Bowel Control/ Fecal Incontinence

An unintentional bowel movement, known as fecal incontinence (FI), is an extremely upsetting experience. It can take a large toll on the quality of life and mental health of patients and their family members.

According to the ACG,
https://acgcasereports.gi.org/topics/fecal-incontinence/

What is fecal incontinence?

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

The ability to hold stool (called continence) requires the rectum, anus, and nervous system to be working normally. Two groups of muscles in the wall of the anus and rectum are responsible for holding the stool in the rectum, the outer muscle group (external anal sphincter) and the inner muscle group (internal anal sphincter). Normal continence also requires the ability to sense the presence of stool in the rectum (called rectal sensation), and the ability to relax and store stool (called rectal compliance). In addition, you need the physical and mental capabilities to recognize the urge to defecate and go to the toilet.

Is it a common condition?

Yes. More than 5.5 million Americans have fecal incontinence. It is more common in older people and in women. However, many people do not like to talk about fecal incontinence, so the problem may be more common than we realize. and it may not be apparent that fecal incontinence is relatively common. If you have fecal incontinence and have not discussed the symptom with a physician or family members, you are not alone.

What causes fecal incontinence?

Fecal incontinence is commonly caused by altered bowel habits (generally diarrhea, but also constipation) and conditions that affect the ability of the rectum and anus to hold stool. The sphincter muscles become weaker as you grow older. The sphincter muscles and/or the nerves supplying them can be damaged during vaginal delivery in women, by trauma, or during anal surgery. Nerve malfunction can also happen in people who strain excessively, for example, in patients with diabetes or after a stroke. The rectal wall can stiffen after radiation treatment or in patients with Crohn’s disease. In these patients, the rectum cannot stretch and relax as much as it needs to (rectal compliance), so the excess stool leaks out. Other conditions where the rectum drops down into the anus (rectal prolapse) or when the rectum protrudes towards the vagina (rectocele) can also cause fecal incontinence.

What are the symptoms of fecal incontinence?

Normally, “accidents” or fecal leakage should not happen in adults except during episodes of severe diarrhea. People with chronic or recurring fecal incontinence may have few or frequent accidents. The symptoms may range from the inability to hold gas, mild leakage of stool during daily activities or exertion or being unable to reach the toilet in time resulting in complete loss of a bowel movement. Other intestinal symptoms such as diarrhea, constipation, and abdominal discomfort may also be present.

Is there any treatment for fecal incontinence?

Fortunately, effective treatments are available for fecal incontinence. Treatment for fecal incontinence can help improve or restore bowel control. Depending on the cause of your incontinence, treatment may include dietary changes, medications, special exercises that help you better control your bowels, or surgery.

Foods that can cause diarrhea and worsen fecal incontinence include spicy foods, fatty and greasy foods, cured or smoked meat, and dairy products (especially if you are lactose intolerant). Caffeine-containing beverages can act as laxatives, as can products that contain artificial sweeteners (e.g., sugar-free gum and diet soda). Several anti-diarrheal agents that effectively treat diarrhea are now available. Some of these agents are available over the counter while others are prescription only. Some medications work better for patients than others.

If you leak large amounts of stool frequently, consider applying a moisture-barrier cream to prevent direct contact between irritated skin and feces. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream. Non-medicated talcum powder or cornstarch also may help relieve anal discomfort. Wear cotton underwear and loose clothing and change your soiled underwear quickly. If you use pads or adult diapers, be sure they have an absorbent wicking layer on top, this layer wicks moisture away from your skin.

If a rigorous trial of the conservative measures specified above is not effective minimally invasive procedures (e.g., sacral nerve stimulation, injection of biomaterials) may be considered.

Injections
Injections into the anal sphincter may improve incontinence by narrowing the anal canal. This is a painless office-based procedure with zero downtime.

Interstim
The sacral nerves travel from the spinal cord to muscles in the pelvis. These nerves regulate the rectal sensation and strength of the anal sphincter muscles. Sacral nerve stimulation is carried out in stages. First, small leads are positioned at the lower back to electronically stimulate the sacral nerves traveling from the spinal cord to the muscles of your lower bowel. These muscles are stimulated by an external pulse generator to identify which muscle stimulates anal contractions the most. The muscle response to the stimulation generally isn’t uncomfortable. If this procedure improves symptoms over a few days, a permanent pulse generator may be implanted.

There are many options to help patients with fecal incontinence. At HGA we can evaluate patients with fecal incontinence and provide therapies to help improve quality of life. Make an appointment with a gastroenterologist for an evaluation.