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Fecal Incontinence

Fecal or bowel incontinence is the loss of control over bowel (stool) movements. Some people may lose only a small amount of liquid stool, while others may be unable to control an entire movement of solid waste. Women are more likely to have fecal incontinence than men, and it is a condition that becomes more common with age. Fecal incontinence can be temporary, such as severe diarrhea after eating a spicy meal, or it can be chronic and ongoing. Because fecal incontinence is not something people like to talk about, you may not be aware that it is not uncommon. But the good news is that treatments are available.

Causes
Normal control of bowel movements depends on proper functioning of the colon and rectum, the muscles surrounding the anus (anal sphincter muscles), the brain and the nervous system, as well as the amount and consistency of stool produced. There are many causes of bowel incontinence, including:

  • Aging
  • Anal surgery for another condition, such as a fistula or hemorrhoid surgery
  • Chemotherapy
  • Conditions associated with chronic constipation or diarrhea, such as Crohn’s disease or ulcerative colitis
  • Damage or injury to the anal sphincter (rectum) muscles or the nerves surrounding these muscles; in women, this may occur during childbirth
  • Improper diet
  • Radiation treatment to the lower-pelvic region
  • Spinal-cord damage
  • Stroke
  • Systemic (whole-body) diseases, such as diabetes or multiple sclerosis
  • Use of certain medications, such as antibiotics

Diagnosis
Even before fecal incontinence becomes a chronic problem, rectal ultrasound (endosonography) allows the doctor to view the anal sphincter muscles to find muscle tears and other abnormalities. Other diagnostic procedures your doctor may suggest include:

  • Defecography: A special X-ray test that shows the shape and position of the rectum as it empties
  • Flexible sigmoidoscopy: Use of a thin, flexible, lighted tube (endoscope) to examine the lower digestive tract (sigmoid colon)
  • Manometry: A test that measures the pressure and strength of the anal muscles to see if they are too weak to function properly
  • Nerve studies: Tests that check for damage to the nerves that serve the sphincter muscles

Treatment
Most people can be cured or significantly improved with treatment once the doctor identifies the underlying cause of fecal incontinence. The treatment depends on the cause, but often the physician will suggest a combination of exercises, biofeedback therapy and medication. Available treatments include:

  • Dietary changes: Elimination of certain foods that cause the problem
  • Injections: New FDA-approved medications can be injected into the anal sphincter to build up tissue mass
  • Changes in medication: Switching from medications (for other conditions) that cause chronic diarrhea to others that do not (when possible)
  • Kegel exercises: Pelvic-floor exercises to strengthen the muscles that control elimination
  • Over-the-counter or prescription medications: These make the stool firmer; most people can control firm stools better than liquid ones
  • Sacral Nerve Stimulation: With this treatment, a special generator and nerve stimulator are implanted near the nerves that control bowel and bladder function
  • Biofeedback: Use of a device inserted into the anus or on the skin that tells the patient when she is using the proper muscles to control defecation; biofeedback helps the patient improve the strength and coordination of the appropriate anal muscles
  • Surgery: Treatment is reserved for patients who do not achieve success with other treatments; patients who have experienced anal muscle injuries, such as during childbirth, may elect to undergo surgery

Fecal incontinence is an embarrassing and disruptive condition. Many women can be completely cured with appropriate treatment, and almost all patients experience improvement.

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