Fecal Incontinence: Causes, Diagnosis, Treatment

A bowel movement normally occurs due to the interactions and feedback responses of the muscles and nerves found in the anus and rectum. This is a very complex system. Fecal incontinence, also known as bowel incontinence, occurs when an individual is unable to control his normal bowel movement.

This causes feces to continuously leak from the rectum, and may be extremely distressful and embarrassing. This leakage can occur occasionally when passing gas or it may be a total loss of bowel control.

Fecal incontinence can develop at any age. However, it is more common in small children and in women, particularly those who are middle-aged or older than 40 years old.

Common Causes Of Fecal Incontinence

Fecal incontinence is a symptom, not a disorder. There is always an underlying reason that is causing the feces to unexpectedly leak out from the body. Various factors may cause fecal incontinence but the most common causes include the following:

Chronic constipation

Chronic constipation occurs when impacted (hard) stool that is too hard to pass remains in the rectum for prolonged periods. Because of this constant impaction, the intestinal and rectal muscles, and at times certain nerves, become weak and damaged respectively. This ultimately causes watery and loose feces from upper regions of the digestive tract to move around the hardened stool and leak through.

Diarrhea

Diarrhea is one of the major causes of fecal incontinence. For people suffering from slight incontinence, developing diarrhea (loose stools) can worsen the leakage.

Rectal Scarring or Stiffness

The rectum may be damaged due to inflammatory bowel diseases or radiation treatments. These conditions can cause muscles in the rectal walls to become stiff or damaged, reducing its capacity to stretch and store adequate amounts of feces.

Destruction or Weakening of Sphincter Muscles

Sphincter muscles play a vital role in the control of bowel movements. Weakening or injury to anal sphincters, commonly after certain complications during childbirth, may also cause fecal incontinence. 

Damage to Nerves

If the nerves that sense the presence of stool in the rectum, or those, which control the relaxation reflexes of the anal sphincters are damaged, bowel control will be lost. This can occur due to multiple reasons, including certain diseases (multiple sclerosis, diabetes), medical conditions (stroke, spinal cord injury, spina bifida) and physical straining during defecation.

Surgery

A hemorrhoidectomy, as well as other operations involving the rectal and anal areas may result in muscular or nervous damage.

Other causes

Conditions such as dementia, late-stage Alzheimer’s disease, rectal prolapse (rectum extended into the anus) and rectocele (rectum protruding into the vagina) may also cause fecal incontinence.

See Also: How To Deal With Irritable Bowel Syndrome

Related Symptoms

It is not surprising to have some other symptoms along with fecal incontinence. Other problems associated with the bowel may also accompany this disorder. Abdominal distention and bloating is one of the most common associated symptoms. Occasional fecal incontinence may simply cause soiling of the undergarments. However, in cases of a more severe lack of bowel control, the symptoms are more distressing. These include:

• Anal itching
• Skin infections, such as lesions and ulcers (of the anal area)

Fecal Incontinence: Diagnostic Tests And Remedies

Many diagnostic tests are used to confirm fecal incontinence, depending on the cause and severity of the condition. A physical examination will be the starting point. This includes a visual examination and inspection of the anus. A probe or pin may also be used to test for any nerve damage.

Medical tests used to diagnose and confirm the exact cause of fecal incontinence include the following:

• A digital rectal exam. The physician inserts his lubricated and gloved finger into the rectum to check the integrity of sphincter muscles as well as any other abnormalities. The presence of rectal prolapsed may also be assessed.
• Anal Manometry. A thin, flexible tube with an inflatable balloon at its end is inserted into the rectum and the anus. This method establishes the strength of the anal sphincter and the overall responsiveness of the rectum
• Anal Electromyography. This method uses electrodes that assess any damage to the nerves surrounding the anal muscles.
• Anorectal Ultrasonography. An instrument inserted into the rectum and anus produces images that help the doctor in diagnosis the cause and extent of fecal incontinence.
• Endorectal Ultrasound. A specialized endoscope inserted into the lower colon uses sound waves to produce images of sphincters.
• Proctography. This test determines how much stool the rectum can hold and how efficiently the body can expel it. It uses a specialized toilet that produces video X-ray images while the patient defecates.  
• Proctosigmoidoscopy. A flexible tube inserted into the rectum inspects the lower end (last two feet) of the colon for inflammation, scarring or tumors. 
• Colonoscopy. A flexible tube inserted into the rectum is used to inspect the entire colon.
• Balloon Expulsion Test. This test inserts a water-filled balloon into the rectum, and the patient is then asked to expel the balloon. The time taken for this expulsion, particularly longer than a minute, indicates a defecation disorder.
• Magnetic Resonance Imaging (MRI). An MRI provides clear images of the anal sphincters to determine their integrity and response during defecation.  

Is Fecal Incontinence Treatable?

Treatment for fecal incontinence depends on the cause of the disorder. Due to the variety of causes, various treatment options are available. These are described below:

• Laxatives – if the cause of fecal incontinence is chronic constipation.
• Anti-diarrheal Drugs – to prevent diarrhea and leakage of feces.
• Certain Medications – to decrease and control involuntary bowel movements.
• Dietary Modifications

Diet directly affects and determines the consistency of stools. Thus, in order to avoid extremely hard or watery stools, a balanced diet is essential. Foods rich in fiber can help prevent both diarrhea and constipation, by adding bulk to the stools and aiding defecation.

Exercise and Therapy

These methods are effective for those who suffer from muscular problems. They help in strengthening sphincter control and defecation response. These treatment options include:

- Timing Bowel Movements. The patient is trained to have a bowel movement at a particular time every day. This helps in regaining bowel control.

- Increase Muscular Strength. Physiotherapists help the patient sense and control their muscular movements. This helps in controlling the timely release of feces.

- Sacral Nerve Stimulation. A device that produces electrical impulses stimulates the muscles of the bowel. This device sends impulses to the sacral nerves, which travel from the spinal cord to the pelvic muscles.

See Also: Blood In Vomit And Stool: Hematemesis, Melena Or Hematochezia

Surgical Options For The Treatment Of Fecal Incontinence

If the above-mentioned methods are not effective in curing the underlying cause, surgery may be required. Such causes include rectal prolapsed or damage to the anal sphincters during delivery. Surgical options include:

• Surgery for Rectal Prolapse, Rectocele or Hemorrhoids – treating or removing these problems may cure or reduce fecal incontinence as well.
• Sphincteroplasty –the weakened or damaged area of the anal sphincter is separated from the adjacent tissue. The edges of the muscles are brought together and sewn to overlap each other, which strengthens and tightens the sphincter.
• Sphincter Repair – a muscle from the inner thigh is wrapped around the sphincter in order to restore the tone of the anal sphincter.
• Sphincter Replacement – an inflatable, artificial sphincter is implanted into the anal canal. It keeps the anal sphincter shut when it is inflated. When there is a need to defecate, an external pump is used to deflate the artificial sphincter, allowing feces to be expelled. The device then re-inflates on its own.
• Colostomy – surgery is performed to divert the stool through an opening made in the abdominal cavity.  An external bag is attached to this opening, which collects the expelled stool. This is mostly the last line of treatment.