Fecal incontinence is the loss of control over bowel movements.
Causes of Fecal Incontinence
Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum (fecal impaction).
Persistent fecal incontinence can develop in people who have birth defects, injuries to the anus or spinal cord, rectal prolapse (protrusion of the rectal lining through the anus), dementia, nerve damage resulting from diabetes, tumors of the anus, or injuries to the pelvis during childbirth.
Diagnosis of Fecal Incontinence
A doctor's examination
Usually sigmoidoscopy
A doctor examines the person for any structural or neurologic abnormality. This examination involves examining the anus and rectum, checking the extent of sensation around the anus, and usually doing a sigmoidoscopy to view the lower portion of the large intestine, the rectum, and the anus.
Other tests, including an ultrasound of the anal sphincter, magnetic resonance imaging (MRI) of the pelvis and perineal area, an examination of the function of nerves and muscles lining the pelvis, and pressure readings of the rectum and anus (anorectal manometry) may be needed.
Treatment of Fecal Incontinence
Measures to regulate bowel movements
Sphincter exercises and sometimes biofeedback
Sometimes a surgical procedure
Exercising the anal muscles (sphincters) by squeezing and releasing them increases their tone and strength, particularly in mild cases. A technique called biofeedback can help a person retrain the sphincters and increase the sensitivity of the rectum to the presence of stool. About 70% of well-motivated people benefit from biofeedback.
If fecal incontinence persists, surgery may help—for instance, when the cause is an injury to the anus or an anatomic defect in the anus. In certain cases, surgical implantation of a device called a sacral nerve stimulator may be used to relieve symptoms of incontinence by stimulating the muscles to contract and prevent leakage.
As a last resort, a colostomy (the surgical creation of an opening between the large intestine and the abdominal wall—see figure Understanding Colostomy) may be done. In a colostomy, the anus is sewn shut, and stool is diverted into a removable plastic bag attached to the opening in the abdominal wall.
