Fecal Incontinence, often referred to as accidental bowel leakage, is the loss of normal control of the bowels. This condition leads to leakage of solid or liquid stool or gas.
The purpose of the colon, also known as the large intestine, is to form and store the stool and then send messages to the brain to signify the need of a bowel movement. Bowel leakage occurs if there are problems with the nerves and/or muscles in the rectum and pelvis.
CAUSES OF FECAL INCONTINENCE
There are many conditions that can lead to accidental bowel leakage:
- Sphincter Muscle Injury
- Loss of Feeling in the Rectum
- Rectal Disease or Abnormalities
- Liquid or Loose Stool
- Severe Constipation
- Prolapsed Hemorrhoids
- Pelvic Surgery or Radiation Therapy
- Gastrointestinal System Abnormalities (i.e. irritable bowel disease)
- Illnesses (i.e. multiple sclerosis)
- Nerve Damage Due to Stroke or Diabetes
Childbirth is the most common cause of accidental bowel leakage as it causes the muscles and tissues of the rectum to be stretched or torn and the anal sphincter can also be injured.
Symptoms with bowel control problems include:
- Stool Spotting in Underwear
- Strong Urgent Need to have a Bowel Movement
- Excessive Diarrhea or Constipation
DIAGNOSIS & TESTING
Rosemark providers will review medical history and symptoms that are being experienced. In women, the provider will conduct a physical examination of the vagina, anus, and rectum to look for signs of abnormalities, such as loss of normal nerve reflexes or muscle tone.
In some cases, tests may be needed to find out more information about fecal incontinence. These tests include:
- Anoscopy or proctoscopy which are tests using a short scope to see inside the anal canal or rectum.
- Anorectal manometry is a test that checks the strength of the anal sphincter muscle.
- Defecography is an X-ray test is used to study the rectum and anal canal during a bowel movement.
- Nerve tests are done to check if the nerves to the rectum and anus are working properly.
- Ultrasound exam displays images inside the rectum.
Treatment for fecal incontinence can include:
- Medications (oral or injection)
- Lifestyle Changes
- Sacral Nerve Stimulation
- Dietary Change
Certain foods can cause diarrhea such as dairy products and foods that contain gluten, a protein found naturally in wheat, rye, and barley. Some people have trouble absorbing fatty foods and spicy foods. Also, caffeine and alcohol can irritate the stomach lining. Keeping a food diary can help identify foods that cause symptoms which can subsequently be eliminated from the diet. In the case of constipation, certain dietary changes such as eating more fruits and vegetables, drinking plenty of water, and adding fiber are helpful.
Bowel retraining may be helpful in preventing constipation and diarrhea and treating accidental bowel leakage. Kegel exercises strengthen the muscles that surround the openings of the anus, urethra, and vagina and may improve accidental bowel leakage.
When a patient has trouble locating the right muscles, biofeedback training may be helpful. Biofeedback is a training technique that helps one locate and strengthen their anal sphincter muscles. In biofeedback, sensors are placed inside or outside the anus. These sensors measure the strength of the muscle contraction. When the correct muscles are contracted, the strength of the contraction will be shown on a monitor. This feedback lets the patient know that they are contracting the right muscles and the strength of the contraction.
Medication is another treatment option that may help control bowel leakage in certain individuals. Medications that treat diarrhea, control gas leakage, or prevent constipation can be prescribed.
SACRAL NERVE STIMULATION
Sacral nerve stimulation can be used when the nerves that control the bowels are not working correctly. A neurostimulator device is implanted under the skin, usually right above the buttocks. A thin wire is placed near the tailbone, which controls the colon, rectum, and anal sphincter. The device sends a mild electrical signal along the wire to these nerves to restore the normal function of the bowels.
There are many causes of fecal incontinence including childbirth, which is the most common cause of the condition. Through an exam and testing, the cause of incontinence can be identified and then effective treatments can be administered or prescribed.
Each individual will have a different medical circumstance and the Rosemark board-certified gynecologists are eager to assist you with this uncomfortable and embarrassing condition. We are here to help so call for an appointment and let’s talk about it!