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Fecal Incontinence

What is Fecal Incontinence?

Fecal incontinence refers to the inability to control bowel movements. This can include minor leakage or complete elimination of bowels. This is not to be confused with overflow incontinence, which refers to the loss of bladder control and urine leakage. Fecal incontinence can be temporary or chronic/recurring. Risk factors include:

  • Being 65 or older

  • Dementia 

  • Nerve damage 

  • Being female 

  • Being physically disabled 

What Causes Fecal Incontinence?

There are many causes for fecal incontinence, including but not limited to: 

Diarrhea: Whether caused by illness or some other GI complication, a loose stool is not as easy to contain as a solid stool and may result in leakage.

Constipation: Although seemingly counterintuitive, impacted stool may cause the muscle of the intestines and rectum to slightly weaken, which then gives way for watery stool to pass around the impaction and leak from the rectum. 
Lack of rectal elasticity: For varying reasons, the rectum can become stiff and fail to conform to the stool it is accommodating. As a result, excess stool may leak through the rectum. 

Muscle/Nerve damage: The inability to control your muscle movements can result in stool leakage.

Hemorrhoids: Swollen internal veins (located in the rectum) can prevent the anus from fully closing, resulting in stool leakage. 

Rectal prolapse: When the rectum drops down into the anus, the rectal sphincter may stretch, and stool leakage may occur. 

What are the Symptoms of Fecal Incontinence?

Symptoms of fecal incontinence, aside from the bowel leakage itself, include:

  • Strong urge to defecate 

  • Gas and bloating 

  • Diarrhea 

  • Constipation 

How is Fecal Incontinence Diagnosed?

When it comes to fecal incontinence, the diagnosis has less to do with confirming what is happening, but rather why it is happening. The following diagnostic exams may be performed to pinpoint the cause:

Colonoscopy: A thin tube fitted with a light and camera is interested into your anus and through your intestines to inspect the colon.

Digital rectal exam: The physician inserts a gloved finger into the rectum to test strength and feel for abnormalities.

Anal manometry: A small balloon is inflated in your anus and rectum to test the strength and responsivity of the anal sphincter and rectum.

Proctography: X-ray images are captured as you pass a bowel movement on a specially designed toilet that measures how much stool your rectum can hold and how well you can expel it. 

MRI: Images of the sphincter can help determine whether or not it is intact. 

What is the Treatment for Fecal Incontinence?

The treatment for fecal incontinence depends on the reason it is occurring in the first place. Some possible avenues of treatment include:

  • Medication to treat any underlying illness causing temporary bowel leakage

  • Exercises and therapy to strengthen the muscles and improve anal sphincter control 

  • Bowel training in which you train your body to pass bowel movements at scheduled times 

  • Surgery to correct issues such as a prolapsed rectum or sphincter damage

  • Fecal transplant may be an option depending on the underlying cause of fecal incontinence, this solution requires transplanting stool from a healthy donor into an unhealthy colon and is most often reserved for those suffering from colitis or diarrhea caused by the pathogen C. difficile 

Dietary changes may also be required to manage fecal incontinence. It is important to consume plenty of fiber to prevent constipation, keep detailed notes of how your body responds to certain foods and stay away from foods that cause diarrhea, and drink at least eight glasses of water a day. 

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