Fecal Incontinence

What is incontinence?

Fecal incontinence is the inability to control feces and flatulence. Incontinence can occur in varying degrees from slight incontinence for gas to massive bowel emptying without any control.

Incontinence is a common problem. Patients often try to hide it because of embarrassment and fear of social consequences.

What is the cause of the problem?

There are many causes of incontinence. The most common cause is injury to the sphincter muscle or sphincter nerves during childbirth.

In many cases sphincter damage is discovered immediately following childbirth and treated/ operated immediately. Minor injuries may not be identified and become a problem later in life when muscle strength of the sphincter and pelvic floor decreases.

Operations in or around the rectum (for hemorrhoids, abcesses and fistulas) can cause sphincter damage. Sphincter damage from minor surgical procedures may also emerge later in life due to age-related decrease in muscle strength.

Transient diarrhea can cause incontinence and is often caused by intestinal infections. If diarrhea lasts longer than a few weeks, and especially if bleeding also occurs you should seek medical attention immidiately. In these cases inflammatory bowel diseases, polyps and colorectal cancer must be ruled out.

Much rarer causes are diseases of the nervous system.

Detailed mapping of the problem is crucial.

Describe to your doctor in detail how you experience the problem (how often, how much, for how long) and if there are other symptoms associated with the incontinence (pain, bleeding, etc.). In this way your doctor often can determine the cause of incontinence, such as childbirth, illnesses, medication use, previous surgeries).

It is necessary to be examined by a colorectal specialist. A thourough examination of the anal canal and rectum must be performed to reveal any damage to the sphincter muscle and pelvic floor. Also an endoscopic examination of the rectum and lower part of the colon is mandatory (a sigmoidoscopy - read more about sigmoidoscopy here).

The specialist will determine if any additional examinations should be carried out.

More advanced studies such as endo-rectal ultrasound scans, MRI scans, examinations of the muscle and nerve functions are carried out in higly specialized specialized hospital units.

How is incontinence treated?

Treatment consists of diet changes, treatment of diarrhea, pelvic floor exercises and squeeze techniques, surgical reconstruction of the sphincter muscle, implantation of artificial sphincter muscle and nerve stimulation.

Following a detailed medical history and thorough examination the cause of incontinence can be determined and a treatment strategy laid out. Mild incontinence is usually resolved by dietary changes and medication. If the cause is inflammatory bowel disease medical treatment is needed. One should be aware that incontinence can be a side-effect of certain medications.

In some cases of inflammatory bowel disease, polyps and, of course, colorectal cancer, surgery is the best option.

Physical training with pelvic floor exercises and squeeze techniques are of great importance in milder cases of incontinence. Biofeedback is another type of training gaining greater awareness of many physiological functions with a goal of being able to manipulate them at will. Some physiotherapists use biofeedback.

Surgical treatment of muscle injuries, implantation of artificial sphincters and nerve stimulators may be necessary. These highly specialized procedures are carried out only in specialized hospital units.

In extreme cases, the best option for an improved quality of life is a colostomy.