occurs when the anatomical and / or functional factors that maintain the normal physiology of defecation are altered. Incontinence is often the result of varied pathogenic factors and very rarely can be attributed to a single factor. Loss of continence may result from the combination of anal sphincter dysfunction, alteration of rectal compliance, and / or decreased rectal sensation. (1, 3)

  The treatment of fecal incontinence should include and begin with education and changes in habits necessary to reduce the possibility of involuntary bowel losses. Therefore, the treatment should be developed based on the patient’s need and expectations, health status and usual activities. It is important to keep in mind that the main objective of treatment is to improve the quality of life of each patient. In an initial phase, for all patients is the implementation of an adequate diet, modify eating habits, and regulation of intestinal transit. Conduct the evaluation of the need and dosage of those medications that may affect the presence or worsening of fecal incontinence. Making use of soluble fiber dietary supplements that generate a more consistent fecal bolus can help in patients with mild diarrhea and / or in patients with difficulty in emptying and post-defecatory soiling. In the case of incontinence associated with diarrhea, treatment of this is the best management option. Other considerations are important to consult gastroenterologist treating. (4)

 

Why does Fecal Incontinence Occur?

 

  Bowel movements are controlled by a serious of coordinated neural networks found in and around our digestive system. This smorgasbord of neuronal activity is ultimately controlled by the spinal cord. If there is an injury at the spinal level, this may cause the neuronal activity from becoming discombobulated and uncoordinated, leading to irregular and/or uncontrollable peristalsis as well as a loss of ability to control the anal sphincter. External and internal mechanical sphincter damage can also lead to fecal incontinence.

  The amount of conditions and diseases that can lead to fecal incontinence is overwhelming, but listed below are the most common:

  • Neurological Disorders
  • Diarrhea
  • IBS (irritable bowel syndrome)
  • Rectocele
  • Extremely scary or stressful experiences can lead to loss of control of bodily functions.
  • Diabetic Neuropathy
  • Child bearing
  • Constipation
  • Dry stools that become lodged in the intestine, causing blockage.
  • Injuries to the pelvic floor muscles and/or nerves

 

How is Fecal Incontinence Diagnosed and Treated?

 

  Diagnosis of Fecal incontinence can be done through various different tests:

  1. Anal Ultrasound
  2. Balloon Expulsion Test
  3. Colonoscopy
  4. Sigmoidoscopy
  5. Barium Enema
  6. Anal electromyography
  7. Anorectal manometry

  Proper dieting guidelines play an important role in the treatment of Fecal Incontinence. Physicians will usually recommend a diet high in fiber or fiber supplements. Besides dieting, others options to include in a treatment regimen include Kegel exercises, surgery, biofeedback, sacral nerve stimulation and enemas.

 

References:

(1) Whitehead, W.; Wald, A.; Norton, N. (2001). Treatment options for fecal incontinence. Dis Colon Rectum. 44:131-42.

(2) Rao, S. (2004). Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 99:1585-604.

(3) Wald, A (2007). Clinical Practice. Fecal incontinence in adults. N Engl J Med. 356:1648-55.   

(4) Scarlett, Y. (2004). Medical management of fecal incontinence. Gastroenterology. 126:S55-63.

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