Fecal Incontinence

Fecal incontinence refers to impaired ability to control the passage of stool or gas, resulting in accidental soilage. This may be of varying type and degree - from inability to hold gas alone, to incontinence to liquid stool only, to incontinence to liquid and formed stool. You may have an urge to move your bowel and can barely hold it long enough to make it to the bathroom, or may notice mild staining on your underwear at times, or leakage of stool without being aware of it. Most people are embarrassed to talk about it, and it may be more common than you think. You should know that there are specific treatments for the condition and you should not live with it and let it get worse.

Causes of fecal incontinence

Fecal incontinence occurs when the anal sphincter muscle is not contracting or tightening to close the anus when you want it to be. One group of such muscle, the internal anal sphincter, works in the background 24/7 to maintain the basal anal tone without you realizing it (they work involuntarily in conjunction with the nerve that senses there is stool in the rectum, so you can sleep and relax and not leak). The other group, the external sphincter muscle, is controlled by you voluntarily or consciously (so you can squeeze and hold your bowel movement if you need to). Some causes of fecal incontinence include:

Child birth-related injury - such as a tear of the anal sphincter from birth of a large baby, forcep delivery or episiotomy, or overstretching of the nerves that control the muscles. Occasionally the injury was obvious and was noticed immediately. Oftentimes, the initial symptom was subtle and transient, but bothersome symptoms start later in life with aging.
Aging - general decrease in muscle strength, including those of anal muscles, occur with aging.
Trauma to the anal sphincter - as a result of anal surgery or other traumatic injuries
Altered nerve conduction and sensation - such as in diabetic neuropathy, spinal cord injury, multiple sclerosis, severe stroke or advanced dementia.

Other less common causes include anal or rectal prolapse, fecal impaction, cancer of lower rectum or anus.

Symptoms of fecal incontinence

When fecal incontinence is not related to anorectal infection or cancer, there is usually no pain or bleeding unless the skin around the anus is severely irritated and "raw". As discussed above, primary symptom is the leakage of stool and/or gas of varying degree and frequency. Typically the incontinence is worse with loose stool than with formed stool. The fecal urgency or the lack of sensation thereof, are reflection of the nerve-sensing function. Other associated symptoms include perianal skin irritation and hygiene issue, feeling of embarrassment and anxiety, avoidance of social activities and consequent social isolation, all of which negatively affect ones quality of life.

Diagnosis and treatment of fecal incontinence

A history and physical exam can diagnosis fecal incontinence and often determine the cause. Exam can also exclude other correctible conditions such as prolapsed hemorrhoids, rectal prolapse, or cancer of anus or rectum. Sometimes evaluation of anal sphincter anatomy and function with ultrasound and manometry may be helpful but not always necessary. Treatment usually is nonsurgical first. These may include a combination of dietary changes, bowel habit and lifestyle adjustments, and medications to optimize stool consistency. Pelvic floor exercise may be used to strengthen the muscles in mild cases. For selective patients, surgical repair of damaged anal sphincter may be offered if the damage was recent. Implantation of a nerve stimulator is a surgical option when nonsurgical treatment is not sufficient. Colostomy is rarely offered as a last resort. Even though the incontinence may not resolve entirely, symptoms can often be managed and minimized to improve your quality of life.