- Patient Comments: Bowel Incontinence - Cause
- Patient Comments: Bowel Incontinence - Symptoms
- Patient Comments: Bowel Incontinence - Treatment
Bowel incontinence (fecal incontinence) definition
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 appropriate.
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 anus.
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 temporarily quieted.
What causes bowel incontinence?
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 vaginal childbirth or after anal or rectal surgery.
- Neurologic diseases such as stroke, multiple sclerosis, spinal cord injury, and spina bifida can be potential causes of fecal incontinence.
- Complications of diabetes can also cause peripheral nerve damage leading to incontinence.
- Patients with inflammatory bowel disease (Crohn's disease, ulcerative colitis) and irritable bowel disease may develop fecal incontinence.
- Stool seepage is different than fecal incontinence.
- Minor staining can occur in people who have hemorrhoids, rectal fistula, rectal prolapse and poor hygiene.
- Other causes include chronic diarrhea, parasite infections, and laxative abuse.
- Paradoxical diarrhea or overflow incontinence may occur is a a person who has chronic constipation. In paradoxical diarrhea, stool fills the rectum, hardens and becomes impacted. Liquid stool leaks around the fecal mass, imitating incontinence.
What are the symptoms of bowel incontinence?
Bowel incontinence refers to the inability to control the passage of small amount of stool, liquid or solid, or control flatus.
People are sometimes reluctant to discuss their lack of bowel control because of the social stigma attached to it. Their initial complaint might be
How is bowel incontinence diagnosed?
Taking a history is very important and the health care professional will spend time learning about how often loss of bowel control occurs, in what situations and whether it is solid, liquid, or gas. Past medical and surgical history is important, especially obstetric history or surgery of the anus, including hemorrhoids. It could be several years before the complication of a surgery or childbirth lead to fecal incontinence. Dietary habits and medications (including over-the-counter medications and laxative) will also be considered and evaluated.
Physical examination will likely include a rectal examination to assess sphincter tone. In females, a pelvic exam will also be performed.
While blood tests are not usually needed to make the diagnosis, other tests may be helpful in deciding the potential cause of fecal incontinence. Anal manometry measures the pressure within the rectum, both at rest and when the patient squeezes the anal sphincter. Nerve and muscle conduction studies may be considered. Ultrasound can evaluate the anal sphincters and look for muscle damage.
Latest Digestion News
Daily Health News
What is the treatment for bowel incontinence?
The treatment approach for a patient with fecal incontinence is individualized based upon the underlying cause. The purpose is to regulate bowel movements, decrease their frequency, and increase stool firmness and consistency. Nonsurgical and surgincal treatments are often recommended for bowel incontinence, these include:
- Medications such as Imodium, Lomotil, or Hyoscyamine should help make liquid stool more solid and easier to control.
- Increasing the strength of the muscles of the pelvic floor might be helpful. Kegel exercises and electrical stimulation may be recommended.
- Biofeedback is often used to help retrain the anal sphincters and have the patient appreciate the sensation of rectal fullness that comes just before the need to defecate.
- If the incontinence persists even after maximum medical therapy has been attempted, surgery may be an alternative.
- If damaged, attempts can be made to repair the muscles of the pelvic floor including the external anal sphincter.
- The internal anal sphincter function may be enhanced by injecting materials like silicone, carbon beads, or collagen.
- As a last resort, where all other options have failed, a colostomy may be performed, where the colon is diverted through the abdominal wall to empty into a removable bag.
What about bowel incontinence in children?
In children, fecal incontinence (also called encopresis) is often due to chronic constipation and overflow incontinence or diarrhea. By definition, there should be at least one inappropriate bowel movement per month for at least three months in a child older than age 4 years. The incontinence usually happens during the day and not at night.
- Most often, the diagnosis is made by history and physical examination by the health care professional and further testing is not needed.
- Treatment is directed at developing a more routine bowel evacuation schedule and may require changes in diet, behavior modification, and the addition of stool bulking agents.
Can bowel incontinence be prevented?
Maintaining sphincter tone may prevent fecal incontinence. This might include preventing constipation by increasing fiber in the diet and keeping well hydrated and avoiding straining to promote a bowel movement.
Unfortunately, many times the cause of incontinence is childbirth anal surgery. It may be years until the symptoms of incontinence arise.
What is the prognosis for bowel incontinence?
The frequency of fecal incontinence increases with age. Once it occurs, the patient may be able to control the symptoms with diet, medication, and exercise. Many patients may initially benefit from surgery, but that benefit gradually decreases over the years and incontinence may recur.
Health Solutions From Our Sponsors
Shah, BJ; Chokhavatia, S; Rose, S .Fecal Incontinence in the Elderly. The American Journal of Gastroenterology;2012. 107 (11): 1635 to 46.
Top Fecal Incontinence Related Articles
ChemotherapyChemotherapy is the treatment of cancer with drugs that can destroy cancer cells. These drugs often are called "anticancer" drugs. Chemotherapy is often used with other treatments. Coping with side effects (fatigue, nausea, vomiting, pain, hair loss, infection, diarrhea, constipation, fluid retention, mouth and throat problems) are important to understand when undergoing chemotherapy treatment. It is important to eat well during chemotherapy, and get the support you need both during and after treatment.
Colonoscopy (Test, Side Effects, Preparation, Recovery)A colonoscopy is a procedure whereby a docotor inserts a viewing tube (colonoscope) into the rectum for the purpose of inspecting the colon. Colonoscopy is the best method currently available to diagnose, detect, and treat abnormalities within the colon.
ConstipationConstipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, laxative abuse, and hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
Constipation Myths and FactsConstipation results in fewer bowel movements. Laxatives, home remedies, and diet changes may bring constipation relief. Change habits that constipate you and adopt lifestyle changes to benefit your intestines and bowel. Bloating and chronic constipation are treatable with the right interventions.
Diabetes (Type 1 and Type 2)Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
DiarrheaDiarrhea is a change is the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.
Endoscopy (EGD) Procedure
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Irritable Bowel Syndrome (IBS)Irritable bowel syndrome (IBS) is a GI (gastrointestinal) disorder with signs and symptoms that include abdominal pain, bloating, increased gas (flatulence), abdominal cramping, diarrhea, constipation, and food intolerance.Two new tests are now available that may help diagnose irritable bowel syndrome with diarrhea and constipation (IBS-M) irritable bowel syndrome with diarrhea (IBS-D), and irritable bowel syndrome with constipation (IBS-C). Treatment for IBS includes diet changes, medications, and other lifestyle changes to manage symptoms.
Kegel Exercises for MenKegel exercises can help a man regain bladder control and help with urinary incontinence. Kegel or pelvic muscle exercises are discrete exercises that strengthen the perineal or pubococcygeus muscles. Kegels help to strengthen the muscles that control urination and improve erections. These exercises are often recommended to patients with weakened pelvic floor muscles such as patients with diabetes, patients having had a prostate surgery in the past such as a radical prostatectomy, or obese patients.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Causes, Symptoms, Treatment for Spinal StenosisSpinal stenosis causes back pain, leg pain, difficulty walking and clumsiness. Learn the symptoms of lumbar spinal stenosis and cervical spinal stenosis and what surgeries are used for spinal stenosis treatment. Discover tips for relieving spinal stenosis pain without surgery, as well as useful medications.
The Digestion Process (Parts, Organs, and Functions)Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food. Learn more about digestion and the body parts that make it possible, including the mouth, pharynx, esophagus, stomach, small intestine, colon, rectum, anus, pancreas, liver, and gallbladder.