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Fecal Incontinence

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Introduction

Fecal incontinence is a condition in which the patient is unable to control bowel movement. Fecal incontinence is prevalent in both male and female without any bias. Because of its inherent characteristic of social embarrassment, there is a need to spread awareness about fecal incontinence.

What is Fecal Incontinence?

The term “incontinence” generally means out of control. Fecal incontinence is a condition in which people lose voluntary control over the passing of feces. The condition is also known as bowel incontinence. The condition involves the unexpected leaking of feces from the rectum. In some cases, people experience the extreme urge of bowel movements but fail to reach the bathroom on time. In others, the people even are not able to sense the bowel movement.
Fecal incontinence may occur temporarily or may have chronic or recurrent occurrence. The condition significantly reduces the quality of life. At times, it may be the reason for social embarrassment.

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What are the Symptoms of Fecal Incontinence?

Patients with fecal incontinence may experience the following symptoms:

  • ● Unawareness about the need to go for a bowel movement.
  • ● The extreme urge of bowel movement but are not able to reach the toilet on time.
  • ● Persistent bloating, flatulence, and gas formation.
  • ● Diarrhea, i.e., loose and watery stools.
  • ● Constipation, i.e., irregular bowel movement or difficulty in passing the stools.

What Causes Fecal Incontinence?

There are various causes of fecal incontinence. Some people may have more than one reason for fecal incontinence. Following are the causes of fecal incontinence:

  • Diarrhea: Diarrhea is a condition of the presence of soft or liquid stools in the rectum. These stools are difficult to retain in the rectum and require immediate expulsion. This results in fecal incontinence.
  • Muscle Damage: Anal sphincter muscles help the rectum to retain stool. Damage to these muscles may result in the fecal sphincter.
  • Hemorrhoids: Hemorrhoid is a condition of swelling of veins of the rectum. Swelling prevents the complete closure of the anus resulting in fecal incontinence.
  • Fecal Impaction: Chronic constipation results in fecal impaction. These hard masses of stool, when passed through the rectum, gradually weaken the muscles. This may cause fecal incontinence.
  • Nerve Damage: Due to nerve damage, the anal sphincter did not close completely. This results in the leaking of feces. The nerve damage may be due to various reasons such as diabetes, multiple sclerosis, stroke, or injury to the spinal cord.
  • Rectal Prolapse: In this condition, the rectum protrudes into the anal region. This causes damage to muscles and nerves, leading to fecal incontinence.
  • Surgery: Various surgeries such as hemorrhoidal surgery or other surgeries related to the anus and rectum may damage the nerves and muscles. This may lead to fecal incontinence.
  • Reduced Rectal Capacity: Because of any condition such as inflammatory bowel disease, radiation therapy, or surgical complications, the rectum becomes stiff and is not able to stretch to retain stool. This may lead to fecal incontinence.
  • Rectocele: Rectocele is a condition in women that involves a protrusion of the anus into the vagina. This may also cause fecal incontinence.

How is Fecal Incontinence Diagnosed?

Your doctor may diagnose fecal incontinence through various techniques. The doctor will also determine the cause of fecal incontinence. Some of the methods to determine the cause of this condition are:

  • Anal manometry: The doctor performs this test to evaluate the health of the anal sphincter. In this method, the doctor inserts a tube into the anus and rectum. The test indicates the sensitivity of the rectum and the functioning of the anal sphincter.
  • Ultrasonography: Through anal ultrasonography, the doctor evaluates the anatomical variation in the anal sphincter. The doctor inserts a tube in the rectum for ultrasonography.
  • Digital rectal examination: During the digital examination, the doctor determines the strength of the sphincter muscles and may also check the presence of rectal prolapse during this test.
  • Colonoscopy: The doctor may also advise you to undergo colonoscopy, allowing the doctor to view and evaluate the complete colon.

How is Fecal Incontinence Treated?

There are various treatment options for managing fecal incontinence. Some of the treatment methods are:

  • Diet: The patient should incorporate those foods in the diet that normalize bowel movement. Exclude the foods from the diet that cause diarrhea and constipation.
  • Medications: Various medications may provide relief from the symptoms of fecal incontinence. These include drugs that manage diarrhea, such as loperamide, or the bulk laxatives, such as psyllium husk, to manage chronic constipation.
  • Surgery: Surgery is another option to treat fecal incontinence. There are various types of surgical treatment available. The doctor may implant an artificial sphincter through surgery. The doctor may also perform sphincteroplasty, which involves reattaching the torn part of the anus. Other surgical options include colostomy and gracilis muscle transplant.
  • Other Therapies: Various other therapies may help in managing fecal incontinence. These are bowel training, kegel exercise, biofeedback, nerve stimulation, and radiofrequency therapy.

Result of Fecal Incontinence Surgery

Surgical interventions for fecal incontinence improve the symptoms and enhances the quality of life of the patient. In patients with sphincter defects, the doctors consider sphincteroplasty as first-line treatment. Patients with gracilis muscle transplants also experience relief from their symptoms. Similarly, the artificial anal sphincter provides excellent functional improvement.

What are the Risks Associated with Fecal Incontinence Surgery?

Like any other surgery, fecal incontinence surgery may also have certain risks. Some of those risks are:

  • ● Infections.
  • ● Local complications.
  • ● Failure of surgery that requires revision surgery.
  • ● Repair breakdown (in case of sphincteroplasty).
  • ● Bleeding.

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FAQ's

What are the Risk Factors for Fecal Incontinence?

Various factors increase the Risk of Fecal Incontinence. These are reduced physical activity, nerve damage, age (people above 65 years are more vulnerable), and dementia.

What are the Complications of Fecal Incontinence?

Untreated Fecal Incontinence may lead to certain complications. The complications are skin irritation, emotional stress, social embarrassment, and reduced quality of life.

How should you Prevent Fecal Incontinence?

There are various ways to prevent Fecal Incontinence. These are avoiding straining while having a bowel movement, prevent chronic constipation, keep strong pelvic muscles through exercise, and manage Diarrhea.

When to see a Doctor in Case of Bowel Problems?

You should visit the doctor if you have constipation, diarrhea, persistent bloating and gas formation, rectal bleeding, blood in stools, and persistent pain in the abdomen.

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