Fecal Incontinence

Bowel incontinence is the inability to control bowel movements. It's a common problem, especially among older adults.

Bowel incontinence is usually not a serious medical problem. But it can seriously interfere with daily life. People with bowel incontinence may avoid social activities for fear of embarrassment.

Many effective treatments can help people with bowel incontinence. These include:

• medicine
• surgery
• minimally invasive procedures

Talking to your doctor is the first step toward freedom from bowel incontinence.

The most common cause of bowel incontinence is damage to the muscles around the anus (anal sphincters). Vaginal childbirth can damage the anal sphincters or their nerves. That's why women are affected by bowel incontinence about twice as often as men.

Anal surgery can also damage the anal sphincters or nerves, leading to bowel incontinence.

There are many other potential causes of bowel incontinence, including:

• Diarrhea (often due to an infection or irritable bowel syndrome)
• Impacted stool (due to severe constipation, often in older adults)
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions)
• Radiation damage to the rectum (such as after treatment for prostate cancer)
• Cognitive (thinking) impairment (such as after a stroke or advanced Alzheimer's disease)

More than one cause for bowel incontinence is frequently present. It's also not unusual for bowel incontinence to occur without a clear cause.

Discussing bowel incontinence may be embarrassing, but it can provide clues for a doctor to help make the diagnosis. During a physical examination, a doctor may check the strength of the anal sphincter muscle using a gloved finger inserted into the rectum.

Other tests may be helpful in identifying the cause of bowel incontinence, such as:

• Stool testing. If diarrhea is present, stool testing may identify an infection or other cause.
• Endoscopy. A tube with a camera on its tip is inserted into the anus. This identifies any potential problems in the anal canal or colon. A short, rigid tube (anoscopy) or a longer, flexible tube (sigmoidoscopy or colonoscopy) may be used.
• Anorectal manometry. A pressure monitor is inserted into the anus and rectum. This allows measurement of the strength of the sphincter muscles.
• Endosonography. An ultrasound probe is inserted into the anus. This produces images that can help identify problems in the anal and rectal walls.
• Nerve tests. These tests measure the responsiveness of the nerves controlling the sphincter muscles. They can detect nerve damage that can cause bowel incontinence.
• MRI defecography. Magnetic resonance imaging of the pelvis can be performed, potentially while a person moves her bowels on a special commode. This can provide information about the muscles and supporting structures in the anus, rectum, and pelvis.

Bowel incontinence is usually treatable. In many cases it can be cured completely.

Recommended treatments vary according to the cause of bowel incontinence. Often, more than one treatment method may be required to control symptoms.

Nonsurgical treatments are often recommended as initial treatment for bowel incontinence. These include:

Diet. These steps may be helpful:

• Eat 20 to 30 grams of fiber per day. This can make stool more bulky and easier to control.
• Avoid caffeine. This may help prevent diarrhea.
• Drink several glasses of water each day. This can prevent constipation.

Medications. Try these medicines to reduce the number of bowel movements and the urge to move the bowels:

• Imodium
• Lomotil
• Hyoscyamine

Methylcellulose can help make liquid stool more solid and easier to control. For people with a specific cause of diarrhea, such as inflammatory bowel syndrome, other medications may also help.

• Exercises. Begin a program of regularly contracting the muscles used to control urinary flow (Kegel exercises). This builds strength in the pelvic muscles and may help reduce bowel incontinence.
• Bowel training. Schedule bowel movements at the same times each day. This can help prevent accidents in between.
• Biofeedback. A sensor is placed inside the anus and on the abdominal wall. This provides feedback as a person does exercises to improve bowel control.

Surgery may be recommended for people whose bowel incontinence is not helped by noninvasive treatments. The types of surgery include:

• Sphincter surgery. A surgeon can stitch the anal muscles more tightly together (sphincteroplasty). Or the surgeon takes muscle from the pelvis or buttock to support the weak anal muscles (muscle transposition). These surgeries can cure many people with bowel incontinence that's due to a tear of the anal sphincter muscles.
• Sacral nerve stimulator. A surgeon implants a device that stimulates the pelvic nerves. This procedure may be most effective in people with bowel incontinence due to nerve damage.
• Sphincter cuff device. A surgeon can implant an inflatable cuff that surrounds the anal sphincter. A person deflates the cuff during bowel movements and reinflates it to prevent bowel incontinence.
• Colostomy. Surgery to redirect the colon through an opening created in the skin of the belly. Colostomy is only considered when bowel incontinence persists despite all other treatments.

Newer, nonsurgical procedures are also available to treat bowel incontinence, such as:

• Radiofrequency anal sphincter remodeling. A probe inserted into the anus directs controlled amounts of heat energy into the anal wall. Radiofrequency remodeling creates a mild injury to the sphincter muscles, which become thicker as they heal.
• Injectable biomaterials. Materials such as silicone, collagen, or dextranomer/hyaluronic acid can be injected into the anal sphincter to boost its thickness and function.

These minimally invasive procedures can reduce bowel incontinence in some people, without the risks of surgery. Because they are relatively new, their long-term effectiveness and safety aren't as well known as other treatments.

WebMD Medical Reference

SLIDESHOW

Super Tips to Boost Digestive Health: Bloating, Constipation, and More See Slideshow