Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Fecal incontinence can be defined as the unintentional loss of stool (feces)
or gas (flatus). It is often due to a failure of one or more of the components
that allow the body to control the evacuation of feces, when it is socially
A normal bowel movement requires a complex interaction and feedback system
between the nerves and muscles of the rectum and anus. The anatomy of this area
is complicated. The rectum is a reservoir for holding stool. Two sphincters or
circular muscles separate the rectum from the anus and control when the anus
should allow a bowel movement. The internal anal sphincter (IAS) is under
involuntary control of the body's nervous system, while the external anal
sphincter (EAS) can be actively controlled by the indivdiual. In addition, the puborectalis muscle tugs at the junction of the rectum and anus, creating a 90
degree angle, which makes it harder for stool to move involuntarily into the
When the rectum is full and for a normal bowel movement to occur, the IAS
relaxes just a little. Cells in the anus can detect feces or flatus and if the
brain says that it is an opportune social time to pass gas or have a bowel
movement, the puborectalis muscle relaxes, straightening the path from the
rectum to the anus. Squatting or sitting helps increase the pressure within the
abdomen, and muscles that surround the rectum squeeze its contents, the EAS
relaxes and a bowel movement occurs.
If it is not an appropriate time to open the bowel, the puborectalis muscle
contracts, the EAS contracts, the rectum relaxes and stool is forced back into
the upper part of the rectum, causing the urge to have a bowel movement to be
Fecal incontinence occurs because of an underlying disease or illness (it is
not considered a "disease"). There are numerous potential causes and many
patients have more than one reason to cause loss of bowel control.
Damage to muscles and nerves may occur directly at the time of
childbirth or after anal or rectal surgery.
Paradoxical diarrhea or overflow incontinence may occur is a a person who has
constipation. In paradoxical diarrhea, stool fills the rectum, hardens and becomes impacted.
Liquid stool leaks around the fecal mass, imitating incontinence.
While the patient's history and physical examination are the initial steps of making a medical diagnosis, the ability to peer inside the body can be a powerful tool. Ultrasound is an imaging technique that provides that"...