Fecal incontinence is defined as the impaired ability to control stool or gas. There are degrees of fecal incontinence that include complete loss of bowel movement, seepage and urgency.
Causes
- Trauma to the anal muscles (surgery, childbirth or local trauma)
- Loss of muscle strength or loss of sensation with aging or medical conditions
- Medical conditions or medications that cause loose bowel movements
- “Overflow” incontinence secondary to constipation
Testing & diagnosis
History and physical: Physical examination of the anal area may identify an obvious anal sphincter injury. The history of childbirth, surgical procedures, medical history and medications are important to discuss.
Bowel diary: A two-week diary to document the frequency and severity of accidents.
Anal manometry: This is a test, performed in the office, to measure the strength of the anal muscles. A small flexible tube is placed in the anus and records muscle strength while the patient relaxes and tightens the muscles.
Electromyography (EMG): This is a test, performed in the office, to measure the activity of the nerves going to the anal muscles. Small sensors are used to record the nerve activity while the patient relaxes and tightens the muscles.
Transrectal ultrasound (TRUS): This is an ultrasound of the anal muscles, performed in the office. A small probe is placed in the rectum and produces images of the anal sphincter to identify any defects in the muscle.
Defocography: X-ray pictures and video demonstrate how the rectum empties and determines if any other organs are involved. Barium contrast medium is introduced into the patient’s rectum, and the patient is asked to evacuate the barium as if having a bowel movement. Video X-rays are also taken while the patient is asked to cough, strain and bare down while sitting on a radiology commode.
Treatment
After discussing your history, performing a physical exam and reviewing your test results, your physician will create a treatment plan. Some possible treatment options are listed below.
Diet and bowel routine: A high-fiber diet along with antidiarrheal medications may help manage mild incontinence.
Strengthening exercises: Simple home exercises, such as Kegels, may help to strengthen the anal muscles
Biofeedback / physical therapy: Therapy and exercises performed by a physical therapist specializing in the pelvic floor can help to strengthen the anal muscles and nerves.
Sacral nerve stimulation (SNS): The implantation of a programmable stimulator, under the skin, which will deliver electrical stimulation to the sacral nerve.
Surgical muscle repair: Your surgeon will discuss this option with you.
Fecal incontinence can be a difficult condition. Treatments are available, with good rates of success, and your doctor will work with you to find a therapy that is effective for you.