Overview:
It is partially or completely inability control bowel movements, which causes fecal leakage from rectum
The severity of fecal incontinence ranges from accidental gas leakage to complete loss of bowel control
Etiology:
Muscle damage may occur then patient loses the ability to control
muscle damage occurs in case of trauma and after surgery and after an episiotomy.
Damage may occur at nerve, that prevents patient controlling the muscles, such as in case of multiple sclerosis, spinal cord injuries and chronic diabetes
Anal hemorrhoids may prevent tight closure of the anus, leading to possibility of fecal incontinence
As a result of chronic constipation, a very hard fecal mass may form in the rectum, causing dilatation of rectum which affecting muscle function
Symptoms:
- stool leakage and inability control the defecation process
- Anal itching
- Perianal dermatitis
Fecal incontinence causes severe psychological disorder where the patient feels embarrassed and ashamed and then develops into frustration and isolation
Fecal incontinence is usually accompanied by diarrhea, constipation or abdominal bloating
Causes:
- Spinal cord injury
- Multiple sclerosis
- Chronic diabetes
- After trans anal surgery
- After episiotomy
- Anal hemorrhoids
- Rectal prolapse
- Rectocele
- Diarrhea: the stool is soft and easy to leak
- Chronic constipation
- Common in old people, especially Alzheimer’s patients
Diagnosis:
- Clinical examination with rectal assessment
- Rectal pressure measurement
- Colonoscopy
- MRI in some cases
Treatment:
- Adequate psychological support must first be provided to patient
- Taking care of skin around the anus
- Treatment of fecal incontinence is by treating condition that causes it:
- In diarrhea: can give antidiarrheal agents Diphenoxylates and Loperamide
- In constipation: can give fiber supplements such as Cellulose and Metamucil
- In anal hemorrhoids: surgery is required to treat hemorrhoids
- In rectal prolapse: surgery using stapling is required
- In surgical sphincter injury: we perform surgical repair of sphincter
- In case of neurological diseases leading to neuromuscular dysfunction we can do one of the following procedures:
- Access bathroom regularly at a specified time after meal
- Kegel exercises to support pelvic floor muscles: it is based on several groups, each group consists of ten contractions, the contraction means that patient tightens pelvic muscles for 3 seconds and then relaxes them same amount
- Installing a balloon inside vagina and insufflating it, which leads to pressure on rectum and relieve episodes of fecal incontinence
- We may do permanent colostomy (opening colon on abdominal wall) in certain cases.
