WHAT IS INCONTINENCE?
Incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Bowel incontinence symptoms can range from an occasional leakage of stool while passing gas to a complete loss of bowel control. Patients wear pads to absorb the leaked stool or in severe cases have to change their clothing after accidents. Fecal incontinence is a much more common condition, but is under reported due to patients’ embarrassment and reluctance to discuss this unpleasant issue with a physician.
WHAT CAUSES INCONTINENCE?
The ability to hold stool requires the normal function to your rectum, anus and nervous system. Also, you have to have the physical and mental capabilities to recognize and appropriately respond to the urge to defecate. There are many causes of incontinence and it is much more common in women than men. Damage to the nerves that control the anal sphincter or those that sense stool in the rectum can result in fecal incontinence. Childbirth is the most common cause of incontinence. Other causes include constantly straining when having a bowel movement, spinal cord injury and stroke can all cause nerve damage leading to incontinence. Disease can also affect these nerves, such as diabetes, multiple sclerosis, and scleroderma can cause damage leading to fecal incontinence.
Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent liquid stools passing through the anal opening. If bleeding accompanies lack of bowel control, consult your physician. These symptoms may indicate inflammation within the colon (colitis), a rectal tumor, or rectal prolapse - all conditions that require prompt evaluation by a physician.
A broad range of conditions and disorders can cause fecal incontinence, including:
- Obstetric/childbirth injuries
- Muscle damage
- Rectal cancer
- Nerve Damage
- Anal Infection
- Loss of muscle strength with age
- Chronic laxative abuse
HOW IS THE CAUSE OF INCONTINENCE DETERMINED?
An initial discussion of the problem with your physician will help establish the degree of control difficulty and its impact on your lifestyle. Many clues to the origin of incontinence may be found in patient histories. For example, a woman's history of past childbirths is very important. Multiple pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute to muscle or nerve injury at the time of childbirth. In some cases, medical illnesses and medications play a role in problems with control.
A physical exam of the anal region should be performed. It may readily identify an obvious injury to the anal muscles. In addition, an ultrasound probe can be used within the anal area to provide a picture of the muscles and show areas in which the anal muscles have been injured.
A number of medical tests can help pinpoint the cause of fecal incontinence. They may include:
- Anal manometry – measures the sensitivity and function of your rectum.
- Anorectal ultrasonography – evaluates the structure of your sphincter.
- Anal electromyography- helps reveal signs of nerve damage.
- Sigmoidoscopy or colonoscopy- helps detect signs of inflammation, tumors or scars tissue that may cause fecal incontinence.
WHAT CAN BE DONE TO CORRECT THE PROBLEM?
Treatment of incontinence may include:
- Dietary changes
- Constipating medications
- Muscle strengthening exercises
- Surgical muscle repair
- Implantation of nerve stimulator (Interstim)
After a careful history, physical examination and testing to determine the cause and severity of the problem, treatment can be addressed. Mild problems may be treated very simply with dietary changes and the use of some constipating medications. Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence. Sometimes a change in prescribed medications may help. Your physician also may recommend simple home exercises that may strengthen the anal muscles to help in mild cases. A type of physical therapy called biofeedback can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles.
Injuries to the anal muscles may be repaired with surgery. Some individuals may benefit from a technique that delivers electrical energy to the skin and muscles surrounding the anus which results in firming and thickening of this area to help with continence.