Washington University Colorectal Surgeons answer patient questions regarding fecal incontinence.
Fecal incontinence is the inability to control gas and stool. Patients may experience accidents to stool in their undergarments, pads, or adult diaper. Without knowing it is happening, patients with fecal incontinence may also pass gas. Some patients also have severe fecal urgency, where they have very little warning to go to the bathroom, and if not close to a toilet they may have an accident. This not only happens with liquid stool, but also solid stool and gas. Some patients may be unable to tell the difference between gas and stool.
Fecal incontinence can be caused by a number of factors and some people may have many of these factors contributing to symptoms. The most common cause is muscle damage to the anus from tearing during childbirth. Nerve damage is also a very common cause of incontinence. This can occur during childbirth, neurologic conditions, or as a result of long standing constipation. Some have incontinence related to severe constipation where the stool is impacted in the rectum. Liquid stool leaks around this hard stool and out of the anus causing accidents. Prior surgery can cause incontinence, and other more rare issues such as inflammatory rectal conditions, radiation damage, or rectal prolapse can also be attributed.
There are many ways to approach fecal incontinence. Typically, the first step is a high fiber diet and fiber supplementation may help to add bulk to the stool. The goal is the make the stool more solid as this is typically easier to control. However, this may worsen control of gas. Foods that loosen stool or cause diarrhea should be avoided. Medications to promote constipation like Imodium can also be used as tolerated.
Additionally, if incontinence is associated with severe constipation dietary changes or medications should be started to correct this. Pelvic floor physical therapy may also be very helpful. Biofeedback and Kegel exercises may be used to strengthening the pelvic floor and anal muscles to allow for better control. If these simple maneuvers fail to improve symptoms further evaluation is done to determine if surgery may be beneficial.
Surgical therapy such as sacral neuromodulation, sphincteroplasty or colostomy have also been proven to be highly effective. Patients are evaluated with anorectal ultrasound to determine if the sphincter muscle is intact or disrupted, and anal manometry to understand how well the muscle and nerves work. Based on these results, patients may be offered reconstruction of the anal sphincter muscle or sphincteroplasty or sacral nerve stimulation. Sphincteroplasty is offered when a clear defect in the sphincter muscle is identified. Alternatively, sacral nerve stimulation is very effective method for treating fecal incontinence. Briefly, patients are asked to keep a short journal of their bowel function to establish a baseline status. Next, temporary stimulation leads are placed with the patient in the operating room. A second journal is then kept to determine if there has been improvement in your symptoms. If the improvement is great enough, then permanent leads and a generator are implanted. A colostomy is the last resort and ultimately is the decision of the patient. Typically, this occurs if all previous treatments have failed to improve symptoms and the quality of the life for the patient is such where they would be happier with a colostomy.
There are many people who have anal sex with no issues related to incontinence. Anal intercourse may be associated with an increased risk of fecal incontinence. If you have baseline issues with fecal incontinence or have any concerning issues talk to your doctor before having anal sex.
Washington University Colorectal can provide treatment options for fecal incontinence. Meet our specialists below.
